Effects of Comprehensive Rehabilitation on Pulmonary Function in Patients Recovering from COVID-19
Abstract
:1. Introduction
2. Materials and Methods
2.1. Characteristics of the Study Group
2.2. Course of the Study
2.3. Statistical Methods
3. Results
3.1. Group Characteristics
3.2. Spirometric Results before and after Rehabilitation
3.3. Spirometric Results Immediately after Rehabilitation and after 2 Months
3.4. Difference in Spirometric Results before and after Rehabilitation vs. Selected Variables
Variable | Correct Weight (n = 30) | Overweight (n = 53) | 1st Degree Obesity (n = 46) | 2nd Degree Obesity (n = 15) | 3rd Degree Obesity (n = 5) | p | |
---|---|---|---|---|---|---|---|
Δ FVC (% predicted) | Me (Q1–Q3) | 10.86 (7.7–20.1) | 4.1 (−1.6–13.06) | 3.1 (−5.5–13.15) | 11.8 (2.7–15.9) | 3.2 (−3.8–7.3) | 0.026 * |
Δ FEV1 (% predicted) | M ± SD | 12.35 ± 13.76 | 10.87 ± 6.99 | 6.85 ± 16.25 | 12.75 ± 15.24 | −11.99 ± 13.66 | 0.007 * |
Δ FEV1/FVC (%) | Me (Q1–Q3) | −1.25 (−5.8–6.6) | 3.27 (−4.6–12.6) | 0.7 (−3.7–8.76) | 0.04 (−8.4–10.6) | 0.3 (−5.2–4.9) | 0.712 |
Δ PEF (% predicted) | M ± SD | 20.15 ± 19.31 | 24.98 ± 24.66 | 18.24 ± 22.32 | 19.73 ± 26.09 | 18.02 ± 15.43 | 0.428 |
Δ MMEF (% predicted) | M ± SD | 15.38 ± 27.59 | 19.43 ± 16.9 | 14.25 ± 30.94 | 14.47 ± 32.26 | −7.98 ± 13.85 | 0.348 |
Δ MEF75 (% predicted) | Me (Q1–Q3) | 24.27 (8.02–35.8) | 28.2 (12.1–42.1) | 13.6 (1.28–38.8) | 24.6 (6.3–42.01) | 23.3 (5–29.5) | 0.461 |
Δ MEF50 (% predicted) | Me (Q1–Q3) | 21.1 (0.24–35.2) | 15.3 (−0.8–35.3) | 6.5 (−4.4–43.8) | 23.1 (−10.4–45.7) | 3.54 (−15–8.3) | 0.456 |
Δ MEF25 (% predicted) | M ± SD | −5.86 ± 41.98 | 9.98 ± 5.46 | 2.38 ± 48.61 | −5.56 ± 41.47 | −28.61 ± 15.32 | 0.188 |
Variable | 30–45 Years (n = 12) | 46–60 Years (n = 31) | 61–75 Years (n = 84) | 76–90 Years (n = 23) | p | |
---|---|---|---|---|---|---|
Δ FVC (% predicted) | Me (Q1–Q3) | 7.05 (−0.24–19.6) | 8.6 (2.3–16.7) | 6.2 (−3.9–12.6) | 7.47 (−0.26–16.6) | 0.562 |
Δ FEV1 (% predicted) | M ± SD | 11.63 ± 9.76 | 10.12 ± 18.41 | 8.76 ± 15.41 | 9.91 ± 14.91 | 0.711 |
Δ FEV1/FVC (%) | Me (Q1–Q3) | 3.2 (−5.04–7.5) | −0.8 (−6.3–6.65) | 2.15 (−4.8–9.7) | 0.3 (−8.9–17.34) | 0.837 |
Δ PEF (% predicted) | M ± SD | 23.33 ± 17.36 | 14.61 ± 21.03 | 24.35 ± 21.71 | 17.15 ± 16.23 | 0.141 |
Δ MMEF (% predicted) | Me (Q1–Q3) | 9.6 (−4.25–30.3) | 7.23 (−11.2–24.7) | 17.6 (−5.25–38.9) | 3.7 (−10.8–29.5) | 0.378 |
Δ MEF75 (% predicted) | Me (Q1–Q3) | 27.1 (11.7–44.7) | 15.75 (1.9–35.8) | 26.65 (7.2–43.01) | 17.4 (4.9–32.3) | 0.322 |
Δ MEF50 (% predicted) | Me (Q1–Q3) | 11.4 (3.6–20.5) | 12.8 (−6.03–23.7) | 15.3 (−1.4–44.3) | 7.9 (−6.4–35.7) | 0.556 |
Δ MEF25 (% predicted) | Me (Q1–Q3) | 10.43 (−7.25–27.3) | −3.3 (−26.7–19.1) | −2.5 (−28–28.6) | −1.7 (−42.8–41.7) | 0.846 |
Variable | 1–5 Days (n = 5) | 6–10 Days (n = 12) | 11–15 Days (n = 28) | 16–20 Days (n = 15) | Over 20 Days (n = 48) | p | |
---|---|---|---|---|---|---|---|
M ± SD | M ± SD | M ± SD | M ± SD | M ± SD | |||
Δ FVC (% predicted) | Me (Q1–Q3) | 5.46 (2.6–19.5) | 3.65 (−7.6–13.7) | 3.4 (−4.3–16.13) | 6.06 (−1.6–10.6) | 11 (−0.74–14.1) | 0.659 |
Δ FEV1 (% predicted) | Me (Q1–Q3) | 6.6 (4.5–10.4) | 13.15 (−3.6–22.9) | 3.2 (−2.06–18.02) | 2.5 (0.7–11.5) | 12.02 (4.3–22.4) | 0.231 |
Δ FEV1/FVC (%) | Me (Q1–Q3) | 1.6 (−27.9–4.9) | 5.7 (−1.4–20.6) | 1.38 (−3.7–12.8) | −1.15 (−8.9–3.7) | 1.94 (−5.3–8.9) | 0.033 * |
Δ PEF (% predicted) | Me (Q1–Q3) | 19.3 (10.3–27) | 18.9 (8.2–26.3) | 25.3 (8.2–32.5) | 15.3 (2.6–27) | 33.4 (15.7–43.6) | 0.174 |
Δ MMEF (% predicted) | Me (Q1–Q3) | 11.9 (−1.6–18.4) | 16.4 (2.8–40.8) | 14.7 (−9.2–36.3) | 0.14 (−8.1–17.3) | 23 (−4.9–46.2) | 0.355 |
Δ MEF75 (% predicted) | M ± SD | 51.21 ± 71.49 | 21.19 ± 18.85 | 20.18 ± 20.94 | 15.75 ± 19.07 | 32.05 ± 25.11 | 0.057 |
Δ MEF50 (% predicted) | Me (Q1–Q3) | 20.9 (2.7–30.3) | 11.6 (0.9–37.2) | 14.04 (−3–34.6) | 0.71 (−12.8–22.1) | 23.3 (2.17–50.2) | 0.171 |
Δ MEF25 (% predicted) | Me (Q1–Q3) | −25.11 (−29.5- −2.8) | 22.6 (6.9–43.4) | 0.01 (−33.5–21.6) | −21.8 (−32.4–4.08) | 13.6 (−22.2–34.3) | 0.068 |
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Procedure | Guidelines | Time |
---|---|---|
General fitness and respiratory improvement exercises | Active breathing exercises, active breathing exercises with resistance, learning to cough and expectorate effectively | 30 min |
Aerobic training | Stair climbing; climbing 2–3 floors at a leisurely pace; gradually increased intensity by 5–10%; assessment of exercise tolerance by oxygenation checks (pulse oximeter); perceived exercise intensity: 2–3 on the Borg scale | 30 min |
Continuous/interval endurance training on a bicycle cycloergometer | Initial low or moderate intensity; gradual increase in intensity by 5–10%; assessment of exercise tolerance by oxygenation checks (pulse oximeter); perceived exercise intensity: 2–3 on the Borg scale | 30 min |
Outdoor march training | Assessment of exercise tolerance by oxygenation checks (pulse oximeter); perceived of exercise intensity: 2–3 on the Borg scale | 2 times a day for 30 min each |
Strength and endurance training | Training selected individually for the patient on the basis of the RM unit and the patient’s exercise tolerance (assessment of the presence of desaturation); load: 70–85% of 1 RM; volume: 3 series of 8–12 repetitions; rest: 1–2 min; progression: 60–70% of 1 RM | 30 min |
Variable | n | % | |
---|---|---|---|
Gender | female | 94 | 54.97 |
male | 77 | 45.03 | |
Age | 30–45 years | 15 | 8.77 |
46–60 years | 33 | 19.3 | |
61–75 years | 96 | 56.14 | |
76–90 years | 27 | 15.79 | |
Nutritional status (BMI) | 18.5–24.99 (norm) | 37 | 21.76 |
25.0–29.9 (overweight) | 61 | 35.88 | |
30.0–34.99 (1st degree obesity) | 49 | 28.82 | |
35.0–39.99 (2nd degree obesity) | 18 | 10.59 | |
over 40 (3rd degree obesity) | 5 | 2.94 | |
Hospitalization | yes | 119 | 69.59 |
no | 45 | 26.32 | |
Length of hospitalization | 1–5 days | 5 | 2.92 |
6–10 days | 13 | 7.6 | |
11–15 days | 32 | 18.71 | |
16–20 days | 18 | 10.53 | |
over 20 days | 51 | 29.82 | |
Pneumonia in the course of COVID-19 | yes | 127 | 74.27 |
no | 37 | 21.64 | |
Duration of rehabilitation | 2–3 weeks | 80 | 46.78 |
3–4 weeks | 27 | 15.79 | |
4–5 weeks | 23 | 13.45 | |
5–6 weeks | 41 | 23.97 | |
Comorbidities | diabetes | 43 | 25.15 |
hypertension | 97 | 56.73 | |
asthma | 19 | 11.11 | |
COPD | 8 | 4.68 |
Variable | Before Rehabilitation (n = 150) | After Rehabilitation (n = 150) | p | |
---|---|---|---|---|
FVC (% predicted) | M ± SD | 83.39 ± 22.71 | 89.71 ± 21.47 | 0.016 * |
FEV1 (% predicted) | Me (Q1–Q3) | 86.36 (68.16–102.75) | 96.81 (80.73–110.43) | <0.001 * |
FEV1/FVC (%) | Me (Q1–Q3) | 86.32 (78.52–91.51) | 87.39 (81.46–91.93) | 0.071 |
PEF (% predicted) | Me (Q1–Q3) | 56.5 (36.85–76.05) | 82.13 (60.12–99.36) | <0.001 * |
MMEF (% predicted) | Me (Q1–Q3) | 82.35 (60.12–108.03) | 99.38 (77.15–125.43) | <0.001 * |
MEF75 (% predicted) | Me (Q1–Q3) | 53.48 (36.27–81.33) | 85.15 (59.78–106.08) | <0.001 * |
MEF50 (% predicted) | Me (Q1–Q3) | 73.97 (51.62–102.73) | 95.81 (70.25–119.86) | <0.001 * |
MEF25 (% predicted) | Me (Q1–Q3) | 106.76 (75.77–141.97) | 108.3 (80.67–146.97) | 0.554 |
Variable | After Rehabilitation (n = 150) | 2 Months after Rehabilitation (n = 18) | p | |
---|---|---|---|---|
M ± SD | M ± SD | |||
FVC (% predicted) | M ± SD | 89.71 ± 21.47 | 83.63 ± 15.41 | 0.304 |
FEV1 (% predicted) | M ± SD | 94.71 ± 22.69 | 90.11 ± 15.27 | 0.265 |
FEV1/FVC (%) | Me (Q1–Q3) | 87.39 (81.46–91.93) | 85.35 (83.44–92.03) | 0.084 |
PEF (% predicted) | M ± SD | 80.24 ± 27.98 | 92.04 ± 33.26 | 0.235 |
MMEF (% predicted) | M ± SD | 101.47 ± 39.6 | 103.22 ± 38.43 | 0.814 |
MEF75 (% predicted) | M ± SD | 84.37 ± 31.65 | 89.94 ± 35.04 | 0.781 |
MEF50 (% predicted) | M ± SD | 95.69 ± 37.35 | 94.53 ± 35.53 | 0.934 |
MEF25 (% predicted) | Me (Q1–Q3) | 108.3 (80.67–146.97) | 108.77 (89.04–119.05) | 0.915 |
Variable | Female (n = 85) | Male (n = 65) | p | |
---|---|---|---|---|
Δ FVC (% predicted) | M ± SD | 6.56 ± 14.64 | 6.34 ± 13.45 | 0.601 |
Δ FEV1 (% predicted) | Me (Q1–Q3) | 5.86 (0.58–18.11) | 10.33 (1.52–16.23) | 0.288 |
Δ FEV1/FVC (%) | Me (Q1–Q3) | 0.3 (−5.4–8.67) | 2.71 (−3.68–12.57) | 0.562 |
Δ PEF (% predicted) | M ± SD | 18.95 ± 21.12 | 24.04 ± 20.04 | 0.123 |
Δ MMEF (% predicted) | Me (Q1–Q3) | 9.07 (−7.91–29.55) | 16.14 (−5.78–36.56) | 0.509 |
Δ MEF75 (% predicted) | Me (Q1–Q3) | 23.13 (4.56–38.76) | 24.61 (9.16–40.74) | 0.366 |
Δ MEF50 (% predicted) | Me (Q1–Q3) | 11.4 (−4.48–32.35) | 13.46 (−0.87–37.77) | 0.411 |
Δ MEF25 (% predicted) | M ± SD | −1.5 ± 46.75 | 6.05 ± 46.56 | 0.192 |
Variable | Pneumonia (n = 115) | No Pneumonia (n = 32) | p | |
---|---|---|---|---|
Δ FVC (% predicted) | M ± SD | 6.66 ± 13.51 | 5.62 ± 16.71 | 0.549 |
Δ FEV1 (% predicted) | Me (Q1–Q3) | 6.96 (0.5–17.91) | 5.03 (1.41–13.36) | 0.522 |
Δ FEV1/FVC (%) | Me (Q1–Q3) | 1.76 (−5.17–8.9) | −0.62 (−7.08–13.29) | 0.604 |
Δ PEF (% predicted) | Me (Q1–Q3) | 22.88 (9.17–35.9) | 11.64 (−1.97–30.35) | 0.079 |
Δ MMEF (% predicted) | Me (Q1–Q3) | 14.69 (−4.62–34.67) | −2.28 (−11.06–24.97) | 0.069 |
Δ MEF75 (% predicted) | Me (Q1–Q3) | 23.46 (6.42–40.74) | 20.75 (−2.34–34.6) | 0.221 |
Δ MEF50 (% predicted) | Me (Q1–Q3) | 15.33 (−1.57–39.04) | 2.92 (−5.74–23.48) | 0.099 |
Δ MEF25 (% predicted) | Me (Q1–Q3) | 0.44 (−26.69–27.72) | −9.89 (−42.03–12.87) | 0.148 |
Outcome | OR (95% CI) | p | |
---|---|---|---|
Gender | male | 1.190 (0.550–2.574) | 0.659 |
Age | 30–45 years | 1.000 (-) | - |
46–60 years | 1.446 (0.272–7.696) | 0.665 | |
61–75 years | 0.644 (0.150–2.776) | 0.555 | |
76–90 years | 0.969 (0.184–5.108) | 0.970 | |
Nutritional status (BMI) | norm | 1.000 (-) | - |
overweight | 0.176 (0.046–0.678) | 0.012 * | |
1st degree obesity | 0.117 (0.030–0.452) | 0.002 * | |
2nd degree obesity | 0.619 (0.088–4.340) | 0.629 | |
3rd degree obesity | 0.155 (0.018–1.377) | 0.094 | |
Hospitalization | 1.405 (0.431–4.581) | 0.573 | |
Pneumonia in the course of COVID-19 | 0.968 (0.271–3.462) | 0.961 |
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Mińko, A.; Turoń-Skrzypińska, A.; Rył, A.; Szylińska, A.; Denisewicz, I.; Rotter, I. Effects of Comprehensive Rehabilitation on Pulmonary Function in Patients Recovering from COVID-19. Int. J. Environ. Res. Public Health 2023, 20, 3985. https://doi.org/10.3390/ijerph20053985
Mińko A, Turoń-Skrzypińska A, Rył A, Szylińska A, Denisewicz I, Rotter I. Effects of Comprehensive Rehabilitation on Pulmonary Function in Patients Recovering from COVID-19. International Journal of Environmental Research and Public Health. 2023; 20(5):3985. https://doi.org/10.3390/ijerph20053985
Chicago/Turabian StyleMińko, Alicja, Agnieszka Turoń-Skrzypińska, Aleksandra Rył, Aleksandra Szylińska, Iwona Denisewicz, and Iwona Rotter. 2023. "Effects of Comprehensive Rehabilitation on Pulmonary Function in Patients Recovering from COVID-19" International Journal of Environmental Research and Public Health 20, no. 5: 3985. https://doi.org/10.3390/ijerph20053985