The Impact of Early Pulmonary Rehabilitation on Dyspnea, Quality of Life, and Symptoms in Moderate to Severe COVID-19 Pneumonia Patients

Abstract

Introduction: COVID-19 pneumonia leads to dyspnea, persistent symptoms and poor quality of life. Inpatient pulmonary rehabilitation (PR) has limited evidence of effectiveness. Therefore, we aimed to determine the effect of a comprehensive inpatient PR program on dyspnea symptoms and quality of life in patients with COVID-19 pneumonia. Methods: A group pretest-posttest design was conducted in patients with COVID-19 pneumonia. Comprehensive PR was administered during hospitalization. Baseline dyspnea index (BDI), Transitional dyspnea score (TDI), Modified Medical Research Council score (mMRC), and St. George’s Respiratory Questionnaire (SGRQ) were assessed at baseline, 4th week and 12th week after discharge. Results: In total, 28 patients were included (9 with oxygen supplementation, 19 without oxygen supplementation). The mean BDI at baseline was 7.82 ± 2.13. TDI scores at the 4th and 12th weeks were 5.14 ± 1.90 and 6.61 ± 1.59, respectively, with a significant difference observed between the 4th and 12th weeks (p < 0.001). Median mMRC scores at baseline, 4th week, and 12th week were 2(1.25 - 3), 1 (1 - 2) and 1 (0 - 1), respectively, showing a significant improvement between baseline vs 4th week, baseline vs 12th week, and 4th week vs 12th week (p < 0.001). The total SGRQ score exhibited a median (IQR) of 11.34 (7.88 - 8.58) at the 4th week and 6.93 (4.43 - 13.03) at the 12th week, demonstrating a statistically significant improvement (p < 0.001). No adverse events were reported during inpatient PR. Conclusion: Inpatient PR provides a safe and feasible profile, reduces dyspnea symptoms, and improves the quality of life in patients with moderate to severe COVID-19 pneumonia. HIGHLIGHTS COVID-19 pneumonia results in dyspnea and persistent symptoms, impacting quality of life. Early pulmonary rehabilitation, from inpatient to a 12-week outpatient program for moderate and severe cases, is safe and improves dyspnea, quality of life, and patient reported symptoms. GRAPHICAL ABSTRACT