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Physical Therapy and COVID-19 Sequelae: Future Challenges for Preventing Related-Disability

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Disabilities".

Deadline for manuscript submissions: closed (31 January 2024) | Viewed by 37450

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Special Issue Editors

Dr. Cesar Fernández-de-las-Peñas

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Guest Editor

Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Madrid, Spain
Interests: headache; pain; physical therapy; rehabilitation; sensitization; manual therapy; COVID-19
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Domingo Palacios-Ceña

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Guest Editor

Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922 Alcorcón, Madrid, Spain
Interests: qualitative research; mixed methods; caring science; vulnerable groups; disability and rehabilitation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The COVID-19 virus has spread rapidly across the globe in a very short time with catastrophic consequences. Although respiratory affectation is the main issue, there is evidence that individuals with COVID-19 also experience other associated symptoms ranging from headache to dizziness, neuralgias (burning pain), neuropathies, and myalgias. Understandably, most of the literature on COVID-19 has concentrated on the disease itself, on the management of acute cases, and on saving lives. However, once the COVID-19 acute phase and hospitalization are surpassed, post-COVID-19 sequelae should be investigated, identified early, and properly managed. The current Special Issue is focused on the role of physical therapy in COVID-19, a topic of emerging relevance. Millions of people will continue to be infected with and will survive COVID-19 infection; therefore, understanding the potential sequelae and the role of physical therapy in their identification and management should be a priority. We invite researchers/clinicians to submit original articles, systematic reviews, narrative reviews, meta-analyses, case reports, and qualitative studies related to physical therapy and COVID-19 to this Special Issue.

You may choose our Joint Special Issue in Healthcare.

Dr. Cesar Fernández-de-las-Peñas
Prof. Dr. Domingo Palacios-Ceña
Guest Editors

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Keywords

COVID-19
physical therapy
pain
treatment
related disability
function
respiratory
treatment
sequelae
public health

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Published Papers (9 papers)

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Research

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12 pages, 1227 KiB

Open AccessArticle

Effects of Adding an Online Exercise Program on Physical Function in Individuals Hospitalized by COVID-19: A Randomized Controlled Trial

by Luis Llurda-Almuzara, Jacobo Rodríguez-Sanz, Carlos López-de-Celis, Ramón Aiguadé-Aiguadé, Raúl Arán-Jové, Noé Labata-Lezaun, César Fernández-de-las-Peñas, Joan Bosch and Albert Pérez-Bellmunt

Int. J. Environ. Res. Public Health 2022, 19(24), 16619; https://doi.org/10.3390/ijerph192416619 - 10 Dec 2022

Cited by 8 | Viewed by 2231

Abstract

The worldwide pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has impacted all healthcare systems. One potential sequela experienced by hospitalized coronavirus disease 2019 (COVID-19) survivors includes muscle weakness with a reduction in strength and, consequently, a possible increase in frailty. The aim of this clinical trial was to evaluate the efficacy of adding an online therapeutic exercise program for 8 weeks to the medical prescriptions on functional variables in patients hospitalized due to COVID-19. A randomized controlled trial including 70 previously hospitalized COVID-19 survivors was conducted. Patients were randomly allocated to an experimental (n = 35) or control (n = 35) group. Both groups received regular prescriptions provided by their medical doctors. The experimental group also received a live online therapeutic exercise program for 8 weeks (3 sessions/week). Handgrip strength, gait speed, lower-extremity strength, balance, and frailty were assessed at baseline, at the end of the program, and one month after the end of the intervention. The repeated measures analysis of variance revealed significant Group*Time interactions for all the outcomes: (handgrip dominant: F = 17.395, p < 0.001, η² = 0.24; handgrip non-dominant: F = 33.197, p < 0.001, η² = 0.33; 4 m walk test (4WT): F = 13.039, p = 0.001, η² = 0.16; short physical performance battery (SPPB): F = 26.421, p < 0.001, η² = 0.28; the five chair-raise test (5CRT): F = 5.628, p = 0.004, η² = 0.08; FRAIL scale: F = 11.249, p = 0.001, η² = 0.14): patients in the experimental group experienced greater improvements in all outcomes than those assigned to the control group. This study revealed that the addition of an online exercise program for 8 weeks obtained greater improvements in handgrip strength, gait speed, lower-extremity strength, balance, and frailty in a sample of previously hospitalized COVID-19 survivors than application of just usual medical prescription. Full article

(This article belongs to the Special Issue Physical Therapy and COVID-19 Sequelae: Future Challenges for Preventing Related-Disability)

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15 pages, 1059 KiB

Open AccessArticle

Effects of Aerobic Training in Patients with Subacute COVID-19: A Randomized Controlled Feasibility Trial

by Stefano Corna, Marica Giardini, Marco Godi, Lucia Bellotti and Ilaria Arcolin

Int. J. Environ. Res. Public Health 2022, 19(24), 16383; https://doi.org/10.3390/ijerph192416383 - 7 Dec 2022

Cited by 6 | Viewed by 1982

Abstract

Many clinical practice recommendations indicate rehabilitation as essential for patients with sequelae of severe or critical COVID-19 and suggest the prompt initiation of a multicomponent rehabilitation program focused on aerobic and endurance training. However, randomized controlled trials (RCTs) regarding aerobic exercise are lacking. Therefore, we aimed to assess the feasibility and effectiveness of the addition of aerobic training to standard rehabilitation in subjects with subacute COVID-19. Participants were 32/214 patients with the sequelae of severe or critical COVID-19 in the acute phase who were eligible and agreed to participate in the study (eligibility = 15%, recruitment = 100%). After randomization and assessment with functional and strength tests, all the participants underwent an inpatient-tailored rehabilitation program (50 min/day, 5 days/week, 10 sessions); in addition, the experimental group performed a low- to moderate-intensity aerobic exercise (30 min/day, 10 sessions). No dropouts or severe adverse events were reported, with an attendance rate of 95.6%. Most of the secondary outcomes significantly improved in both groups, but the improvement in the Functional Independence Measure and Cumulated Ambulation Score—Italian version was significantly greater in the experimental group (at least, p < 0.05). This RCT showed that aerobic exercise is feasible and safe in subacute COVID-19. Moreover, it appears to be beneficial and useful in improving patients’ independence and mobility. Full article

(This article belongs to the Special Issue Physical Therapy and COVID-19 Sequelae: Future Challenges for Preventing Related-Disability)

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12 pages, 1297 KiB

Open AccessArticle

The Coronavirus Footprint on Dual-Task Performance in Post-Acute Patients after Severe COVID-19: A Future Challenge for Rehabilitation

by Marica Giardini, Ilaria Arcolin, Marco Godi, Simone Guglielmetti, Alessandro Maretti, Armando Capelli and Stefano Corna

Int. J. Environ. Res. Public Health 2022, 19(17), 10644; https://doi.org/10.3390/ijerph191710644 - 26 Aug 2022

Cited by 2 | Viewed by 1502

Abstract

Recent studies suggest that also the non-critical form of COVID-19 infection may be associated with executive function impairments. However, it is not clear if they result from cognitive impairments or by COVID-19 infection per se. We aimed to investigate if patients in the post-acute stage of severe COVID-19 (PwCOVID), without manifest cognitive deficits, reveal impairments in performing dual-task (DT) activities compared to healthy controls (HS). We assessed balance in 31 PwCOVID vs. 30 age-matched HS by stabilometry and the Timed Up and Go (TUG) test with/without a cognitive DT. The DT cost (DTC), TUG test time and sway oscillations were recorded; correct cognitive responses (CCR) were calculated to evaluate cognitive performance. Results show a significant difference in overall DT performance between PwCOVID and HS in both stabilometry (p < 0.01) and the TUG test (p < 0.0005), although with similar DTCs. The main difference in the DTs between groups emerged in the CCR (effect size > 0.8). Substantially, PwCOVID gave priority to the motor task, leaving out the cognitive one, while HS performed both tasks simultaneously. Our findings suggest that PwCOVID, even without a manifest cognitive impairment, may present a deficit in executive function during DTs. These results encourage the use of DTs and CCR in PwCOVID. Full article

(This article belongs to the Special Issue Physical Therapy and COVID-19 Sequelae: Future Challenges for Preventing Related-Disability)

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11 pages, 894 KiB

Open AccessArticle

Self-Assessed Aspects of Health 3 Months after COVID-19 Hospitalization—A Swedish Cross-Sectional Study

by Alexandra C. Larsson, Marie Engwall, Annie Palstam and Hanna C. Persson

Int. J. Environ. Res. Public Health 2022, 19(13), 8020; https://doi.org/10.3390/ijerph19138020 - 30 Jun 2022

Cited by 7 | Viewed by 1922

Abstract

It is not yet fully understood how the patients self-assess their overall health in the early recovery after COVID-19 and if certain patient groups are more prominent in perceived long-time effects of COVID-19. The aim of this study was to describe self-assessed aspects of health in body function, activity and participation 3 months after hospitalization due to COVID-19 and identify difference between groups depending in age, sex and level of hospital care. This cross-sectional study consists of self-assessed aspects of health and recovery in 168 participants (mean age 64 years old, 69% men) previously hospitalized patients due to COVID-19. We have previously published data, from hospital discharge, on this cohort were predominantly the older patients and previous ICU-treated participants were affected. In this study there were differences in between groups. Of the study population 72% perceived fatigue, 64% respiratory difficulties, 37% perceived symptoms of anxiety. Three-months after COVID-19 this cohort was overall still affected. The recovery process is multifaced and the cohort heterogeneous, hence the rehabilitation needs to be highly individualized, and the follow-up of this patient group is of importance regardless of age, sex and previous level of hospital care. Full article

(This article belongs to the Special Issue Physical Therapy and COVID-19 Sequelae: Future Challenges for Preventing Related-Disability)

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13 pages, 1122 KiB

Open AccessArticle

Development of a Medium Care Unit Using an Inexperienced Respiratory Staff: Lessons Learned during the COVID-19 Pandemic

by Olivier Van Hove, Alexis Gillet, Jérôme Tack, Gregory Reychler, Magda Guatteri, Asuncion Ballarin, Justine Thomas, Rolando Espinoza, Frédéric Bonnier, Michelle Norrenberg, Pauline Daniel, Michel Toussaint, Dimitri Leduc, Bruno Bonnechère and Olivier Taton

Int. J. Environ. Res. Public Health 2022, 19(12), 7349; https://doi.org/10.3390/ijerph19127349 - 15 Jun 2022

Cited by 2 | Viewed by 2055

Abstract

The different waves of the COVID-19 pandemic caused dramatic issues regarding the organization of care. In this context innovative solutions have to be developed in a timely manner to adapt to the organization of the care. The establishment of middle care (MC) units is a bright example of such an adaptation. A multidisciplinary MC team, including expert and non-expert respiratory health care personnel, was developed and trained to work in a COVID-19 MC unit. Important educational resources were set up to ensure rapid and effective training of the MC team, limiting the admission or delaying transfers to ICU and ensuring optimal management of palliative care. We conducted a retrospective analysis of patient data in the MC unit during the second COVID-19 wave in Belgium. The aim of this study was to demonstrate the feasibility of quickly developing an effective respiratory MC unit mixing respiratory expert and non-expert members from outside ICUs. The establishment of an MC unit during a pandemic is feasible and needed. MC units possibly relieve the pressure exerted on ICUs. A highly trained multidisciplinary team is key to ensuring the success of an MC unit during such kind of a pandemic. Full article

(This article belongs to the Special Issue Physical Therapy and COVID-19 Sequelae: Future Challenges for Preventing Related-Disability)

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14 pages, 560 KiB

Open AccessArticle

Future Challenges for Physical Therapy during and after the COVID-19 Pandemic: A Qualitative Study on the Experience of Physical Therapists in Spain

by Domingo Palacios-Ceña, César Fernández-de-las-Peñas, Lidiane L. Florencio, María Palacios-Ceña and Ana I. de-la-Llave-Rincón

Int. J. Environ. Res. Public Health 2021, 18(16), 8368; https://doi.org/10.3390/ijerph18168368 - 7 Aug 2021

Cited by 19 | Viewed by 6707

Abstract

This qualitative exploratory study addressed the perspectives of Spanish physical therapists (PTs) regarding (a) the organization of their work during the first wave of the pandemic; (b) their role within the intensive care units (ICUs); (c) management of COVID-19 survivors; (d) potential future challenges identified for the physical therapy profession. Thirty PTs who had worked at a National Public Hospital in Madrid during the first COVID-19 outbreak were recruited by purposeful sampling and snowball techniques. In-depth interviews and researcher field notes were used to collect data. Interviews were transcribed verbatim. An inductive thematic analysis was used to identify emerging themes. After identifying 1110 codes, four themes emerged. Throughout the first wave of the pandemic, the role and work of PTs in hospitals experienced a change. These changes took place at their organizational level, affecting the distribution of PTs in the hospital, and the role of PTs in front-line COVID units such as ICUs, as well as direct management of outpatients at the onset of the pandemic, and after discharge from the ICUs. This situation has led to PTs foreseeing challenges and developing new expectations concerning their role and the physical therapy profession in the future. Full article

(This article belongs to the Special Issue Physical Therapy and COVID-19 Sequelae: Future Challenges for Preventing Related-Disability)

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9 pages, 647 KiB

Open AccessArticle

Short-Term Effects of a Respiratory Telerehabilitation Program in Confined COVID-19 Patients in the Acute Phase: A Pilot Study

by Juan Jose Gonzalez-Gerez, Manuel Saavedra-Hernandez, Ernesto Anarte-Lazo, Carlos Bernal-Utrera, Manuel Perez-Ale and Cleofas Rodriguez-Blanco

Int. J. Environ. Res. Public Health 2021, 18(14), 7511; https://doi.org/10.3390/ijerph18147511 - 14 Jul 2021

Cited by 57 | Viewed by 6078

Abstract

The COVID-19 pandemic has caused distress for healthcare providers due to the respiratory problems it causes, among others. In this situation, rehabilitation of the respiratory system has been suggested and implemented in different COVID-19 patients. This study evaluated the feasibility and effectiveness of a novel program based on breathing exercises through telerehabilitation tools in COVID-19 patients with mild to moderate symptomatology in the acute stage. Forty subjects were randomized in an experimental group, based on pulmonary rehabilitation, and in a control group, of which the subjects did not perform physical activity. Thirty-eight subjects, with nineteen in each group, completed the one-week intervention. We performed measurements using the Six-Minute Walk Test, Multidimensional Dyspnoea-12, Thirty-Second Sit-To-Stand Test, and Borg Scale. Both groups were comparable at baseline. Significant differences were found for all of the outcome measures in favour of the experimental group. Ninety percent adherence was found in our program. A one-week telerehabilitation program based on respiratory exercises is effective, safe, and feasible in COVID-19 patients with mild to moderate symptomatology in the acute stage. Full article

(This article belongs to the Special Issue Physical Therapy and COVID-19 Sequelae: Future Challenges for Preventing Related-Disability)

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Review

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21 pages, 1142 KiB

Open AccessReview

The Impact of COVID-19 Infection on Cognitive Function and the Implication for Rehabilitation: A Systematic Review and Meta-Analysis

by Sarah Houben and Bruno Bonnechère

Int. J. Environ. Res. Public Health 2022, 19(13), 7748; https://doi.org/10.3390/ijerph19137748 - 24 Jun 2022

Cited by 30 | Viewed by 5725

Abstract

There is mounting evidence that patients with severe COVID-19 disease may have symptoms that continue beyond the acute phase, extending into the early chronic phase. This prolonged COVID-19 pathology is often referred to as ‘Long COVID’. Simultaneously, case investigations have shown that COVID-19 individuals might have a variety of neurological problems. The accurate and accessible assessment of cognitive function in patients post-COVID-19 infection is thus of increasingly high importance for both public and individual health. Little is known about the influence of COVID-19 on the general cognitive levels but more importantly, at sub-functions level. Therefore, we first aim to summarize the current level of evidence supporting the negative impact of COVID-19 infection on cognitive functions. Twenty-seven studies were included in the systematic review representing a total of 94,103 participants (90,317 COVID-19 patients and 3786 healthy controls). We then performed a meta-analysis summarizing the results of five studies (959 participants, 513 patients) to quantify the impact of COVID-19 on cognitive functions. The overall effect, expressed in standardized mean differences, is −0.41 [95%CI −0.55; −0.27]. To prevent disability, we finally discuss the different approaches available in rehabilitation to help these patients and avoid long-term complications. Full article

(This article belongs to the Special Issue Physical Therapy and COVID-19 Sequelae: Future Challenges for Preventing Related-Disability)

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18 pages, 1483 KiB

Open AccessReview

Could Physical Therapy Interventions Be Adopted in the Management of Critically Ill Patients with COVID-19? A Scoping Review

by Carlos Bernal-Utrera, Ernesto Anarte-Lazo, Juan Jose Gonzalez-Gerez, Elena De-La-Barrera-Aranda, Manuel Saavedra-Hernandez and Cleofas Rodriguez-Blanco

Int. J. Environ. Res. Public Health 2021, 18(4), 1627; https://doi.org/10.3390/ijerph18041627 - 8 Feb 2021

Cited by 14 | Viewed by 7445

Abstract

As part of COVID-19 consequences, it has been estimated that 5% of patients affected by this disease will require admission to the intensive care unit (ICU), and physical therapy techniques have been implemented in patients with other conditions admitted to ICU. The aim of the present study is to summarize all the available information about the implementation of physical therapy management in critically ill patients. From three clinical guidelines already published, we performed a search in PubMed, Scopus, ScienceDirect, and CINAHL, including systematic reviews, clinical guidelines, and randomized controlled trials, among others. Data extraction was performed independently by two reviewers. Quality assessment was developed through the AMSTAR-2 tool and PEDro Scale. A narrative synthesis was performed and 29 studies were included. The information extracted has been classified into four folders: ICU environment in COVID-19 (security aspects and management of the patient), respiratory physiotherapy (general indications and contraindications, spontaneously breathing and mechanically ventilated patient approaches), positional treatment, and exercise therapy (safety aspects and progression). The implementation of physiotherapy in patients affected with COVID-19 admitted to the ICU is a necessary strategy that prevents complications and contributes to the stabilization of patients in critical periods, facilitating their recovery. Full article

(This article belongs to the Special Issue Physical Therapy and COVID-19 Sequelae: Future Challenges for Preventing Related-Disability)

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