RESUMEN
Purpose: To describe the functional trajectory and physical rehabilitation of an individual who underwent lung transplantation for COVID-19 acute respiratory distress syndrome (ARDS). Client Description: A previously healthy 60-year-old man admitted to critical care pre-transplantation and followed six months post-transplant. Intervention: Physical rehabilitation in the critical care, acute ward and in-patient rehabilitation settings. Measures and Outcome: Despite a successful surgery, a long and complex acute care admission contributed to a slow and variable functional recovery. Significant functional limitations and physical frailty were present in the early post-transplant period. Implications: Little is known of the effects of COVID-19 superimposed upon lung transplantation on muscle function, exercise capacity, and physical activity. Future research should include case series to further understand the functional deficits and trajectory of recovery in this emerging clinical population. Standard core outcome measures should be identified for this population to enable synthesis of findings and inform short- and long-term rehabilitation strategies.
Objectif: décrire la trajectoire fonctionnelle et la réadaptation physique d'une personne qui a subi une transplantation pulmonaire à cause d'un syndrome de détresse respiratoire aiguë consécutif à la COVID-19. Description du client: un homme de 60 ans auparavant en santé a été admis en soins intensifs avant la transplantation et a été suivi pendant six mois par la suite. Intervention: réadaptation physique en soins intensifs, à l'aile de soins aigus et en milieu de réadaptation pour patients hospitalisés. Mesures et résultats cliniques: malgré une opération réussie, une hospitalisation longue et complexe en soins aigus a contribué à un rétablissement fonctionnel lent et variable. D'importantes limites fonctionnelles et une fragilité physique ont été observées au début de la période suivant la transplantation. Implications: On sait peu de choses sur les effets de la COVID-19 qui s'ajoutent à la transplantation pulmonaire sur le fonctionnement musculaire, la capacité à l'exercice et l'activité physique. Les futures recherches devraient inclure des séries de cas pour mieux comprendre les déficits fonctionnels et la trajectoire de la convalescence auprès de cette population clinique en émergence. Il faudrait établir des mesures de résultats de référence standards dans cette population afin de synthétiser les observations et d'éclairer les stratégies de réadaptation à court et à long terme.
RESUMEN
Introduction: Digital health interventions may support physical activity among solid organ transplant recipients. These interventions should be designed with users in mind, including healthcare professionals who counsel transplant recipients on physical activity to ensure acceptance and to promote an optimal user experience. The purpose of this study was to explore the perspectives of health care providers on the features of digital health interventions that would be useful in the promotion, implementation, and maintenance of physical activity among solid organ transplant recipients. Methods: This qualitative, cross-sectional study used semistructured interviews that were conducted remotely, via videoconferencing software, with providers who worked with transplant recipients. Interviews were transcribed, and an iterative-inductive, thematic analysis was used to identify common themes. Data were coded using NVivo software. Findings: Thirteen providers participated in this study. Four main themes were identified: (a) physical activity and exercise features (eg, physical activity guidelines, and exercise instructions); (b) credibility; (c) self-management; and (d) user engagement. Potential barriers to using digital health interventions included staffing requirements, professional regulatory issues, cost, perceived low patient motivation to use, and lack of technological literacy or access. Discussion: Digital health interventions were perceived to be a potential adjunct to current physical activity counseling practices, and part of an innovative strategy to address identified barriers to physical activity participation in solid organ transplant recipients.
