Comparison of post-COVID symptoms in patients with different severity profiles of the acute disease visited at a rehabilitation unit.

BACKGROUND AND AIM: Studies in the literature suggest the severity of COVID-19 may impact on post-COVID sequelae. We retrospectively compared the different patterns of symptoms in relation to the severity of acute COVID-19 in patients visited at our post-COVID rehabilitation unit. METHODS: We compared respiratory, muscular, cognitive, emotional, and health-related-quality-of-life (HRQoL) measures in three groups of post-COVID patients: those who had not required hospitalization for the acute disease, those who had been admitted to a general hospital ward, and those who had been admitted to the ICU. The main inclusion criteria were persistent dyspnoea (mMRC ≥2) and/or clinical frailty (scale value ≥3). RESULTS: We analyzed data from 178 post-COVID patients (91 admitted to the ICU, 60 to the ward, and 27 who had not required admission) at first visit to our post-COVID rehabilitation unit. Most patients (85.4%) had at least one comorbidity. There were more males in all groups (58.1%). ICU patients were older (p<0.001). The most frequent symptoms in all groups were fatigue (78.2%) and dyspnea (75.4%). Muscle strength and effort capacity were lower in the ICU group (p<0.001). The SF36 mental component and level of anxiety were worse in patients not admitted to the ICU (p<0.001). No differences were found between groups regarding respiratory pressure but 30 of 57 patients with a decrease in maximum inspiratory pressure had not required mechanical ventilation. CONCLUSION: Clinical profiles of post-COVID syndrome differed between groups. Muscle parameters were lower in the ICU group but patients who had not needed ICU admission had worse anxiety and HRQoL scores. Many patients who had not required mechanical ventilation had respiratory muscle weakness. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04852718.

Comparative Study of Postural Garment Versus Exercises for Patients With Nonspecific Cervical Pain: Protocol for a Randomized Crossover Trial.

BACKGROUND: There is a high prevalence of work-related musculoskeletal disorders among health care professionals. Posture is an essential point to be addressed for health care professionals with musculoskeletal disorders. Cervical pain can result from several conditions. Treatment should include posture modification and home exercise. OBJECTIVE: This study aims to compare a new postural garment (Posture Plus Force; Medi, Bayreuth, Germany) with exercises for women with nonspecific cervical pain. The investigators focus on nurses and allied health professionals due to the importance of posture in work-related musculoskeletal disorders. METHODS: This randomized crossover clinical trial has a 3-month treatment sequence and a 3-month washout period. Participants will include nurses and allied health professionals 21 to 55 years of age with cervical pain. Participants are allocated at random to two intervention groups: a postural garment (Posture Plus Force) to be worn for 2 to 4 hours per day for 90 days (P+ group) and five physiotherapy sessions (20 minutes each) to learn stretching and strengthening exercises with instructions to continue at home on a daily basis for 90 days (Ex group). The participants in each group will crossover interventions after a 3-month washout period. The primary outcomes are postural control and pain intensity. A static posturography will be performed with a scan (SpinalMouse; Idiag AG, Fehraltorf, Switzerland). The visual analogue scale is a psychometric measuring instrument designed to document cervical pain severity in individual participants. The secondary outcomes are cervical pain-related disability, catastrophizing, the global perceived effect of treatment, and the evaluation of garment comfort. Physical activity is assessed with the International Physical Activity Questionnaire. Assessment of primary and secondary outcomes is performed at T0 (pre-intervention), T1 (immediately after garment fitting for P+ group), T30, T60, and T90. The same measurements are recorded after the washout period and during the second intervention following the same sequence. All patients are provided with a logbook for compliance recording, over the counter drug use, pain evaluation, and sick leave. Statistical analysis is conducted following intention-to-treat principles and the treatment effects calculated using linear mixed models. RESULTS: The study design has been approved by the Ethics Commission of Hospital N Sra de Meritxell, Andorra in March 2017. A total of 32 participants are already enrolled in the study. An extension of the study is planned in a Spanish university hospital to achieve a larger sample. Study results are expected to be published during 2020. CONCLUSIONS: The Postural garment is expected to improve cervical pain by enhancing posture. TRIAL REGISTRATION: ClinicalTrials.gov NCT03560492; https://clinicaltrials.gov/ct2/show/NCT03560492. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/14807.