Telerehabilitation for Post-Hospitalized COVID-19 Patients: A Proof-of-Concept Study During a Pandemic

  • Pamela Tanguay ÉCOLE DE RÉADAPTATION, UNIVERSITÉ DE SHERBROOKE, QC, CANADA
  • Nicole Marquis ÉCOLE DE RÉADAPTATION, UNIVERSITÉ DE SHERBROOKE, QC, CANADA
  • Isabelle Gaboury ÉCOLE DE RÉADAPTATION, UNIVERSITÉ DE SHERBROOKE, QC, CANADA
  • Dahlia Kairy ÉCOLE DE RÉADAPTATION, UNIVERSITÉ DE MONTRÉAL, QC, CANADA
  • Matthieu Touchette FACULTÉ DE MÉDECINE ET DES SCIENCES DE LA SANTÉ, UNIVERSITÉ DE SHERBROOKE, QC, CANADA
  • Michel Tousignant ÉCOLE DE RÉADAPTATION, UNIVERSITÉ DE SHERBROOKE, QC, CANADA & CENTRE DE RECHERCHE SUR LE VIEILLISSEMENT, CIUSSS-IUGS, QC, CANADA
  • Simon Décary TIER 1 CANADA RESEARCH CHAIR IN SHARED DECISION MAKING AND KNOWLEDGE TRANSLATION, VITAM - CENTRE DE RECHERCHE EN SANTÉ DURABLE, QC, CANADA

Abstract

Purpose: Telerehabilitation could prevent sequelae from COVID-19. We aimed to assess the feasibility of telerehabilitation; describe pulmonary and functional profiles of COVID-19 patients; and explore the effect of telerehabilitation on improving pulmonary symptoms and quality of life. Methods: We conducted a pre-experimental, pre-post pilot study. We recruited COVID-19 patients who had returned home following hospitalization. The intervention included eight weeks of supervised physiotherapy sessions. We documented technological issues, success of recruitment strategies, and participants’ attendance to supervised sessions. We measured the impact of pulmonary symptoms on quality of life and functional health. Results: We scheduled 64 supervised sessions with seven participants with few technological issues. Initial scores showed that pulmonary symptoms moderately to highly impacted quality of life. At eight weeks, all patients had improved from 10 to 45 points on the EuroQol-Visual Analog Scale (EQ-VAS) instrument, indicating clinical significance. Conclusion: We developed and administered a telerehabilitation intervention during a global pandemic that targets key symptoms of the relevant disease.

  

References

Barker-Davies, R. M., O’Sullivan, O., Senaratne, K. P. P., Baker, P., Cranley, M., Dharm-Datta, S., Ellis, H., Goodall, D., Gough, M., Lewis, S., Norman, J., Papadopoulou, T., Roscoe, D., Sherwood, D., Turner, P., Walker, T., Mistlin, A., Phillip, R., Nicol, A. M., … Bahadur, S. (2020). The Stanford Hall consensus statement for post-COVID-19 rehabilitation. British Journal of Sports Medicine, bjsports-2020-102596. https://doi.org/10.1136/bjsports-2020-102596

BMJ Best Practice. (2021). Coronavirus disease 2019 (COVID-19)—Symptoms, diagnosis and treatment | BMJ Best Practice. https://bestpractice.bmj.com/topics/en-gb/3000168

Bourbeau, J., & Nault, D. (2007). Self-management strategies in chronic obstructive pulmonary disease. Clinics in Chest Medicine, 28(3), 617. mnh.

Burge, A. T., Holland, A. E., McDonald, C. F., Abramson, M. J., Hill, C. J., Lee, A. L., Cox, N. S., Moore, R., Nicolson, C., O’Halloran, P., Lahham, A., Gillies, R., & Mahal, A. (2020). Home-based pulmonary rehabilitation for COPD using minimal resources : An economic analysis. Respirology (Carlton, Vic.), 25(2), 183‑190. MEDLINE with Full Text. https://doi.org/10.1111/resp.13667

Carfì, A., Bernabei, R., & Landi, F. (2020). Persistent symptoms in patients after acute COVID-19. JAMA. MEDLINE with Full Text. https://doi.org/10.1001/jama.2020.12603

Chow, N., Fleming-Dutra, K., Gierke, R., Hall, A., Hugues, M., Pilishvili, T., Ritchey, M., Roguski, K., Skoff, T., & Usery, E. (2020). Preliminary estimates of the prevalence of selected underlying health conditions among patients with Coronavirus Disease 2019—United States, February 12-March 28, 2020. MMWR: Morbidity & Mortality Weekly Report, 69(13), 382‑386. MEDLINE with Full Text.

EQ-5D. (2020). https://euroqol.org/eq-5d-instruments/

Garvey, C., Bayles, M. P., Hamm, L. F., Hill, K., Holland, A., Limberg, T. M., & Spruit, M. A. (2016). Pulmonary rehabilitation exercise prescription in chronic obstructive pulmonary disease: Review of selected guidelines: An official statement from the American Association of Cardiovascular and Pulmonary Rehabilitation. Journal of Cardiopulmonary Rehabilitation and Prevention, 36(2), 75-83. https://journals.lww.com/jcrjournal/Fulltext/2016/03000/Pulmonary_Rehabilitation_Exercise_Prescription_in.1.aspx

Greenhalgh, T., Knight, M., A’Court, C., Buxton, M., & Husain, L. (2020). Management of post-acute covid-19 in primary care. BMJ, 370, m3026. https://doi.org/10.1136/bmj.m3026

Hansen, H., Bieler, T., Beyer, N., Kallemose, T., Wilcke, J. T., Østergaard, L. M., Frost Andeassen, H., Martinez, G., Lavesen, M., Frølich, A., & Godtfredsen, N. S. (2020). Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: A randomised multicentre trial. Thorax, 75(5), 413‑421. MEDLINE with Full Text. https://doi.org/10.1136/thoraxjnl-2019-214246

Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wei, Y., Wu, W., Xie, X., Yin, W., Li, H., Liu, M., … Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England), 395(10223), 497‑506. MEDLINE with Full Text. https://doi.org/10.1016/S0140-6736(20)30183-5

Jones, C., Eddleston, J., McCairn, A., Dowling, S., McWilliams, D., Coughlan, E., & Griffiths, R. D. (2015). Improving rehabilitation after critical illness through outpatient physiotherapy classes and essential amino acid supplement: A randomized controlled trial. Journal of Critical care, 30(5), 901‑907. MEDLINE with Full Text. https://doi.org/10.1016/j.jcrc.2015.05.002

Kon, S. S. C., Canavan, J. L., Jones, S. E., Nolan, C. M., Clark, A. L., Dickson, M. J., Haselden, B. M., Polkey, M. I., & Man, W. D.-C. (2014). Minimum clinically important difference for the COPD Assessment Test: A prospective analysis. The Lancet. Respiratory Medicine, 2(3), 195‑203. mnh. https://doi.org/10.1016/S2213-2600(14)70001-3

Krist, A. H., DeVoe, J. E., Cheng, A., Ehrlich, T., & Jones, S. M. (2020). Redesigning primary care to address the COVID-19 pandemic in the midst of the pandemic. Annals of Family Medicine, 18(4), 349‑354. MEDLINE with Full Text. https://doi.org/10.1370/afm.2557

Marquis N, Larivée P, Dubois M-F., Tousignant, M. (2014) Are improvements maintained after in-home pulmonary telerehabilitation for patients with chronic obstructive pulmonary disease? International Journal of Telerehabilitation, 6(2), 21–30.

Marquis N, Larivée P, Saey D, Dubois M.-F., & Tousignant, M. (2015 Nov;21). In-home pulmonary telerehabilitation for patients with chronic obstructive pulmonary disease: A pre-experimental study on effectiveness, satisfaction, and adherence. Telemedicine and e-Health, (11), 870–879.

Lazzeri, M., Lanza, A., Bellini, R., Bellofiore, A., Cecchetto, S., Colombo, A., D’Abrosca, F., Del Monaco, C., Gaudellio, G., Paneroni, M., Privitera, E., Retucci, M., Rossi, V., Santambrogio, M., Sommariva, M., & Frigerio, P. (2020). Respiratory physiotherapy in patients with COVID-19 infection in acute setting: A Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Archives for Chest Disease, 1. Directory of Open Access Journals. https://doi.org/10.4081/monaldi.2020.1285

McCarthy, B., Casey, D., Devane, D., Murphy, K., Murphy, E., & Lacasse, Y. (2015). Pulmonary rehabilitation for chronic obstructive pulmonary disease. The Cochrane Database of Systematic Reviews, 2, CD003793. mnh. https://doi.org/10.1002/14651858.CD003793.pub3

Moffet H, Tousignant M, Nadeau S, Mérette, C., Boissy, P., Corriveau, H., Marquis, F., Cabana, F., Belzile, E. L., Ranger, P., & Dimentberg, R. (2017). Patient satisfaction with in-home telerehabilitation after total knee arthroplasty: Results from a randomized controlled trial. Telemedicine Journal and e-Health, 23(2), 80–87.

Moldofsky, H., & Patcai, J. (2011). Chronic widespread musculoskeletal pain, fatigue, depression and disordered sleep in chronic post-SARS syndrome: A case-controlled study. BMC Neurology, 11, 37. MEDLINE with Full Text. https://doi.org/10.1186/1471-2377-11-37

National Institute for Health and Care Excellence. (2020). COVID-19 rapid guideline: Managing the long-term effects of COVID-19 (33555768). MEDLINE with Full Text. https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=33555768&site=ehost-live

Oxley, T. J., Mocco, J., Majidi, S., Kellner, C. P., Shoirah, H., Singh, I. P., De Leacy, R. A., Shigematsu, T., Ladner, T. R., Yaeger, K. A., Skliut, M., Weinberger, J., Dangayach, N. S., Bederson, J. B., Tuhrim, S., & Fifi, J. T. (2020). Large-vessel stroke as a presenting feature of Covid-19 in the young. The New England Journal of Medicine, 382(20), e60. MEDLINE with Full Text. https://doi.org/10.1056/NEJMc2009787

Pedersini, P., Corbellini, C., & Villafañe, J. H. (2020). Italian physical therapists’ response to the novel COVID-19 emergency. Physical Therapy. MEDLINE with Full Text. https://doi.org/10.1093/ptj/pzaa060

Pitta, F., Troosters, T., Probst, V. S., Spruit, M. A., Decramer, M., & Gosselink, R. (2006). Quantifying physical activity in daily life with questionnaires and motion sensors in COPD. The European Respiratory Journal, 27(5), 1040‑1055. MEDLINE with Full Text.

Polkey, M., Vogelmeier, C., & Dransfield, M. (2018). COPD Assessment Test. https://www.catestonline.org/hcp-homepage/clinical-practice.html

Ries, A. L. (2005). Minimally clinically important difference for the UCSD Shortness of Breath Questionnaire, Borg Scale, and Visual Analog Scale. COPD, 2(1), 105‑110.

Spruit, M. A., Singh, S. J., Garvey, C., ZuWallack, R., Nici, L., Rochester, C., Hill, K., Holland, A. E., Lareau, S. C., Man, W. D.-C., Pitta, F., Sewell, L., Raskin, J., Bourbeau, J., Crouch, R., Franssen, F. M. E., Casaburi, R., Vercoulen, J. H., Vogiatzis, I., … Wouters, E. F. M. (2013). An official American Thoracic Society/European Respiratory Society statement : Key concepts and advances in pulmonary rehabilitation. American Journal of Respiratory and Critical Care Medicine, 188(8), e13‑e64. MEDLINE with Full Text. https://doi.org/10.1164/rccm.201309-1634ST

Thomas, P., Baldwin, C., Bissett, B., Boden, I., Gosselink, R., Granger, C. L., Hodgson, C., Jones, A. Y., Kho, M. E., Moses, R., Ntoumenopoulos, G., Parry, S. M., Patman, S., & van der Lee, L. (2020). Physiotherapy management for COVID-19 in the acute hospital setting: Clinical practice recommendations. Journal of Physiotherapy, 66(2), 73‑82. MEDLINE with Full Text. https://doi.org/10.1016/j.jphys.2020.03.011

Tousignant M, Marquis N, Pagé C, Imukuze N, and al. (2012 Apr 13) In-home telerehabilitation for older persons with chronic obstructive pulmonary disease: A pilot study. International Journal of Telerehabilitation, 4(1), 7–14.

Troosters, T., Sciurba, F., Battaglia, S., Langer, D., Valluri, S. R., Martino, L., Benzo, R., Andre, D., Weisman, I., & Decramer, M. (2010). Physical inactivity in patients with COPD, a controlled multi-center pilot-study. Respiratory Medicine, 104(7), 1005‑1011. MEDLINE with Full Text. https://doi.org/10.1016/j.rmed.2010.01.012

Vasilopoulou, M., Papaioannou, A. I., Kaltsakas, G., Louvaris, Z., Chynkiamis, N., Spetsioti, S., Kortianou, E., Genimata, S. A., Palamidas, A., Kostikas, K., Koulouris, N. G., & Vogiatzis, I. (2017). Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits. European Respiratory Journal, 49(5), 1602129. https://doi.org/10.1183/13993003.02129-2016

World Health Organization. (2020). Coronavirus disease (COVID-19) Pandemic. https://www.who.int/emergencies/diseases/novel-coronavirus-2019

Yip, M. P., Chang, A. M., Chan, J., & MacKenzie, A. E. (2003). Development of the Telemedicine Satisfaction Questionnaire to evaluate patient satisfaction with telemedicine : A preliminary study. Journal of Telemedicine and Telecare, 9(1), 46‑50. MEDLINE with Full Text.

Zadro, J. R., Cheng, S., O’Keeffe, M., & Maher, C. G. (2020). What interventions do physical therapists provide for patients with cardiorespiratory conditions, neurological conditions, and conditions requiring acute hospital care? A Systematic Review. Physical Therapy. MEDLINE with Full Text. https://doi.org/10.1093/ptj/pzaa064

Zhang, P., Li, J., Liu, H., Han, N., Ju, J., Kou, Y., Chen, L., Jiang, M., Pan, F., Zheng, Y., Gao, Z., & Jiang, B. (2020). Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: A 15-year follow-up from a prospective cohort study. Bone Research, 8, 8. MEDLINE with Full Text. https://doi.org/10.1038/s41413-020-0084-5

Published
2021-05-18
How to Cite
Tanguay, P. ., Marquis, N. ., Gaboury, I., Kairy, D., Touchette, M., Tousignant, M., & Décary, S. . (2021). Telerehabilitation for Post-Hospitalized COVID-19 Patients: A Proof-of-Concept Study During a Pandemic . International Journal of Telerehabilitation, 13(1). https://doi.org/10.5195/ijt.2021.6383
Section
Clinical Practice -COVID 19