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Introduction
The multisystem COVID-19 can cause prolonged symptoms requiring rehabilitation. This study describes the creation of a remote COVID-19 rehabilitation assessment tool to allow timely triage, assessment and management. It hypotheses those with post-COVID-19 syndrome, potentially without laboratory confirmation and irrespective of initial...
Contexts in source publication
Context 1
... during the acute illness were most commonly SOB (n=115, 74.2%), fever (n=114, 73.5%), fatigue (n=109, 70.3%) and cough (n=100, 64.5%) (Table 3). ...Similar publications
Objective
This study investigated clinicians’ perspectives on the feasibility and effectiveness of using telemedicine in the context of providing first aid. It is crucial to identify and explore clinicians’ attitudes and awareness of tele-first-aid in China to keep pace with ongoing global trends.
Design
This was a qualitative study. Data gathered...
Citations
... COVID-19 patient's rehabilitation can include education, breathing exercises, therapeutic exercise, and anxiety management. the study by Baker-Davies et al.,2021 andKokhan et al.,2021 stated that It is feasible and effective to develop a cardiorespiratory rehabilitation program for COVID-19 patients to prevent and manage long-term disability and return them to a normal functional capacity after their illness (Kokhan et al., 2021;O'Sullivan et al., 2021). ...
... Compared to the other two populations presented here, it seems that the cardiorespiratory profile of long COVID patients is less altered. This could be explained by the relatively early care offered [54,55], which avoids the chronic state of physical deconditioning that is well described in fibromyalgia [56][57][58]. Moreover, the age, gender, and smoking profile was different because of coronary risk factors that are more prevalent in older men and smokers, whereas the long COVID and fibromyalgia population appears to be younger and female. ...
Exercise in long COVID is poorly studied. Nevertheless, exerciserehabilitation could improve cardiorespiratory, muscular and autonomic functions. We aimed to investigate improvement in physical and autonomic performances of long COVID patients (n = 38) after a 4-week exercise rehabilitation program (3 sessions/week) compared to two control groups composed of coronary artery disease (n = 38) and fibromyalgia patients (n = 38), two populations for whom exercise benefits are well known. Efficacy of exercise training was assessed by a cardiopulmonary exercise test, a handgrip force test, and a supine heart rate variability recording at rest before and after the rehabilitation program. Cardiorespiratory and muscular parameters were enhanced after exercise rehabilitation in the three groups (p < 0.001). No significant difference was observed for the autonomic variables. Through this comparative study with control groups, we confirm and reinforce the interest of caring for long COVID patients without post-exertional symptom exacerbation by exercise rehabilitation of both strength and endurance training, by personalizing the program to the patient and symptoms.
... A linked limitation is that of limited generalizability. However, given the similarities to other civilian [16,17] and military [12,18] cohorts, we suggest that the findings are of considerable relevance to wider populations. Another key strength is the completeness of the data set, with only 22 of 12 768 data points missing. ...
Background:
Significant numbers of individuals struggle to return to work following acute coronavirus disease 2019 (COVID-19). The UK Military developed an integrated medical and occupational pathway (Defence COVID-19 Recovery Service, DCRS) to ensure safe return to work for those with initially severe disease or persistent COVID-19 sequalae. Medical deployment status (MDS) is used to determine ability to perform job role without restriction ('fully deployable', FD) or with limitations ('medically downgraded', MDG).
Aims:
To identify which variables differ between those who are FD and MDG 6 months after acute COVID-19. Within the downgraded cohort, a secondary aim is to understand which early factors are associated with persistent downgrading at 12 and 18 months.
Methods:
Individuals undergoing DCRS had comprehensive clinical assessment. Following this, their electronic medical records were reviewed and MDS extracted at 6, 12 and 18 months. Fifty-seven predictors taken from DCRS were analysed. Associations were sought between initial and prolonged MDG.
Results:
Three hundred and twenty-five participants were screened, with 222 included in the initial analysis. Those who were initially downgraded were more likely to have post-acute shortness of breath (SoB), fatigue and exercise intolerance (objective and subjective), cognitive impairment and report mental health symptoms. The presence of fatigue and SoB, cognitive impairment and mental health symptoms was associated with MDG at 12 months, and the latter two, at 18 months. There were also modest associations between cardiopulmonary function and sustained downgrading.
Conclusions:
Understanding the factors that are associated with initial and sustained inability to return to work allows individualized, targeted interventions to be utilized.
... In contrast, studies by Menges et al. [22] and Grover et al. [34] found that there were not any correlations between sex and depression. Age was not associated with depression in six studies [16,22,23,34,36], but Taquet et al. [21] found a correlation between young age and depression. Medical history of psychiatric diagnosis and treatment was found to be associated with depression [16]. ...
... In contrast, one study found that sex does not correlate with anxiety [34]. Four studies rejected age as a risk factor for anxiety [16,31,34,36], but one study showed young age as one of the risk factors [21]. Other risk factors were medical history variables such as a history of psychiatric diagnosis and treatment [16]. ...
Prolonged symptoms of COVID-19 have been found in many patients, often known as Long COVID. Psychiatric symptoms are commonly seen in Long COVID patients and could last for weeks, even months, after recovery. However, the symptoms and risk factors associated with it remain unclear. In the current systematic review, we provide an overview of psychiatric symptoms in Long COVID patients and risk factors associated with the development of those symptoms. Articles were systematically searched on SCOPUS, PubMed, and EMBASE up to October 2021. Studies involving adults and geriatric participants with a confirmed previous COVID-19 diagnosis and reported psychiatric symptoms that persist for more than four weeks after the initial infection were included. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies. Prevalence rates and risk factors associated with psychiatric symptoms were collected. This present study was registered at PROSPERO (CRD42021240776). In total, 23 studies were included. Several limitations in this review were the heterogeneity of studies' outcomes and designs, studies limited to articles published in English, and the psychiatric symptoms mainly were assessed using self-report questionnaires. The most prevalent reported psychiatric symptoms, from the most to the least reported, were anxiety, depression, post-traumatic stress disorder (PTSD), poor sleep qualities, somatic symptoms, and cognitive deficits. Being female and having previous psychiatric diagnoses were risk factors for the development of the reported symptoms.
... Regardless of initial disease severity or SARS-CoV-2 laboratory confirmation, patients with LC would likely benefit from multidisciplinary rehabilitation assessment, especially when addressing the most prevalent symptoms of shortness of breath, fatigue and mood disturbance. 30 Correction notice This article has been corrected since it first published. ...
Introduction
Long COVID (LC) is a medical condition first described and documented through anecdotes on social media by patients prior to being recognised by WHO as a disease. Although >50 prolonged symptoms of LC have been described, it remains a diagnostic challenge for military providers and therefore threatens operational readiness.
Methods
On 9 September 2021, an online survey was emailed to 2192 Belgian Defence personnel who had previously tested PCR positive for SARS-CoV-2 between 17 August 2020 and 31 May 2021. A total of 718 validated responses were received.
Descriptive analyses determined the prevalence of LC and 10 most common symptoms and their duration following infection. In the explanatory analyses, risk factors related to LC were identified. To establish the health-related impact of LC on quality of life (HRQoL), we used the results from the EuroQol 5 Dimension 5 Level questionnaire.
Results
The most frequent symptoms that were reported for >3 months were fatigue, lack of energy and breathing difficulties.
47.35% of the respondents reported at least one persistent symptom, while 21.87% reported more than 3 symptoms lasting for at least 3 months after the initial COVID-19 infection. Most patients with LC suffered from symptoms of a neuropsychiatric nature (71.76%).
LC was significantly associated with obesity; pre-existing respiratory disease and blood or immune disorders. Physical activity of >3 hours per week halved the risk of LC.
The total QoL is reduced in patients with LC. Considering the five dimensions of the questionnaire, only the self-care dimension was not influenced by the presence of LC.
Conclusions
Almost half of Belgian Defence personnel developed LC after a confirmed COVID-19 infection, similar to numbers found in the Belgian population. Patients with LC would likely benefit from a multidisciplinary rehabilitation approach that addresses shortness of breath, fatigue and mood disturbance.
... Following an apparently mild initial COVID-19 presentation patients frequently suffer prolonged symptoms such as fatigue, breathlessness and chest pain. [1][2][3] These symptoms, commonly experienced post-COVID-19, are also hallmark symptoms of myocarditis, which has been implicated following COVID-19. 4 Myocarditis has been implicated in 10% of cases of sudden cardiac death. ...
Detailed characterisation of cardiopulmonary limitations in patients post-COVID-19 is currently limited, particularly in elite athletes. A male elite distance runner in his late 30s experienced chest pain following confirmed COVID-19. He underwent cardiopulmonary exercise testing (CPET) at 5 months postacute illness. Subjective exercise tolerance was reduced compared with normal, he described inability to ‘kick’ (rapidly accelerate). His CPET was compared with an identical protocol 15 months prior to COVID-19. While supranormal maximal oxygen uptake was maintained (155% of peak predicted V̇O 2 ) anaerobic threshold (AT), a better predictor of endurance performance, reduced from 84% to 71% predicted peak V̇O 2 maximum. Likewise, fat oxidation at AT reduced by 21%, from 0.35 to 0.28 g/min. Focusing exclusively on V̇O 2 maximum risks missing an impairment of oxidative metabolism. Reduced AT suggests a peripheral disorder of aerobic metabolism. This finding may result from virally mediated mitochondrial dysfunction beyond normal ‘deconditioning’, associated with impaired fat oxidation.
... Further detail on the referral pathway can be found here. 11 All rehabilitation VTC consultations on the Defence Medical Information Capability Programme (DMICP) electronic health record during the study period were coded, with anonymised data extracted and analysed. Patients were excluded if key data were unavailable. ...
... Primary outcomes are all the symptoms listed in the proforma, both acute phase and postacute phase. 11 All acute symptoms were selected for analysis given the multisystem nature of post-COVID-19 syndrome. Secondary outcomes were the time to consultation, and timing of acute illness and VTC assessment, and therefore the wave and alert level. ...
... Previous work has suggested that the acute severity or symptom burden was predictive of post-COVID sequelae. 24 This was not our prior experience, 11 nor in other populations 13 ; however, this study does reveal that acute hospitalisation was predictive of developing multiple postacute symptoms including ADL limitations (p<0.001), low mood (p=0.003) and memory/ concentration issues (p=0.016). ...
Background
In the UK, there have been multiple waves of COVID-19, with a five-tier alert system created to describe the transmission rate and appropriate restrictions. While acute mortality decreased, there continued to be a significant morbidity, with individuals suffering from persistent, life-restricting symptoms for months to years afterwards. A remote rehabilitation tool was created at the Defence Medical Rehabilitation Centre (DMRC) Stanford Hall to assess post-COVID-19 symptoms and their impact on the UK military.
This study aims to understand changes in post-COVID-19 syndrome between wave 1 and wave 2, identify interactions between alert level and symptoms and investigate any predictive nature of acute symptoms for postacute symptomology in a young, physically active population.
Methods
Cross-sectional study of 458 consecutive remote rehabilitation assessments performed at DMRC Stanford Hall between 2 April 2020 and 29 July 2021. Consultations were coded, anonymised, and statistical analysis was performed to determine associations between acute and postacute symptoms, and between symptoms, alert levels and waves.
Results
435 assessments were eligible; 174 in wave 1 and 261 in wave 2. Post-COVID-19 syndrome prevalence reduced from 43% to 2% between the waves. Acutely, widespread pain was more prevalent in wave 2 (p<0.001). Postacutely, there was increased anxiety (p=0.10) in wave 1 and increased sleep disturbance (p<0.001), memory/concentration issues (p<0.001) and shortness of breath/cough (p=0.017) in wave 2. Increasing alert level was associated with increased postacute symptom prevalence (p=0.046), with sleep disturbance increasing at higher alert level (p=0.016). Acute symptoms, including fatigue, sleep disturbance and myalgia, were associated with multiple postacute symptoms.
Conclusions
This study reports the overall prevalence and symptom burden in the UK military in the first two waves of COVID-19. By reporting differences in COVID-19 in different waves and alert level, this study highlights the importance of careful assessment and contextual understanding of acute and postacute illnesses for individual management plans.
... Therefore, exercise training may potentially have beneficial effects on the recovery of PASC patients, and preliminary studies support the positive impact of exercise rehabilitation on cardiorespiratory fitness [6,17,[19][20][21][22]. Moreover, it seems necessary for early intervention during the ongoing symptomatic COVID-19 phase to prevent PASC syndrome and avoid the chronicity of fatigue [23][24][25]. Hence, COVID-19 patients can benefit from an early rehabilitation program after hospital discharge, composed of resistance and aerobic exercises, as it may improve their functional capacity and quality of life (QoL) (reducing stress and mental disorders) [26][27][28][29]. ...
Post-acute sequelae of coronavirus disease 19 (COVID-19) (PASC) describe a wide range of symptoms and signs involving multiple organ systems occurring after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, representing a growing health problem also in the world of sport and the athletic population. Patients with PASC have new, returning, or persisting symptoms four or more weeks after the infection. Among the most frequent symptoms, patients complain of fatigue, dyspnea, exercise intolerance, and reduced functional capacity that interfere with everyday life activity. The role of exercise programs in PASC patients will be identified, and upcoming studies will establish the magnitude of their benefits. However, the benefits of exercise to counteract these symptoms are well known, and an improvement in cardiopulmonary fitness, functional status, deconditioning, and quality of life can be obtained in these patients, as demonstrated in similar settings. Based on this background, this review aims to summarise the current evidence about the PASC syndrome and the benefit of exercise in these patients and to provide a practical guide for the exercise prescription in PASC patients to help them to resume their functional status, exercise tolerance, prior activity levels, and quality of life, also considering the athletic population and their return to play and sports competitions.
... Substantial heterogeneity across studies was observed in each of the three meta-analyses (I 2 =98.8%, 97.4% and 95.9%, respectively; p<0.001). ASADI-POOYA [24] AUL [91] AYDIN [65] BALDINI [62] FERNÁNDEZ-DE-LAS-PEÑAS [105] SUÁREZ-ROBLES [128] DARCIS [101] DREYER [103] ZAYET [137] YOMOGIDA [34] VENTURELLI [135] VARGHESE [134] TAYLOR [131] TAWFIK [14] SZEKELY [66] SULTANA [129] STAVEM [127] SONNWEBER [58] RIGHI [123] PELUSO [13] O'SULLIVAN [122] O'KEEFE [121] NAIK [54] MOTIEJUNAITE [64] MECHI [44] MALLIA [115] KLEIN [111] GABER [106] EROL [25] DIAZ-FUENTES [102] DANKOWSKI [100] CARFI [96] CORTÉS-TELLES [69] CARVALHO-SCHNEIDER [97] BOARI [94] VIJAYAKUMAR [65] Total (I 2 =95.9%, p<0.001) ...
... [63] BALDINI [62] BELL [92] DARCIS [101] CARFI [96] CARVALHO-SCHNEIDER [97] CORTÉS-TELLES [59] DANKOWSKI [100] DIAZ-FUENTES [102] DREYER [103] EROL [25] GABER [106] GALVÁN-TEJADA [19] ÇALIK KÜTÜKCÜ [95] BOARI [94] MORADIAN [117] MEIJE [56] MAHMUD [114] LANDI [112] JACOBS [109] KLEIN [111] MALLIA [115] COMEBAC STUDY GROUP [85] MOTIEJUNAITE [64] GHOSN [11] GARRIGUES [53] FORTINI [36] BLOMBERG [93] ARNOLD [89] AUGUSTIN [90] ARMANAGE [88] SUÁREZ-ROBLES [128] VIJAYAKUMAR [65] VARGHESE [134] VENTURELLI [135] Subtotal (I 2 =97.8%, p<0.001) Heterogeneity between groups: p=0.014 ZHAO [138] TOSATO [133] SZEKELY [66] TAWLIK [14] TAYLOR [131] SUN [130] SHOUCRI [126] SULTANA [129] STAVEM [127] SONNWEBER [58] SHANG [27] SATHYAMURTHY [124] RIOU [52] RIGHI [123] QIN [47] SEEßLE [41] O'KEEFE [121] O'SULLIVAN [122] PELUSO [13] MUMOLI [118] NEHME [120] NAIK [54] Subtotal (I 2 =98.3%, p<0.001) ...
Persistent breathlessness >28 days after acute COVID-19 infection has been identified as a highly debilitating post-COVID symptom. However, the prevalence, risk factors, mechanisms and treatments for post-COVID breathlessness remain poorly understood. We systematically searched PubMed and Embase for relevant studies published from 1 January 2020 to 1 November 2021 (PROSPERO registration number: CRD42021285733) and included 119 eligible papers. Random-effects meta-analysis of 42 872 patients with COVID-19 reported in 102 papers found an overall prevalence of post-COVID breathlessness of 26% (95% CI 23-29) when measuring the presence/absence of the symptom, and 41% (95% CI 34-48) when using Medical Research Council (MRC)/modified MRC dyspnoea scale. The pooled prevalence decreased significantly from 1-6 months to 7-12 months post-infection. Post-COVID breathlessness was more common in those with severe/critical acute infection, those who were hospitalised and females, and was less likely to be reported by patients in Asia than those in Europe or North America. Multiple pathophysiological mechanisms have been proposed (including deconditioning, restrictive/obstructive airflow limitation, systemic inflammation, impaired mental health), but the body of evidence remains inconclusive. Seven cohort studies and one randomised controlled trial suggested rehabilitation exercises may reduce post-COVID breathlessness. There is an urgent need for mechanistic research and development of interventions for the prevention and treatment of post-COVID breathlessness.
... When described, the settings of rehabilitation care models were outpatient rehabilitation (11 studies), 17,35,38,44,46,51,53,55,59,62,63 community-based rehabilitation (nine studies) 30,31,49,52,53,55,57,59,63 and inpatient rehabilitation (six studies). 17,30,42,44,46,53 Study designs included conceptual model proposals (12 studies), 30,32,38,49,52,[55][56][57][58][59][60]63 literature reviews (eight studies), 31,34,37,39,48,54,64,65 qualitative articles, such as surveys, interviews, focus group discussions and Delphi methods (six studies), 40,41,[45][46][47]51 cohort studies (six studies), 32,35,36,42,44,53 letters and practice pointers (four studies) 17,33,43,61 and one RCT. ...
... When described, the settings of rehabilitation care models were outpatient rehabilitation (11 studies), 17,35,38,44,46,51,53,55,59,62,63 community-based rehabilitation (nine studies) 30,31,49,52,53,55,57,59,63 and inpatient rehabilitation (six studies). 17,30,42,44,46,53 Study designs included conceptual model proposals (12 studies), 30,32,38,49,52,[55][56][57][58][59][60]63 literature reviews (eight studies), 31,34,37,39,48,54,64,65 qualitative articles, such as surveys, interviews, focus group discussions and Delphi methods (six studies), 40,41,[45][46][47]51 cohort studies (six studies), 32,35,36,42,44,53 letters and practice pointers (four studies) 17,33,43,61 and one RCT. ...
... When described, the settings of rehabilitation care models were outpatient rehabilitation (11 studies), 17,35,38,44,46,51,53,55,59,62,63 community-based rehabilitation (nine studies) 30,31,49,52,53,55,57,59,63 and inpatient rehabilitation (six studies). 17,30,42,44,46,53 Study designs included conceptual model proposals (12 studies), 30,32,38,49,52,[55][56][57][58][59][60]63 literature reviews (eight studies), 31,34,37,39,48,54,64,65 qualitative articles, such as surveys, interviews, focus group discussions and Delphi methods (six studies), 40,41,[45][46][47]51 cohort studies (six studies), 32,35,36,42,44,53 letters and practice pointers (four studies) 17,33,43,61 and one RCT. 50 Box 1. Data charting framework to classify concepts on rehabilitation care models for post COVID-19 condition ...
Objective:
To systematically map the current evidence about the characteristics of health systems, providers and patients to design rehabilitation care for post coronavirus disease 2019 (COVID-19) condition.
Methods:
We conducted a scoping review by searching the databases: MEDLINE®, Embase®, Web of Science, Cochrane COVID-19 Registry and Cochrane Central Register of Controlled Trials, from inception to 22 April 2022. The search strategy included terms related to (i) post COVID-19 condition and other currently known terminologies; (ii) care models and pathways; and (iii) rehabilitation. We applied no language or study design restrictions. Two pairs of researchers independently screened title, abstracts and full-text articles and extracted data. We charted the evidence according to five topics: (i) care model components and functions; (ii) safe delivery of rehabilitation; (iii) referral principles; (iv) service delivery settings; and (v) health-care professionals.
Findings:
We screened 13 753 titles and abstracts, read 154 full-text articles, and included 37 articles. The current evidence is conceptual and expert based. Care model components included multidisciplinary teams, continuity or coordination of care, people-centred care and shared decision-making between clinicians and patients. Care model functions included standardized symptoms assessment, telehealth and virtual care and follow-up system. Rehabilitation services were integrated at all levels of a health system from primary care to tertiary hospital-based care. Health-care workers delivering services within a multidisciplinary team included mostly physiotherapists, occupational therapists and psychologists.
Conclusion:
Key policy messages include implementing a multilevel and multiprofessional model; leveraging country health systems' strengths and learning from other conditions; financing rehabilitation research providing standardized outcomes; and guidance to increase patient safety.
