Rehabilitation of Patients with Post-COVID-19 Syndrome: A Narrative Review.

Objectives: : We aimed to review the most recent articles on the rehabilitation of patients after coronavirus disease 2019 (COVID-19) and to identify the methods and effects of rehabilitation on such patients. Methods: : A literature search was conducted using PubMed and Web of Science from study inception to October 2022 using the following search terms to identify meta-analyses and randomized controlled studies with abstracts written in English: ["COVID-19" or "COVID 19" or "2019-nCoV" or "SARS-CoV" or "novel coronavirus" or "SARS-CoV-2"] and ["rehabilitation"]. Publications investigating the effects of pulmonary and physical rehabilitation on patients with COVID-19 were extracted. Results: The extraction process selected four meta-analyses, two systematic reviews, two literature reviews, and two randomized controlled trials. Pulmonary rehabilitation recovered forced vital capacity (FVC), 6-min walk distance (6MWD), health-related quality of life (HRQOL), and dyspnea. Pulmonary rehabilitation increased predicted FVC, distance in the 6MWD test, and HRQOL score compared with baseline values. Physical rehabilitation, comprising aerobic exercises and resistance training, effectively improved fatigue, functional capacity, and quality of life with no adverse events. Telerehabilitation was an effective tool to provide rehabilitation for patients with COVID-19. Conclusions: Our study suggests that rehabilitation after COVID-19 should be considered an effective therapeutic strategy to improve the functional capacity and quality of life of patients with COVID-19.

Short stature and short distance between the anterior acetabular rim to the femoral nerve are risk factors for femoral nerve palsy following primary total hip arthroplasty using the modified Watson-Jones approach.

BACKGROUND: Nerve palsy following total hip arthroplasty (THA) critically impacts patient clinical function. However, few studies have focused on femoral nerve palsy (FNP) following THA via the modified Watson-Jones approach. Previous reports have suggested that THA, regardless of the approach, is associated with several FNP risk factors, including female gender, hip dysplasia, revision surgery, and short stature. Magnetic resonance imaging (MRI) has suggested that a shorter distance between the femoral nerve and the anterior acetabular edge (dFN) is related to FNP after THA. The purposes of this study were: 1) to determine the presumed risk factors through a retrospective investigation of FNP clinical courses, and 2) to identify the relationships between FNP occurrence and the short dFN following primary THA via the modified Watson-Jones approach. HYPOTHESIS: Short stature is a risk factor for femoral nerve palsy following THA. i.e. a significant difference in dFN exists between patients with and without FNP. PATIENTS AND METHODS: This retrospective case-control study was performed at a single university hospital. From January 2016 to December 2020, 676 THAs were performed via the modified Watson-Jones approach at our institution. These included 495 THAs performed in the supine position and 181 in the lateral position. In this study, FNP was defined as weakness of the quadriceps femoris (manual muscle test

Rehabilitation Characteristics of Acute-stage COVID-19 Survivors Managed with Extracorporeal Membrane Oxygenation in the Intensive Care Unit.

Objectives: This study aimed to describe the rehabilitation characteristics of patients with acute stage coronavirus disease managed with extracorporeal membrane oxygenation (ECMO) in the intensive care unit. Methods: This retrospective study enrolled coronavirus disease patients who underwent rehabilitation following ECMO between April 21, 2020, and August 20, 2021. The following patient data were evaluated: age, sex, weaning, peak C-reactive protein, lowest albumin level, white blood cell count, use of steroids and muscle relaxants, duration of respiratory management, ECMO management and rehabilitation, Medical Research Council (MRC) score, and Barthel index after sedation and at discharge. Results: ECMO was performed in 20 patients, and 16 were weaned successfully. The median durations of ECMO and respiratory management in survivors were 14.5 and 38 days, respectively. The median MRC scores after sedation and after rehabilitation therapy were 18 and 45, respectively. The median rehabilitation duration after sedation was 14 days. The MRC score after sedation showed significant correlations with the durations of ECMO and intubation. The median Barthel index values after sedation and at discharge were 0 and 30, respectively. Conclusions: Rehabilitation was important for patients with severe coronavirus disease because muscle weakness advanced in proportion with the durations of ECMO and ventilation management in the intensive care unit.

Intra-articular Injections of Cross-linked Hyaluronic Acid in Japanese Patients with Symptomatic Osteoarthritis of the Hip.

OBJECTIVES: We investigated the efficacy and safety of Hylan G-F 20 for the treatment of hip osteoarthritis in Japanese patients. METHODS: Twenty-nine patients with hip osteoarthritis (OA) received Hylan G-F 20 injection into the hip. The visual analog scale of pain during gait (VAS-G), VAS of pain at rest, hip joint function evaluated by the Japanese Orthopaedic Association (JOA) score, health-related quality of life (HRQoL), and adverse events were evaluated before, immediately after, and at 4, 8, and 12 weeks after injection. Patients were categorized according to the severity of OA (mild and severe OA groups) and dysplasia (dysplastic and non-dysplastic groups) and these groups were compared. RESULTS: After the injection, VAS-G improved significantly for 12 weeks. VAS-G was lower (less pain) in the mild OA group than in the severe OA group at each time point. There were no differences in VAS-G between the dysplastic and non-dysplastic groups throughout the observation period. VAS-G improved significantly in the dysplastic group after the injection. The JOA score and HRQoL demonstrated the same tendency as VAS-G. Three patients experienced worsening of local pain immediately after the injection; however, the pain on the following day was less than that before the injection in all three hips. CONCLUSIONS: Hylan G-F 20 injection into the hip joint was effective in reducing hip pain and can be used as a non-operative treatment option for hip OA in the Japanese population.

Rehabilitation for Patients with COVID-19: A Japanese Single-center Experience.

OBJECTIVES: The aim of the study was to describe the characteristics and efficiency of rehabilitation for patients diagnosed with moderate-to-severe coronavirus disease (COVID-19). METHODS: We retrospectively assessed the medical records of patients with COVID-19 who underwent rehabilitation for early mobilization and to maintain activities of daily living at our hospital between April 21 and August 20, 2020. The following patient data were evaluated: age, sex, diseases, and the total number of sessions completed by patients with severe COVID-19 in the intensive care unit (ICU) and by patients with moderate disease in the general COVID-19 wards. The number of daily sessions performed by physiotherapists was also evaluated. RESULTS: Of 161 patients with COVID-19 admitted during the study period, 95 underwent rehabilitation (78 in the general COVID-19 wards and 17 in the ICU). These 95 COVID-19 patients completed 1035 rehabilitation sessions in total (882 in the general ward and 153 in the ICU). Polymerase chain reaction test results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were positive for 79 patients on the initiation of rehabilitation. Moreover, 86 sessions were supervised remotely, thereby reducing the duration of the medical staff's stay in the SARS-CoV-2 isolation area. Patients with COVID-19 in the ICU received significantly more daily physiotherapy sessions than general ward patients (P<0.001). Each physiotherapist performed, on average, 4.6 sessions daily, with 4.3 daily sessions being performed wearing personal protective equipment (PPE). CONCLUSIONS: COVID-19 rehabilitation required more efforts as wearing PPE was necessary for most cases although tried with remote rehabilitation in some cases. Overall, a longer rehabilitation period was needed for ICU patients.

Remote rehabilitation for patients with COVID-19.

OBJECTIVE: To describe the effectiveness and risk management of remote rehabilitation for coronavirus disease (COVID-19) patients. DESIGN: Single-centre, retrospective, observational study. PATIENTS: COVID-19 patients undergoing rehabilitation (24 April to 24 May 2020). METHODS: All COVID-19 inpatients undergoing rehabilitation in the general ward were assessed. Data were collected on age, sex, physical ability, rehabilitation modality (remote/direct), need for intubation or extracorporeal membrane oxygenation, degree of pneumonia, oxygen therapy from the start of rehabilitation, D-dimer and C-reactive protein levels, and rehabilitation-related complications. Activities of daily living were measured using the Barthel Index. RESULTS: Out of a total of 43 patients, 14 were initially provided with remote rehabilitation and 29 with direct rehabilitation. Four patients were switched from direct to remote rehabilitation during the study, thus at the end of the study there were 18 in the remote rehabilitation group and 25 in the direct rehabilitation group. Patients in remote rehabilitation were significantly younger than those in direct rehabilitation. Of 12 patients who required intubation, 3 were given remote rehabilitation. One extracorporeal membrane oxygenation survivor underwent direct rehabilitation. All patients on remote rehabilitation were discharged home or to a hotel. Twelve out of 29 patients were transferred to a rehabilitation hospital due to delayed recovery of activities of daily living. No serious adverse events occurred. CONCLUSION: Effective and safe remote rehabilitation was performed in 41.9% of COVID-19 patients in this study, which resulted in improved rehabilitation in COVID-19 zones.

The Safety and Effect of Early Mobilization in the Intensive Care Unit According to Cancellation Criteria.

OBJECTIVE: The aim of this study was to investigate the effect and risk management of early mobilization in the intensive care unit (ICU) with multidisciplinary collaboration and daily goal planning. METHODS: Rehabilitation of ICU patients in our hospital between April 1, 2019, and September 30, 2019, was investigated retrospectively. The following factors were evaluated: age and sex of the subjects; diseases; the total number of early mobilization therapy sessions done at a lowered goal level; the clinical course of the step-down sessions; reasons for lowering goal levels that corresponded to the cancellation criteria from the officially issued guidelines of the Japanese Association of Rehabilitation Medicine, the expert consensus on ICU, or other reasons for step down; and the rate of planned goals that were achieved. RESULTS: Of the 1908 overall rehabilitation sessions carried out during the period of investigation, 9.6% had the planned level lowered; changes in vital signs accounted for 54.6% of the reasons for lowering the level. Of the step-down sessions, 92.3% corresponded with the cancellation criteria of rehabilitation. Early mobilization in the ICU in accordance with daily goal planning via collaboration within the multidisciplinary team during rounds was accomplished in 90.4% of sessions. No serious mobilization-related adverse events were noted during the study period. CONCLUSION: Early mobilization should be performed with daily goal planning by a multidisciplinary team during rounds and should be governed by the cancellation criteria of rehabilitation.

Assessment of the Need for Early Initiation of Rehabilitation Treatments in Patients with Coronavirus Disease 2019.

OBJECTIVE: The aim of this study was to describe the clinical characteristics of coronavirus disease (COVID-19) patients, including risk factors for deep vein thrombosis and pulmonary embolism, and to evaluate the need for rehabilitation to prevent pulmonary embolism. METHODS: A retrospective medical record review was conducted of patients admitted to the study hospital with COVID-19 between April 2 and April 23, 2020. The clinical characteristics and blood test results of patients with no history on admission of oral anticoagulant use were evaluated to assess the importance of inflammation and clotting function as risk factors for pulmonary embolism. RESULTS: A total of 51 patients with COVID-19 were admitted during the study period. Their median age was 54.0 years (range: 41-63 years) and 38 of 51 (74.5%) were men. The most common comorbidities in men were diabetes (9/38, 23.7%) and hypertension (13/38, 34.2%). On admission, white blood cell counts were normal in both sexes, whereas C-reactive protein and hemostatic marker levels, except for the activated partial thromboplastin time, were significantly higher in men. Moreover, C-reactive protein and hemostatic marker levels were significantly higher in patients that required invasive ventilation. Two patients were diagnosed with acute pulmonary embolism, neither of whom required invasive ventilation. CONCLUSIONS: Hypercoagulability and hyperinflammation were observed in COVID-19 patients, especially in men with high oxygen demand. We recommend anticoagulant therapy and early rehabilitation intervention to prevent pulmonary embolism in COVID-19 patients.

Femoral nerve palsy following primary total hip arthroplasty with the direct anterior approach.

Nerve palsy following total hip arthroplasty (THA) can have a serious effect on a patient`s functional prognosis and on cost-effectiveness, and it is the leading cause of THA-associated medical litigation. However, only a few studies focus on femoral nerve palsy (FNP) following THA with the direct anterior approach (DAA). Moreover, several studies have reported that THA with DAA may result in higher complication rates, particularly during the so-called 'learning-curve period' for the surgeon. This study aimed to identify the incidence of FNP following primary THA with DAA, to determine presumed etiologies through a retrospective investigation of FNP clinical courses following primary THA with DAA and to identify any relationship between the occurrence of FNP following primary THA with DAA and the surgeon's experience of DAA. Since August 2007, DAA for primary THA was introduced in our institution. All 273 consecutive primary THAs with DAA (42 bilateral and 189 unilateral cases) between August 2007 and February 2014 were included in this study. All patients' charts and radiographs were reviewed to identify cases with palsy and to retrieve related factors. In this study, FNP was defined as weakness of the quadriceps femoris (manual muscle test <3) with or without sensory disturbance over the anteromedial aspect of the thigh. The incidence of FNP following primary THA with DAA was 1.1% (3/273 joints). In all 3 cases, the motor deficit recovered completely within a year. Suspected causes of the palsy in the 3 cases were believed to be improper positioning of the anterior acetabular retractor, excessive leg lengthening, or unknown etiology. There was no significant relationship between palsy and surgeon's experience of DAA. In THA with DAA for patients requiring major leg lengthening, the likelihood of FNP must be considered. To prevent FNP, the anterior acetabular retractor must be placed properly.

Cancellation Criteria of Acute Rehabilitation: Rehabilitation Risk Management.

OBJECTIVE: This study aimed to investigate risk management during acute rehabilitation in cases where rehabilitation was canceled after prescription. METHODS: Rehabilitation cases that were judged to be canceled after prescription in our hospital between April 1, 2017, and September 30, 2017, were investigated prospectively. The following parameters were examined: the total number of canceled rehabilitation therapies, the age and sex of the patients, the rehabilitation categories, the reasons for cancellation of rehabilitation, the clinical course after cancellation of rehabilitation, the number of cancellation cases with reasons corresponding to the cancellation criteria from the officially issued guidelines of the Japanese Association of Rehabilitation Medicine, and the applicable elements of the cancellation criteria. RESULTS: Of the 2263 patients prescribed rehabilitation during the investigation period, rehabilitation was canceled in 110 (4.9%). The reasons for discontinuation were changes in vital signs in 53.6% of these 110 patients. Among the 21 patients in whom rehabilitation was stopped because of decreased oxygen saturation, six were found to have symptomatic pulmonary thromboembolism. In 92.8% of canceled cases, the reasons for cancellation corresponded to the cancellation criteria of rehabilitation. No serious adverse events were noted during the study period. CONCLUSION: The judgments of discontinuation of rehabilitation in this study were similar to the cancellation criteria of rehabilitation. Acute rehabilitation should be performed under the control of the cancellation criteria of rehabilitation.

Is closed suction drainage effective in early recovery of hip joint function? Comparative evaluation in one-stage bilateral total hip arthroplasty.

One-stage primary bilateral cementless total hip arthroplasty with unilateral closed suction drainage (CSD) was prospectively performed for 51 patients (102 hips), and local effects of CSD were quantitatively evaluated. Postoperatively, pain scores evaluated by visual analog scale and periwound temperatures measured by thermography were lower in the CSD side than the non-CSD side. CT measurements also showed that postoperative cross-sectional area of the thigh was smaller in the CSD side. Active straight leg raising and weight bearing were more accelerated in the CSD side., showing earlier recovery of hip joint function. CSD for hip arthroplasty has an advantage in reducing postoperative local inflammation and be recommended from the viewpoint of postoperative pain relief and early recovery of hip joint function.

A plateau potential mediated by the activation of extrasynaptic NMDA receptors in rat hippocampal CA1 pyramidal neurons.

Hippocampal pyramidal neurons express various extrasynaptic glutamate receptors. When glutamate spillover was facilitated by blocking glutamate uptake and fast synaptic transmission was blocked by antagonists of AMPA- and NMDA-type glutamate receptors and an ionotropic GABA receptor blocker, repetitive synaptic stimulation evoked a persistent membrane depolarization that consisted of an early Ca(2+)-independent component and a late Ca(2+)-dependent component. The early component, which we refer to as a plateau potential, had a half-width of 770 +/- 160 ms and a steady peak level of -9.54 +/- 3.50 mV. It was accompanied by an increase in membrane conductance, the I-V relationship of which showed a peak at -19.91 +/- 2.18 mV and reversal of the current at -4.32 +/- 2.13 mV, and was suppressed by high concentration of an NMDA receptor (NMDAR) antagonist d-APV, or an NMDAR glycine-binding site antagonist 5,7-dCK. After blocking synaptically located NMDARs using MK801, the potential was still evoked synaptically when spillover was facilitated. A sustained depolarization was evoked by iontophoretic application of glutamate in the presence or absence of a glutamate uptake blocker. This potential was not affected by Na(+) or Ca(2+) channel blockers, but was suppressed by 5,7-dCK, leaving an unspecified depolarizing potential. Iontophoresis of NMDA evoked a sustained depolarization that was blocked by a high concentration of d-APV or 5,7-dCK. The I-V relationship of the current during this potential was similar to that obtained during the synaptically induced plateau potentials. These results show that CA1 pyramidal neurons generate plateau potentials mediated most likely by activation of extrasynaptic NMDARs.