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COVID-19: Rehabilitation Needs, Therapeutic Development, and Impact on the Health System

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A special issue of Applied Sciences (ISSN 2076-3417). This special issue belongs to the section "Applied Biosciences and Bioengineering".

Deadline for manuscript submissions: closed (30 August 2022) | Viewed by 30026

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Prof. Dr. Alessandro de Sire

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Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
Interests: rehabilitation; physical exercise; osteoporosis; sarcopenia; osteoarthritis; sports medicine; pain management; fractures; musculoskeletal disorders
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Antonio Ammendolia

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Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", 88100 Catanzaro, Italy
Interests: rehabilitation; orthopaedics; sports medicine; spine; physical exercise; scoliosis; biomechanics; osteoarthritis; gait; musculoskeletal disorders
Special Issues, Collections and Topics in MDPI journals

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Dear Colleagues,

The coronavirus disease 2019 (COVID-19) pandemic started at the end of 2019, evolving with growing numbers since then. A large number of COVID-19 patients need rehabilitation (inpatient, outpatient, or home-based) to reduce dyspnea and to improve muscle function, physical performance, and independence of activities of daily living. In this scenario, an early rehabilitation treatment is crucial immediately after discharge from intensive care units, with COVID-19 patients stabilized in post-acute rehabilitation units.

COVID-19 has also had a negative impact on health systems around the world, causing deficiencies in meeting patient needs. Thus, an adequate remodeling of hospitals and territorial services is mandatory, such as the potential role that novel therapeutic developments such as telerehabilitation might play for COVID-19 patients.

Furthermore, the COVID-19 has pandemic generated additional challenges and significant disruptions across work environments and physical medicine and rehabilitation (PRM) professionals. In recent years, a notable number of short- and long-term effects related to health have been identified, with a considerable economic burden on healthcare systems.

Lastly, monitoring the mental health of PRM professionals has become a crucial point for researchers, organizations, and governments; indeed, several hospitals have begun to promote positive mental wellbeing through increased research on mental health and burnout in the workplace during the COVID-19 pandemic.

Therefore, the aim of this Special Issue is to provide findings on i) the role of rehabilitation in COVID-19 patients; ii) new therapeutic development, including telerehabilitation; and iii) the impact of COVID-19 on the economic burden of healthcare and psychological alterations for PRM professionals.

Prof. Dr. Alessandro de Sire
Prof. Dr. Antonio Ammendolia
Guest Editors

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Keywords

COVID-19
rehabilitation
therapeutics
healthcare
health system
pulmonary rehabilitation
post-COVID-19
telerehabilitation

Published Papers (12 papers)

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Editorial

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4 pages, 201 KiB

Open AccessEditorial

COVID-19: Rehabilitation Needs, Therapeutic Development, and Impact on the Health System

by Alessandro de Sire and Antonio Ammendolia

Appl. Sci. 2023, 13(8), 4872; https://doi.org/10.3390/app13084872 - 13 Apr 2023

Viewed by 882

Abstract

The COVID-19 pandemic has impacted the health of millions of people worldwide, with many survivors experiencing persistent symptoms and long-term disabilities [...] Full article

(This article belongs to the Special Issue COVID-19: Rehabilitation Needs, Therapeutic Development, and Impact on the Health System)

Research

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11 pages, 297 KiB

Open AccessArticle

Clinical and Functional Evolution in Subjects with Parkinson’s Disease during SARS-CoV-2 Pandemic

by Marianna Capecci, Nicolò Baldini, Francesca Campignoli, Lorenzo Pasquale Lombardo, Elisa Andrenelli and Maria Gabriella Ceravolo

Appl. Sci. 2023, 13(2), 1126; https://doi.org/10.3390/app13021126 - 14 Jan 2023

Cited by 3 | Viewed by 1451

Abstract

The COVID-19 pandemic has been a stress test for the population, especially for people with chronic disorders such as Parkinson’s disease (PD). In addition to public health restrictions that contrast with PD management recommendations, there were deep changes in health care delivery. This retrospective study evaluates the impact of COVID-19 on the clinical and functional evolution of a cohort of 221 PD patients consecutively referred to the Movement Disorders Center between 2018 and 2021. We analyzed the trend in motor and non-motor symptoms and functional status across years based on the Unified Parkinson’s Disease Rating Scale (UPDRS) and Non-Motor Symptom Scale (NMSS). We also compared the number of emerging complications, neurologic visits, and rehabilitation sessions per subject per year. In 2020, all primary endpoint measures worsened compared to 2019, without age, disease duration, or greater neurologic impairment explaining this outcome. Concurrently, the percentage of patients receiving neurologic visits or rehabilitation sessions reduced by 53% and 58%, respectively. The subgroup analysis of 167 subjects revealed that those who received at least one cycle of rehabilitation sessions in 2020 maintained their independence level. These findings lead to emphasizing the importance of regular monitoring and rehabilitation delivery in people with chronic neurological disorders. Full article

(This article belongs to the Special Issue COVID-19: Rehabilitation Needs, Therapeutic Development, and Impact on the Health System)

16 pages, 4018 KiB

Open AccessArticle

Estimating Infection-Related Human Mobility Networks Based on Time Series Data of COVID-19 Infection in Japan

by Tetsuya Yamada and Shoi Shi

Appl. Sci. 2022, 12(18), 9236; https://doi.org/10.3390/app12189236 - 15 Sep 2022

Cited by 3 | Viewed by 1429

Abstract

Background: Comprehensive and evidence-based countermeasures against emerging infectious diseases have become increasingly important in recent years. COVID-19 and many other infectious diseases are spread by human movement and contact, but complex transportation networks in the 21st century make it difficult to predict disease spread in rapidly changing situations. It is especially challenging to estimate the network of infection transmission in countries where traffic and human movement data infrastructure is not yet developed. Methods: In this study, we devised a method utilizing an ordinary and partial differential equations-based mathematical model and a modified mathematical optimization method to estimate the network of transmission of COVID-19 from the time series data of its infection and applied it to determine its spread across areas in Japan. Furthermore, utilizing the estimated human mobility network, we predicted the spread of infection using the Tokyo Olympics as a model. Findings: We incorporated the effects of soft lockdowns, such as the declaration of a state of emergency, and changes in the infection network due to government-sponsored travel promotion, and revealed that the estimated effective distance captured human mobility changing dynamically in the different stages of the pandemic. The model predicted that the Tokyo Olympic and Paralympic Games would increase the number of infected cases in the host prefectures by up to 80%. Interpretation: The models used in this study are available online, and our data-driven infection network models are scalable, whether it be at the level of a city, town, country, or continent, and applicable anywhere in the world, as long as the time-series data of infections per region is available. These estimations of effective distance and the depiction of infectious disease networks based on actual infection data are expected to be useful in devising data-driven countermeasures against emerging infectious diseases worldwide. Full article

(This article belongs to the Special Issue COVID-19: Rehabilitation Needs, Therapeutic Development, and Impact on the Health System)

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21 pages, 3797 KiB

Open AccessArticle

A Brief Analysis of a New Device to Prevent Early Intubation in Hypoxemic Patients: An Observational Study

by Luís Alberto Brêda Mascarenhas, Bruna Aparecida Souza Machado, Valter Estevão Beal, Katharine Valéria Saraiva Hodel, Luciana Moreira Nogueira, Thayse Barreto, Sérgio Fernandes de Oliveira Jezler, Leonardo Redig Lisboa De Azevedo, Uener Franklyn Teixeira da Silva, Laiane Lopes da Cruz, Lúcio Couto de Oliveira Júnior, Vinicius Silva Oliveira and Roberto Badaró

Appl. Sci. 2022, 12(12), 6052; https://doi.org/10.3390/app12126052 - 14 Jun 2022

Cited by 1 | Viewed by 1485

Abstract

The need for mechanical ventilation is one of the main concerns related to the care of patients with COVID-19. The aim of this study is to evaluate the efficacy of a bubble device for oxygen supplementation. This device was implemented for the selected patients hospitalized with severe COVID-19 pneumonia with persistent low oxygen saturation. Patients were selected in three major COVID-19 hospitals of Bahia state in Brazil from July to November 2020, where they remained with the device for seven days and were monitored for different factors, such as vital signs, oximetry evaluation, and arterial blood gasometry. Among the 51 patients included in the study, 68.63% successfully overcame hypoxemia without the necessity to be transferred to mechanical ventilation, whereas 31.37% required tracheal intubation (p value < 0.05). There was no difference of note on the analysis of the clinical data, chemistry, and hematological evaluation, with the exception of the SpO₂ on follow-up days. Multivariate analysis revealed that the independent variable, male sex, SpO₂, and non-inhaled mask, was associated with the necessity of requiring early mechanical ventilation. We concluded that this bubble device should be a prior step to be utilized before indication of mechanical ventilation in patients with persistent hypoxemia of severe COVID-19 pneumonia. Full article

(This article belongs to the Special Issue COVID-19: Rehabilitation Needs, Therapeutic Development, and Impact on the Health System)

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13 pages, 1715 KiB

Open AccessArticle

Impact of Physiotherapy on Patients Suffering from COVID-19: An Observational Study

by Ilie Onu, Daniel-Andrei Iordan, Daniela Matei, Oana-Diana Hrisca-Eva, Ioana Buculei, Anca-Irina Galaction, Ionela Lăcrămioara Serban, Mona-Elisabeta Dobrin, Ovidiu Popa-Velea, Dan Eugen Costin, George Dănuț Mocanu, Andreea-Georgiana Dobre and Robert Gherghel

Appl. Sci. 2022, 12(12), 5795; https://doi.org/10.3390/app12125795 - 07 Jun 2022

Cited by 4 | Viewed by 2189

Abstract

Introduction: COVID-19 was the turning point of 2020, endangering the health of the entire population around the world. Among other therapeutic methods and supportive measures, physiotherapy represents a useful intervention applied on COVID-19 patients suffering from respiratory symptoms, this being supported by recent literature data. Materials and Methods: The study was performed on 45 patients diagnosed with COVID-19 (28 men, 17 women, mean age = 65.03, standard deviation = 14.83). They participated for 2 weeks (the required period of hospitalization) to a series of 14 physiotherapy sessions, which included: position changing, respiratory control, passive joint movements, bed workout, and walking exercises. Depending on the status of the patient, two distinct types of physiotherapy were performed (mild and active). The status of the patients was assessed through a basic assessment of the vital signs, range of motion, degree of dyspnea, and also through the UZ Leuven Start To Move protocol (STMP). The statistical analysis of the data was performed using the Statistica 10 program and included the Spearman correlations (for measuring the strength and direction of association between the ranked variables), the Mann-Whitney test (for measuring the significance of the differences between the groups of patients who undergone light vs. active physiotherapy) and factor analysis (for assessing the changes of the clinical parameters investigated in the study, depending on the type of applied therapy). All differences were considered significant at p < 0.05. Results: The majority of patients (n = 38) benefited from physiotherapy, with the complete disappearance of symptoms met only in the group of patients who followed active physiotherapy. These effects depended on the applied type of physiotherapy (mild vs. active, p = 0.47). In contrast, all patients who were unable to perform physiotherapy (n = 7) remained symptomatic at discharge. Conclusion: The results of this study point out the significant additional role of physiotherapy for a better management of COVID-19 patients. More studies are needed to investigate not only the impact that physiotherapy has on the symptoms of this disease, but also its effects on effort capacity, muscle strength and lung capacity. Full article

(This article belongs to the Special Issue COVID-19: Rehabilitation Needs, Therapeutic Development, and Impact on the Health System)

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8 pages, 236 KiB

Open AccessArticle

Utility of High Flow Nasal Cannula during Pulmonary Rehabilitation in COVID-19 Patients in Acute Respiratory Failure

by Teresa Paolucci, Giorgia Patrizio, Domenico Pietrantonio, Giorgia Rapacchiale, Antonella Spacone, Giustino Parruti, Giancarlo Graziani, Marzia Damiani, Vitalma Liotti and Carlo D’Aurizio

Appl. Sci. 2022, 12(9), 4637; https://doi.org/10.3390/app12094637 - 05 May 2022

Cited by 2 | Viewed by 1511

Abstract

High-flow nasal cannula (HFNC) has often been used in the treatment of acute respiratory failure during pulmonary rehabilitation setting. The aim of this retrospective study was to investigate the utility of HCFN during the early rehabilitation in COVID-19 pneumonia. Twenty-two patients (10 males and 12 females, mean age 64.5 ± 5.9 years) with COVID-19 pneumonia were considered. Medical data and rehabilitative scales were used to evaluate acute hypoxemic respiratory failure (PaO2/FiO2 < 300), treated with HFNC three times during evaluation. Overall clinical outcomes from the evaluation of the synergy between HFNC strategy and rehabilitation were evaluated. A statistically significant improvement was observed at T2 (and of treatment) in 1 minute sit to stand test (1STST) (4 ± 3 vs. 17 ± 5, p < 0.05), short physical performance battery (SPPB) (4.3 ± 2.81 vs. 9.15 ± 2.39, p < 0.05), SpO2% post effort (93 ± 1.26 vs. 98 ± 1.01, p < 0.05), respiratory rate post effort (RR) (24 ± 3.91 vs. 20 ± 3.13, p < 0.05), heart rate (HR) (97 ± 11.9 vs. 87 ± 9.17, p < 0.05), P/F rate (235 ± 7.35 vs. 331 ± 10.91, p < 0.05), SpO2 (86 ± 4.54 vs. 97 ± 1.01 p < 0.05), RR (20 ± 4 vs. 12 ± 1.39, p < 0.05). Then, treated HFNC patients showed a good improvement in physical performance at T2 and a good compliance with treatments proved to be extremely useful in the control and reduction of dyspnea and fatigue symptoms. Full article

(This article belongs to the Special Issue COVID-19: Rehabilitation Needs, Therapeutic Development, and Impact on the Health System)

9 pages, 458 KiB

Open AccessArticle

The Role of Acetyl-Carnitine and Rehabilitation in the Management of Patients with Post-COVID Syndrome: Case-Control Study

by Dalila Scaturro, Fabio Vitagliani, Vito Emanuele Di Bella, Vincenzo Falco, Sofia Tomasello, Lorenza Lauricella and Giulia Letizia Mauro

Appl. Sci. 2022, 12(8), 4084; https://doi.org/10.3390/app12084084 - 18 Apr 2022

Cited by 9 | Viewed by 4412

Abstract

Post-COVID syndrome is characterized by the persistence of nonspecific disabling symptoms, even several months after the resolution of the infection, with clinical characteristics similar to fibromyalgia (FM) and a prevalence of 31%. We evaluated the effectiveness of physical exercise, in association with L-acetyl-carnitine (ALC) therapy, in patients with Post-COVID syndrome, on musculoskeletal pain, dyspnea, functional capacity, quality of life, and depression. We conducted an observational case-control study on patients with Post-COVID syndrome. The patients were randomly divided into two groups: a treatment group that received rehabilitation treatment in combination with ALC 500 mg therapy; a control group that received only rehabilitation treatment. Patients were assessed at the time of recruitment (T0) and one month after the end of therapy (T1), with the administration of rating scales: NRS, Barthel Dyspnea Index (NPI), 12-Item Short Form Survey (SF-12) scale, Fibromyalgia Impact Questionnaire (FIQ), and Patient Health Questionnaire (PHQ-9). The treatment group showed statistically higher variations in pain scores, quality of life, and depression. No statistically significant differences between the two groups emerged regarding changes in dyspnea and functional capacity scores. Combining exercise with ALC is a promising and effective treatment in the management of Post-COVID syndrome, especially for musculoskeletal pain, depression, and quality of life. Full article

(This article belongs to the Special Issue COVID-19: Rehabilitation Needs, Therapeutic Development, and Impact on the Health System)

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11 pages, 809 KiB

Open AccessArticle

Neuromuscular Impairment of Knee Stabilizer Muscles in a COVID-19 Cluster of Female Volleyball Players: Which Role for Rehabilitation in the Post-COVID-19 Return-to-Play?

by Alessandro de Sire, Andrea Demeco, Nicola Marotta, Riccardo Spanò, Claudio Curci, Giacomo Farì, Francesco Fortunato, Teresa Iona, Lorenzo Lippi, Teresa Paolucci, Marco Invernizzi and Antonio Ammendolia

Appl. Sci. 2022, 12(2), 557; https://doi.org/10.3390/app12020557 - 06 Jan 2022

Cited by 16 | Viewed by 4064

Abstract

COVID-19 athletes reported persistent and residual symptoms many weeks after initial infection, including cough, fatigue, and neuromuscular disorders. Poor neuromuscular control may cause inefficient movement strategies increasing anterior cruciate ligament load. This is particularly relevant in female athletes, who show a 3-time higher risk than male counterparts. Aim is to evaluate the impairment in thigh muscles activation, body composition, and physical performance after COVID-19 in volleyball athletes. We recruited a cohort of female professional players from the same team. We assessed the pre-activation time of Rectus Femoris (RF), Vastus Medialis (VM), Medial Hamstring (MH), and Lateral Hamstring (LH) before (T0) and after (T1) COVID-19 infection, bioelectrical impedance analysis (BIA), and jump tests. We included 12 athletes with COVID-19 infection diagnosis in January 2021. At T1 we found a significant (p < 0.05) delay (ms) of the activation time of RF (426 ± 188 vs. 152 ± 106); VM (363 ± 192 vs. 140 ± 96); BF (229 ± 60 vs. 150 ± 63); MH (231 ± 88 vs. 203 ± 89), and a significant reduction of body composition at BIA. The neuromotor imbalance of the knee stabilizer muscle in female athletes after COVID-19 infection determines a deficit of knee stabilization. Physicians should consider neuromuscular and metabolic sequelae to identify athletes at higher risk of injury and set up specific neuromuscular rehabilitation protocols. Full article

(This article belongs to the Special Issue COVID-19: Rehabilitation Needs, Therapeutic Development, and Impact on the Health System)

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9 pages, 1039 KiB

Open AccessArticle

The Impact of the Second Wave of COVID-19 on Outcomes in Hip Fracture Patients: An Observational Study

by Mattia Morri, Cristiana Forni, Andrea Evangelista, Tania Broggian, Elisa Ambrosi, Antonella Magli Orlandi and Annella Mingazzini

Appl. Sci. 2021, 11(24), 11589; https://doi.org/10.3390/app112411589 - 07 Dec 2021

Cited by 2 | Viewed by 1265

Abstract

The aim of this work was to measure the healthcare outcomes for patients undergoing surgery for femur fractures during the second wave of the COVID-19 pandemic within a context of orthopaedic surgery units and living with the pandemic and compare them with pre-pandemic outcomes. A retrospective observational study was conducted. The incidence of pressure ulcers and deambulation recovery time were the main outcome. The pre-pandemic group consisted of 108 patients and the second wave pandemic group included 194 patients. The incidence of pressure ulcers increased from 10% in the pre-pandemic period to 21% in the second wave (p = 0.016) and the crude relative risk (RR) was 2.06 (p = 0.023). The recovery of deambulation showed no significant difference in the recovery time in terms of days needed to walk the first time (3 days vs. 2 days; p = 0.44). During the second wave of COVID-19, the risk of pressure ulcers for patients undergoing femur fracture surgery increased significantly. This variation could be explained by the absence of a caregiver for these patients and the increased average complexity of the patients managed in the orthopaedic setting. The hospital management should take into account these aspects when restoring the hospital’s normal surgical activities. Full article

(This article belongs to the Special Issue COVID-19: Rehabilitation Needs, Therapeutic Development, and Impact on the Health System)

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Review

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10 pages, 891 KiB

Open AccessReview

The Use of Modern Technologies in Post-COVID-19 Cardiopulmonary Rehabilitation

by Doru Andritoi, Catalina Luca, Ilie Onu, Calin Corciova, Robert Fuior, Alexandru Salceanu and Daniel-Andrei Iordan

Appl. Sci. 2022, 12(15), 7471; https://doi.org/10.3390/app12157471 - 25 Jul 2022

Cited by 10 | Viewed by 2335

Abstract

Managing cardiopulmonary rehabilitation in patients with COVID-19 remains a global challenge due to the facets of this virus. The technologies used in the rehabilitation of post-COVID-19 patients fail to keep pace with the global epidemiological developments. The purpose of this article is to review the medical technologies used in post-COVID-19 cardiopulmonary rehabilitation and the innovations that have allowed us to adapt and care for our patients. The pandemic highlighted the need for seismic changes in diagnostic and rehabilitation paradigms. We discuss advances in telemedicine and telemedicine-based rehabilitation, remote patient monitoring and emerging technologies used in cardiopulmonary rehabilitation. The rapid adoption of modern technologies in the practice of post-COVID-19 cardiopulmonary rehabilitation is promising and can improve patients’ access to complex rehabilitation programs with outstanding results. Full article

(This article belongs to the Special Issue COVID-19: Rehabilitation Needs, Therapeutic Development, and Impact on the Health System)

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Other

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15 pages, 1029 KiB

Open AccessSystematic Review

Impact of Rehabilitation on Fatigue in Post-COVID-19 Patients: A Systematic Review and Meta-Analysis

by Alessandro de Sire, Lucrezia Moggio, Nicola Marotta, Francesco Agostini, Anna Tasselli, Vera Drago Ferrante, Claudio Curci, Dario Calafiore, Francesco Ferraro, Andrea Bernetti, Ozden Ozyemisci Taskiran and Antonio Ammendolia

Appl. Sci. 2022, 12(17), 8593; https://doi.org/10.3390/app12178593 - 27 Aug 2022

Cited by 21 | Viewed by 5417

Abstract

The post-COVID-19 syndrome may affect patients after the COVID-19 post-acute phase. In particular, the 69% of patients reported persistent fatigue at the discharge. To date, no clear data are available regarding the most effective rehabilitative approaches for the treatment of this condition. Thus, this systematic review aimed to evaluate the rehabilitation treatment’s efficacy on fatigue in post-COVID-19 patients. We systematically searched PubMed, Scopus, and Web of Science databases to find longitudinal study designs presenting: post-COVID-19 patients as participants; a rehabilitative approach aimed to reduce post-COVID-19 syndrome as intervention; and fatigue intensity assessed through an evaluation tool that quantified the perceived exertion (i.e., fatigue severity scale, FSS; Borg Scale (BS); Borg Category Ratio 10, CR10; Checklist Individual Strength (CIS) fatigue scale; FACIT (Functional Assessment of Chronic Illness Therapy) fatigue scale). The present systematic review protocol was registered on PROSPERO (registration number CRD42021284058). Out of 704 articles, 6 studies were included. Nearly all patients showed COVID-19-related fatigue, and after the rehabilitation treatment, only 17% of subjects reported the persistency of symptoms. The overall effect size reported a −1.40 decrease in Borg Category Ratio 10 with a SE of 0.05 and a 95% CI between −1.50 and −1.30 (p < 0.001). The present systematic review and meta-analysis underlines the rehabilitation role in the fatigue reduction in patients affected by post-COVID-19 syndrome. Full article

(This article belongs to the Special Issue COVID-19: Rehabilitation Needs, Therapeutic Development, and Impact on the Health System)

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19 pages, 747 KiB

Open AccessCase Report

Whole-Body Cryostimulation: A Rehabilitation Booster in Post-COVID Patients? A Case Series

by Paolo Piterà, Michele Gobbi, Jacopo Maria Fontana, Stefania Cattaldo, Maurizio Massucci and Paolo Capodaglio

Appl. Sci. 2022, 12(10), 4830; https://doi.org/10.3390/app12104830 - 10 May 2022

Cited by 3 | Viewed by 1980

Abstract

Given the severity and prevalence of post-COVID-19 symptoms in the general population, the identification of boosters for rehabilitation programs appears to be of paramount importance. The purpose of this case series is to provide some preliminary evidence about the role of whole-body cryostimulation (WBC) as an effective adjuvant for the recovery of patients with the post-COVID-19 condition (PCC). We recruited seven patients with previously confirmed SARS-CoV-2 infection and symptoms of PCC of different severities for a comprehensive rehabilitation program, including WBC. The main symptoms were dyspnea, chronic and muscular fatigue, chronic pain, and poor sleep quality. Moreover, some patients presented high levels of hematological markers of inflammation. Because we provided a range of interventions, including nutritional and psychological support along with physical exercise and physiotherapy, we could not determine to what extent WBC may per se have accounted for the clinical and functional improvements. However, for all reported cases, it was observed that the introduction of WBC sessions represented a turning point in the patient’s subjective and objective improvements related to health and functioning. Full article

(This article belongs to the Special Issue COVID-19: Rehabilitation Needs, Therapeutic Development, and Impact on the Health System)

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