Telerehab helps severe COVID-19 survivors get back on their feet

Survivors of severe COVID-19 face another challenge following their discharge from the hospital: a harder recovery and low functional exercise capacity. But the good news is that a simple telerehabilitation programme may help them return to form after 3 months, as reported in a study.

“This study highlighted the feasibility of an adapted telerehabilitation even if the included patients presented very low functional exercise capacity and did not have specific equipment at home,” according to the investigators.

“No adverse events were reported, and all the participating patients attended and completed … this short and incomplete programme of pulmonary rehabilitation at home. [As a result, the patients] recovered a better functional exercise capacity after 3 months than the other ones [who did not undergo the programme],” they added.

A total 48 severe (n=35) or critical (n=13) COVID-19 hospitalized patients (mean age 61.5 years, 58.3 percent male) participated in the study. Following discharge, all of them underwent a 1-min sit-to-stand test (STST).

None of the patients had STST scores >50th percentile, and the scores were <2.5th percentile in 77 percent. The pulsed oxygen saturation (SpO₂) decreased from 95.3 percent prior to STST to 92.6 percent after the test; 15 patients had oxygen desaturation. The mean differences in heart rate (HR) and dyspnoea score between the start and end of the test were 21.6 percent and 5, respectively.

Fourteen patients underwent telerehabilitation, which involved real-time clinician-patient interactions. All patients performed home-based exercises twice a week for 6 weeks. Each session lasted 50 minutes, including 30 minutes of endurance exercises followed by upper and lower body muscular strengthening.

The first two sessions were conducted individually to evaluate the physical condition of the patient and to ensure the proper execution of the exercises. From the second week onwards, the sessions were performed in groups of four patients at a time.

After 3 months, the number of repetitions during STST increased substantially in the telerehabilitation (p<0.001) and in control groups (n=13; p=0.002). Yet, only a single patient showed an STST score >50th percentile (in the telerehabilitation group), and the scores remained <2.5th percentile in 37 percent of the overall population. The improvement in STST score was much greater following the telerehabilitation programme (p=0.005). [Respir Med 2021;doi:10.1016/j.rmed.2021.106438]

“[T]he patients with severe COVID-19 presented a low functional exercise capacity at discharge, an observation in striking contrast with their almost complete recovery in terms of lung function or high resolution computed tomography lesions based on expected normal values before the COVID-19,” according to the investigators.

“This functional exercise limitation persisted even if the cardio-respiratory recovery was achieved based on parameters after 3 months. Indeed, SpO₂, dyspnoea, and lung function cannot predict this limitation because these parameters were normal or close to the normality at the time of the follow-up,” they added.

Further studies should be conducted to investigate the exact mechanisms underlying the low functional exercise capacity in severely ill COVID-19 survivors, the investigators said. They added that telerehabilitation programmes, which are expected to be used more widely soon, “should be adapted to fit more closely with the international pulmonary rehabilitation guidelines.” [Am J Respir Crit Care Med 2013;188:e13-64]