Postorotracheal intubation dysphagia in patients with COVID-19: A retrospective study.

BACKGROUND: The cause of oropharyngeal dysphagia in patients with coronavirus disease (COVID-19) can be multifactorial and may underly limitations in swallowing rehabilitation. OBJECTIVE: Analyze the factors related to dysphagia in patients with COVID-19 immediately after orotracheal extubation and the factors that influence swallowing rehabilitation. DESIGN AND SETTING: A retrospective study. METHODS: The presence of dysphagia was evaluated using the American Speech-Language Hearing Association National Outcome Measurement System (ASHA NOMS) scale and variables that influenced swallowing rehabilitation in 140 adult patients who required invasive mechanical ventilation for >48 h. RESULTS: In total, 46.43% of the patients scored 1 or 2 on the ASHA NOMS (severe dysphagia) and 39.29% scored 4 (single consistency delivered orally) or 5 (exclusive oral diet with adaptations). Both the length of mechanical ventilation and the presence of neurological disorders were associated with lower ASHA NOMS scores (odds ratio [OR]: 0.80, 95% confidence interval [CI]: 0.74-0.87 P < 0.05; and OR: 0.13, 95% CI: 0.61-0.29; P < 0.05, respectively). Age and the presence of tracheostomy were negatively associated with speech rehabilitation (OR: 0.92; 95% CI: 0.87--0.96; OR: 0.24; 95% CI: 0.80--0.75), and acute post-COVID-19 kidney injury requiring dialysis and lower scores on the ASHA NOMS were associated with longer time for speech therapy outcomes (ß: 1.62, 95% CI, 0.70-3.17, P < 0.001; ß: -1.24, 95% CI: -1.55--0.92; P < 0.001). CONCLUSION: Prolonged orotracheal intubation and post-COVID-19 neurological alterations increase the probability of dysphagia immediately after extubation. Increased age and tracheostomy limited rehabilitation.

Effectiveness of Pulmonary Rehabilitation in Interstitial Lung Disease, Including Coronavirus Diseases: A Systematic Review and Meta-analysis.

OBJECTIVE: A meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effect of pulmonary rehabilitation on functional capacity and quality of life in interstitial lung diseases, including those caused by coronaviruses. DATA SOURCES: MEDLINE, EMBASE, SPORTDiscus, Cochrane Library, Web of Science, and MedRxiv from inception to November 2020 were searched to identify documents. STUDY SELECTION: Publications investigating the effect of pulmonary rehabilitation on lung function (forced vital capacity [FVC]), exercise capacity (6-minute walk distance [6MWD]), health related quality of life (HRQOL), and dyspnea were searched. DATA EXTRACTION: The data were extracted into predesigned data extraction tables. Risk of bias was evaluated with the Cochrane Risk of Bias tool (RoB 2.0). DATA SYNTHESIS: A total of 11 RCTs with 637 interstitial lung disease patients were eligible for analyses. The pooled effect sizes of the association for pulmonary rehabilitation were 0.37 (95% confidence interval [CI], 0.02-0.71) for FVC, 44.55 (95% CI, 32.46-56.64) for 6MWD, 0.52 (95% CI, 0.22-0.82) for HRQOL, and 0.39 (95% CI, -0.08 to 0.87) for dyspnea. After translating these findings considering clinical improvements, pulmonary rehabilitation intervention increased predicted FVC by 5.5%, the 6MWD test improved by 44.55 m, and HRQOL improved by 3.9 points compared with baseline values. Results remained similar in sensitivity analyses. CONCLUSIONS: Although specific evidence for pulmonary rehabilitation of coronavirus disease 2019 patients has emerged, our data support that interstitial lung disease rehabilitation could be considered as an effective therapeutic strategy to improve the functional capacity and quality of life in this group of patients.

COVID-19 Outbreak During Inpatient Rehabilitation: Impact on Settings and Clinical Course of Neuromusculoskeletal Rehabilitation Patients.

OBJECTIVE: The COVID-19 pandemic affects a large number of patients. The impact on feasibility and outcome of rehabilitation during COVID-19 actually remains unclear. Nosocomial infection of healthcare workers or hospitalized patients is common, and prevention of nosocomial infections during rehabilitation is challenging. Therefore, we analyzed a cohort of nosocomial infected COVID-19 patients in a single-center inpatient rehabilitation clinic and described performance and outcome. DESIGN: The cohort (N = 27) describes patients with nosocomial SARS-CoV-2 infection while participating in neuromusculoskeletal rehabilitation. Infection was caused by an initially unidentified so-called superspreader. We compared this cohort with all neuromusculoskeletal rehabilitation inpatients of 2019 (comparison group). Normally distributed continuous variables were presented as mean with standard deviation and the t test was used for comparison between groups. Linear regression was used to assess the impact of COVID-19 on Functional Independence Measure at discharge. RESULTS: COVID-19 patients were mostly male (66.7%) with an age of 71.5 ± 12.3 yrs. Age, sex, and cumulated comorbidities of the comparison group (n = 786) were not different from the COVID-19 group. A total of 92.6% of COVID-19 patients had a mild or moderate course, two patients had to be referred to acute hospital because of respiratory failure, and one of these patients died in the acute hospital. After implementation of a strict hygiene concept, no further nosocomial COVID-19 infections were detected. The rehabilitation duration was significantly longer in the COVID-19 group (54.2 ± 23.6 days vs. 32.1 ± 17.7 days, P < 0.001). Daily therapy duration was 132.3 ± 44 mins before SARS-CoV-2 infection and reduced to 81.9 ± 27.3 mins during COVID-19 (P < 0.001). After discontinuation of isolation measures, therapy duration increased significantly (99.3 ± 70.2 mins, P < 0.05).The baseline Functional Independence Measure score was higher in the COVID-19 group (91.93 ± 25.64 points vs. 82.98 ± 22.73 points) and Functional Independence Measure improvements were lower in COVID-19 patients than in the 2019 comparison group (6.96 ± 8.96 points vs. 20.3 ± 15.98 points, P < 0.001). COVID-19 infection itself had a strong negative impact on Functional Independence Measure change as identified by regression analysis. Linear regression analysis showed that COVID-19 reduced the Functional Independence Measure at discharge by 8.9 points (95% CI = -14.725 to -3.097, P = 0.003) after correction for Functional Independence Measure at admission, age, sex, and morbidity index at admission. CONCLUSIONS: COVID-19 had a strong negative impact on rehabilitation benefits as assessed by Functional Independence Measure. Neuromusculoskeletal rehabilitation could be continued, but all patients received less therapy minutes during isolation. After implementation of a strict COVID-19-specific hygiene concept, no further infections were detected.

Functional outcome after inpatient rehabilitation in postintensive care unit COVID-19 patients: findings and clinical implications from a real-practice retrospective study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic is quickly spreading worldwide, with survivors that suffer functional impairments with a consequent key role of rehabilitation in this context. To date, there is a lack of findings on the role of rehabilitation in postacute COVID-19 patients. AIM: Thus, we aimed at describing the role of a patient-tailored rehabilitation plan on functional outcome in hospitalized COVID-19 patients. DESIGN: Real-practice retrospective study. SETTING: Inpatients Rehabilitation Unit. POPULATION: Postacute COVID-19 patients. METHODS: Medical records of patients referred to an Italian COVID-19 Rehabilitation Unit from March 10th, 2020 to April 30th, 2020 were collected. All patients underwent a rehabilitative (30 minutes/set, 2 times/day), aimed to improve gas exchanges, reducing dyspnoea, and improving muscle function. At the admission (T0) and at the discharge (T1), we evaluated as outcome measures: Barthel Index (BI), modified Medical Research Council Dyspnea Scale, 6-Minute Walking Test (6-MWT) and Borg Rating of Perceived Exertion (RPE) scale. We also assessed: type of respiratory supports needed, pulmonary function, coagulation and inflammation markers and length of stay (LOS) in Rehabilitation Unit. RESULTS: We included 41 postacute COVID-19 patients (25 male and 19 female), mean aged 72.15±11.07 years. Their mean LOS in the Rehabilitation Unit was 31.97±9.06 days, as 39 successfully completed the rehabilitation treatment and 2 deceased. We found statistically significant improvement in BI (84.87±15.56 vs. 43.37±26.00; P<0.0001), 6-MWT (303.37±112.18 vs. 240.0±81.31 meters; P=0.028), Borg RPE scale (12.23±2.51 vs. 16.03±2.28; P<0.0001). CONCLUSIONS: These findings suggest that postacute COVID-19 patients might beneficiate of a motor and respiratory rehabilitation treatment. However, further studies are advised to better understand long-term sequelae of the disease. CLINICAL REHABILITATION IMPACT: This study provides evidence on the role of rehabilitation COVID-19 postacute inpatients through a patient-tailored treatment.

Hospital physical therapy management in pediatric patients with covid-19: case reports / Manejo da fisioterapia no âmbito hospitalar no paciente pediátrico com covid-19: relato de casos

ABSTRACT Objective: To report the physiotherapeutic management of two pediatric cases with COVID-19 admitted in a reference state hospital to treat the disease in Porto Alegre, Southern Brazil. Cases description: Case 1, female, 10-month-old child, pre-existing chronic disease, hospitalized since birth, mechanical ventilation dependency via tracheotomy, progressed with hypoxemia, requiring oxygen therapy, and increased ventilator parameters, and a diagnosis of COVID-19 was confirmed. Airway clearance and pulmonary expansion maintenance therapies were performed. During hospitalization, the child acquired cephalic control, sitting without support, rolling, holding, and reaching objects. Recommendations were provided to a family member to maintain motor development milestones. Case 2, male, nine years old, previous psychiatric disease and obesity, showed worsening of the sensory state, requiring intensive care and invasive mechanical ventilation, with the diagnosis of SARS-Cov-2 infection. The physical therapy was performed to maintain airway clearance, pulmonary expansion, and early mobilization, showing ventilatory improvement during the intensive care hospitalization and successfully extubated after 17 days. The physical therapy evolved from passive to resistive exercises during the hospitalization, and the patient was able to walk without assistance at discharge, with the same previous functional status. Comments: The COVID-19 showed different manifestations in both cases. Physical therapy treatment was essential to maintain and to recover the functional status of the patients. Future studies are needed to improve the understanding of disease course and its functional consequences to offer an efficient treatment to pediatric patients with COVID-19.

RESUMO Objetivo: Relatar as condutas fisioterapêuticas dos dois casos de pacientes pediátricos com COVID-19 internados em hospital de referência estadual em Porto Alegre para tratamento da doença. Descrição dos casos: Caso 1, sexo feminino, 10 meses de idade com doença crônica preexistente, internada desde o nascimento, utilizava ventilação mecânica via traqueostomia, evoluiu com hipoxemia, necessidade de oxigenoterapia e aumento dos parâmetros ventilatórios, sendo confirmada COVID-19. Foram realizadas técnicas de desobstrução brônquica e manutenção da expansão pulmonar. Além disso, a criança durante a internação adquiriu controle cefálico, sedestação sem apoio, rolar e alcance de objetos e durante infecção por coronavírus foram passadas orientações ao familiar para manutenção dos marcos motores adquiridos. Caso 2, sexo masculino, 9 anos, com doença psiquiátrica prévia e obesidade, evoluiu com quadro de rebaixamento do sensório e necessidade de tratamento intensivo, sendo o paciente colocado em ventilação mecânica invasiva na chegada à unidade e confirmada a infecção por SARS-CoV-2. Realizou fisioterapia para desobstrução brônquica, reexpansão pulmonar e mobilização precoce, apresentando melhora ventilatória ao longo da internação, e após 17 dias foi extubado com sucesso. Evoluiu de cinesioterapia passiva para assistida e resistida na internação pediátrica, conseguindo deambular sem auxílio, e teve alta hospitalar com condição funcional prévia à internação hospitalar. Comentários: A COVID-19 apresentou-se de forma distinta nos casos, todavia a fisioterapia foi essencial para a manutenção e recuperação do quadro funcional dos pacientes. Estudos futuros são necessários para melhor compreensão do curso da doença e suas repercussões funcionais, a fim de traçar um tratamento eficiente para os pacientes pediátricos acometidos pela COVID-19.

HOSPITAL PHYSICAL THERAPY MANAGEMENT IN PEDIATRIC PATIENTS WITH COVID-19: CASE REPORTS.

OBJECTIVE: To report the physiotherapeutic management of two pediatric cases with COVID-19 admitted in a reference state hospital to treat the disease in Porto Alegre, Southern Brazil. CASES DESCRIPTION: Case 1, female, 10-month-old child, pre-existing chronic disease, hospitalized since birth, mechanical ventilation dependency via tracheotomy, progressed with hypoxemia, requiring oxygen therapy, and increased ventilator parameters, and a diagnosis of COVID-19 was confirmed. Airway clearance and pulmonary expansion maintenance therapies were performed. During hospitalization, the child acquired cephalic control, sitting without support, rolling, holding, and reaching objects. Recommendations were provided to a family member to maintain motor development milestones. Case 2, male, nine years old, previous psychiatric disease and obesity, showed worsening of the sensory state, requiring intensive care and invasive mechanical ventilation, with the diagnosis of SARS-Cov-2 infection. The physical therapy was performed to maintain airway clearance, pulmonary expansion, and early mobilization, showing ventilatory improvement during the intensive care hospitalization and successfully extubated after 17 days. The physical therapy evolved from passive to resistive exercises during the hospitalization, and the patient was able to walk without assistance at discharge, with the same previous functional status. COMMENTS: The COVID-19 showed different manifestations in both cases. Physical therapy treatment was essential to maintain and to recover the functional status of the patients. Future studies are needed to improve the understanding of disease course and its functional consequences to offer an efficient treatment to pediatric patients with COVID-19.

The effect of meditative movement on the quality of life in patients recovering from COVID-19: A protocol for systematic review and meta-analysis.

BACKGROUND: The outbreak of a novel coronavirus (2019-nCoV)-infected pneumonia is currently ongoing all over the world. The treatment scheme is generally isolation treatment and symptomatic support treatment. While the majority of patients recover from this disease through methods above, COVID-19 Infection severely affect the physical and mental health of rehabilitation patients, as well as their living quality. Thus, meditative movement is needed to improve outcome of COVID-19 patients in recovery period. METHODS: We will conduct systematic searches to identify all relevant studies without any language limitation from the following electronic databases from inception to October 2020: Medline, Ovid, PubMed, Embase, Cochrane Library, Google Scholar, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP), Chinese Biomedical Database, Chinese Biomedical Literature Service System and Wan fang Database. At the same time, we will search the following Clinical trial registries to identify records of on-going or completed but not yet published trials, including WHO International Clinical Trials Registry Platform (ICTRP), Trials Register of Promoting Health Interventions (TRoPHI) and Chinese Clinical Trial Registry (ChiCTR). No limits will be placed on language. The article will study the effect of meditative movement on the quality of life of convalescent patients. The main outcome will be the effect of meditative movement on the quality of life of patients in recovery period. The secondary results will select accompanying symptoms (including myalgia, cough, sputum, runny nose, pharyngalgia, anhelation, chest distress, nausea, vomiting, anorexia, diarrhea), disappearance rate, negative COVID-19 results rate on 2 consecutive occasions (not on the same day), the quality of life improved, CT image improvement, average hospitalization time, occurrence rate of common type to severe form, clinical cure rate, and mortality. Data collection and management 3 authors will independently carry out data from eligible studies in a pretested and standardized Microsoft Excel sheet, with reciprocal validation of data extraction results. Data analysis and quantitative data synthesis will be performed using RevMan software (V.5.3). RESULTS: The findings of the study will provide new and relatively high-quality evidence in meditative movement treatment for COVID-19. CONCLUSION: The conclusion of systematic review will provide evidence to judge whether meditative movement is an effective intervention for patient with COVID-19 in recovery period. PROSPERO REGISTRATION NUMBER: CRD42020210256.

Traditional Chinese exercise for COVID-19: A protocol for systematic review and meta-analysis.

BACKGROUND: A new type of coronavirus (COVID-19), is spreading all over the world. Under the background of the comprehensive medical treatment and strict prevention and control in China, the number of discharged patients increased substantially. By the end of July, more than 80,000 patients had been cured and discharged from hospital in China. In order to effectively promote the full recovery of the patient's physical and mental functions and quality of life, gradually shift the emphasis of clinical work to convalescence therapy is very important, thus Chinese experts draw up Expert Consensus on Rehabilitation of Chinese Medicine for COVID-19. This systematic review and meta-analysis will assess studies of the effects of traditional Chinese exercise (TCE) for COVID-19 patients. METHODS AND ANALYSIS: We will search 6 English and 4 Chinese databases by 01, December 2020. After a series of screening, Randomized Clinic Trials (RCTs) will be included related to TCE for COVID-19. Two assessors will use the Cochrane bias risk assessment tool to assess the RCTs. Finally, the evidence grade of the results will be evaluated. RESULTS: This study will provide a reliable evidence for the selection of TCE therapies for COVID-19. CONCLUSION: The results of this study will provide references for the selection of TCE treatment for COVID-19, and provide decision making references for clinical research. PROSPERO REGISTRATION NUMBER: CRD42020179095.

Reabilitação pós COVID-19 / Post COVID-19 rehabilitation

A partir do conceito de "reabilitação" sintetiza evidências relevantes disponíveis sobre a reabilitação de pacientes internados e/ou recuperados da infecção pelo SARS-CoV-2 (COVID-19). Citam as principais recomendações para pacientes com Covid-10 e os Programas de Reabilitação direcionados para reabilitação na síndrome pós COVID-19 no Brasil, neste contexto, afirmam que a maioria dos programas de reabilitação é composta por equipes multiprofissionais envolvendo diferentes categorias: médico, enfermeiro, fisioterapeuta, terapeuta ocupacional, psicólogo, educador físico e fonoaudiólogo. Discorre sobre a atenção primária e apontam mudanças na forma de atendimento no cenário da pandemia da covid-19, e lista os cuidados, recomendações pertinentes

From the concept of "rehabilitation" it synthesizes relevant evidence available on the rehabilitation of hospitalized and/or recovered patients from SARS-CoV-2 (COVID-19) infection. They cite the main recommendations for patients with Covid-10 and the Rehabilitation Programs aimed at rehabilitation in post COVID-19 syndrome in Brazil, in this context, they state that most rehabilitation programs are composed of multidisciplinary teams involving different categories: doctor, nurse , physiotherapist, occupational therapist, psychologist, physical educator and speech therapist. It discusses primary care and points to changes in the form of care in the covid-19 pandemic scenario, and lists the precautions, pertinent recommendations

Consideraciones clínicas para fonoaudiólogos en el tratamiento de personas con COVID-19 y traqueostomía. Parte I: Deglución / Clinical considerations for speech-language pathologists in the treatment of people with COVID-19 and tracheostomy. Part I: Swallowing

A la fecha de redacción de este artículo, más de 500 mil personas han sido afectadas por el virus SARS-CoV-2 en Chile, manifestando diferentes grados de la enfermedad COVID-19. Aquellas que sobrellevan condiciones más severas generan una condición que requiere soporte ventilatorio invasivo y tratamiento en unidades de cuidados intensivos, que de prolongarse en el tiempo deriva en la necesidad de una traqueostomía. A pesar de los beneficios que posee esta en la recuperación de personas con dificultades respiratorias, su implementación se asocia a alteraciones deglutorias que se suman a las generadas por COVID-19. Condición que supone un desafío para los/as fonoaudiólogos/as, quienes están expuestos/as al virus debido a su proceder en estructuras del tracto aerodigestivo y la realización de procedimientos potencialmente generadores de aerosol. El objetivo de este artículo es entregar orientaciones y herramientas clínicas para la intervención en la deglución de personas con traqueostomía y COVID-19. Estas emanan de un análisis pragmático de la evidencia disponible a la fecha, interpretadas bajo nuestra experiencia de atender a más de 561 personas con dicha condición. Se espera contribuir a la rehabilitación de la deglución en personas con COVID-19 y traqueostomía. Para ello se expone sobre las características de la deglución en esta población, su tratamiento, consideraciones para el uso de técnicas específicas, y orientaciones para la mejora de la calidad de vida mediante la mantención y/o recuperación de la funcionalidad deglutoria. Siempre bajo un esquema centrado en el cuidado y protección de las personas hospitalizadas y el equipo de salud.

At the time of writing this article, more than a million people have been affected by the SARS-CoV-2 virus in Chile, displaying different degrees of COVID-19 disease. Severe infections generate a condition that requires invasive ventilatory support and treatment in intensive care units, which, when extended in time, makes necessary conducting a tracheostomy. Despite its benefits for the recovery of patients with respiratory difficulties, it is linked to swallowing disorders that add to the problems generated by COVID-19. This represents a challenge for speech pathologists, who are potentially exposed to the virus because they work on structures of the aerodigestive tract and becuase they conduct procedures that may be aerosol-generating. The aim of this article is to provide guidance and clinical tools for swallowing-intervention in people with tracheostomies and COVID-19. Thees tools spring from a pragmatic analysis of the currently available evidence , interpreted based on our experience of caring more than561 infected patients. We hope to contribute to the rehabilitation of swallowing of patients with COVID-19 and a tracheostomy. The characteristics of swallowing in this population, its treatment, considerations for the use of specific techniques, and guidelines for improving the quality of life through the maintenance and/or recovery of swallowing functionality are discussed, focused caring and protecting hospitalized patients and the health team.

Consideraciones clínicas para fonoaudiólogos en el tratamiento de personas con COVID-19 y traqueostomía. Parte II: Mejorando la fonación para facilitar la comunicación / Clinical considerations for speech-language pathologists in the treatment of people with COVID-19 and tracheostomy. Part II: Improving phonation to facilitate communicatio

La enfermedad COVID-19 fue declarada pandemia por la Organización Mundial de la Salud. Su presentación más severa genera una condición que requiere tratamiento en unidades de cuidados intensivos, condición que al prolongarse en el tiempo requiere la implementación de una traqueostomía para facilitar la entrega de soporte ventilatorio invasivo. Si bien este dispositivo posee importantes ventajas que favorecen la recuperación y rehabilitación, también es cierto que genera diversas complicaciones en la comunicación de las personas, condición que se suma a los efectos propios del COVID-19 y la frecuente historia de intubación endotraqueal previa. El objetivo de este artículo es proveer orientaciones y herramientas clínicas para el tratamiento de la fonación para la comunicación en personas con traqueostomía y COVID-19. Se considera para ello las recomendaciones de la literatura existentes a la fecha, bajo un análisis pragmático y basado en nuestra experiencia de atender a más de 561 personas con esta condición. Se exponen las características de la comunicación en esta población, su tratamiento, consideraciones para el uso de técnicas específicas y orientaciones para la mejora de la calidad de vida. Siempre con un enfoque orientado al cuidado y protección de las/os usuarias/os y el equipo de salud, en particular fonoaudiólogas y fonoaudiólogos del país.

The COVID-19 disease was declared a pandemic by the World Health Organization. When most severe, it generates a condition that requires treatment in intensive care units, which, when extended in time, requires implementing of a tracheostomy to facilitate invasive ventilatory support. Although ventilatory support has important advantages that favor recovery and rehabilitation, it generates various complications for patients' communication, a condition that adds to the effects of COVID-19 and the frequent history of previous endotracheal intubation. The aim of this article is to provide guidance and clinical tools for the treatment of phonation to facilitate communication in people with tracheostomy and COVID-19. For this, the recommendations of the existing available literature are considered, under a pragmatic analysis and based on our experience of treating more than 561 infected patients. The characteristics of communication in this population, its treatment, considerations for the use of specific techniques and guidelines to improve quality of life are exposed. Always with an approach oriented to the care and protection of users and the health team, in particular speech-language pathologists in the country.

A Review of Nutrition Support Guidelines for Individuals with or Recovering from COVID-19 in the Community.

COVID-19 negatively impacts nutritional status and as such identification of nutritional risk and consideration of the need for nutrition support should be fundamental in this patient group. In recent months, clinical nutrition professional organisations across the world have published nutrition support recommendations for health care professionals. This review summarises key themes of those publications linked to nutrition support of adults with or recovering from COVID-19 outside of hospital. Using our search criteria, 15 publications were identified from electronic databases and websites of clinical nutrition professional organisations, worldwide up to 19th June 2020. The key themes across these publications included the importance in the community setting of: (i) screening for malnutrition, which can be achieved by remote consultation; (ii) care plans with appropriate nutrition support, which may include food based strategies, oral nutritional supplements and referral to a dietitian; (iii) continuity of nutritional care between settings including rapid communication at discharge of malnutrition risk and requirements for ongoing nutrition support. These themes, and indeed the importance of nutritional care, are fundamental and should be integrated into pathways for the rehabilitation of patients recovering from COVID-19.

COVID-19 pandemic in Indonesia: Situation and challenges of rehabilitation medicine in Indonesia.

AbstrakCOVID-19 telah menjadi pandemik di Indonesia sejak ditemukannya kasus pertama pada tanggal 2 Maret 2020 di Depok. Peningkatan kasus perhari semakin tinggi sejak akhir Agustus 2020 yang mencapai lebih dari 2000 kasus per hari. Sistem kesehatan di Indonesia perlu ditingkatkan dalam hal kapasitas, termasuk rehabilitasi medik yang harus dilibatkan dari fase akut hingga jangka panjang dalam penanganan pasien COVID-19. Rehabilitasi medik juga diperlukan untuk pasien lain yang bukan COVID-19. Pentingnya keterlibatan, pelayanan rehabilitasi medik dan implementasinya dimasa pandemic COVID-19 memerlukan strategi tersendiri yang harus dilakukan baik oleh pekerja kesehatannya, rumah sakit dan kebijakan pemerintah. Hal ini diperlukan untuk percepatan peningkatan kesehatan pasien, percepatan pemulangan dan menghindari readmisi pasien, dan juga pengoptimalan program kembali bekerja untuk pasien yang sembuh dari COVID-19.AbstractCOVID-19 has become a pandemic in Indonesia since the first cases have been positively diagnosed on 2 March 2020 in Depok. The cases have been increased gradually since the end of August 2020 that has reached 1000 cases per day. The health system in Indonesia needs to be improved in terms of capacity, including rehabilitation medicine that should be involved in all health phases (from acute to long-term) in managing patients with COVID-19. Rehabilitation is also still needed for other non-COVID-19 patients. The importance of involvement and implementation of rehabilitation services during the COVID-19 pandemic will need special strategies that should be done by rehabilitation professionals, hospitals, and government. These are necessary to accelerate the improvement of patients' health, discharge, and avoid re-admission, as well as optimize return-to-work for patients who are recovered from COVID-19.

Residual clinical damage after COVID-19: A retrospective and prospective observational cohort study.

Data on residual clinical damage after Coronavirus disease-2019 (COVID-19) are lacking. The aims of this study were to investigate whether COVID-19 leaves behind residual dysfunction, and identify patients who might benefit from post-discharge monitoring. All patients aged ≥18 years admitted to the Emergency Department (ED) for COVID-19, and evaluated at post-discharge follow-up between 7 April and 7 May, 2020, were enrolled. Primary outcome was need of follow-up, defined as the presence at follow-up of at least one among: respiratory rate (RR) >20 breaths/min, uncontrolled blood pressure (BP) requiring therapeutic change, moderate to very severe dyspnoea, malnutrition, or new-onset cognitive impairment, according to validated scores. Post-traumatic stress disorder (PTSD) served as secondary outcome. 185 patients were included. Median [interquartile range] time from hospital discharge to follow-up was 23 [20-29] days. 109 (58.9%) patients needed follow-up. At follow-up evaluation, 58 (31.3%) patients were dyspnoeic, 41 (22.2%) tachypnoeic, 10 (5.4%) malnourished, 106 (57.3%) at risk for malnutrition. Forty (21.6%) patients had uncontrolled BP requiring therapeutic change, and 47 (25.4%) new-onset cognitive impairment. PTSD was observed in 41 (22.2%) patients. At regression tree analysis, the ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and body mass index (BMI) at ED presentation, and age emerged as independent predictors of the need of follow-up. Patients with PaO2/FiO2 <324 and BMI ≥33 Kg/m2 had the highest odds to require follow-up. Among hospitalised patients, age ≥63 years, or age <63 plus non-invasive ventilation or diabetes identified those with the highest probability to need follow-up. PTSD was independently predicted by female gender and hospitalisation, the latter being protective (odds ratio, OR, 4.03, 95% confidence interval, CI, 1.76 to 9.47, p 0.0011; OR 0.37, 95% CI 0.14 to 0.92, p 0.033, respectively). COVID-19 leaves behind physical and psychological dysfunctions. Follow-up programmes should be implemented for selected patients.

Rehabilitation of a Post-Intensive Care Unit Patient After Severe COVID-19 Pneumonia.

The recent novel severe acute respiratory syndrome coronavirus 2 infection resulted in a coronavirus disease 2019 pandemic that significantly strained healthcare systems globally. The early wave of patients in Singapore with severe pneumonia requiring intensive care units are gradually being referred for post-critical illness management with our inpatient medical rehabilitation unit. There is growing information regarding the actual rehabilitation process for patients severely affected by coronavirus disease 2019. This case report shares experiences and challenges faced during rehabilitation of severe coronavirus disease 2019 pneumonia and post-intensive care syndrome. It also describes the post-discharge rehabilitation program in a setting of strict nationwide safe distancing and stay-home policies.