Rehabilitation after COVID-19

Last updated

Rehabilitation after COVID-19 is needed in individuals experiencing longer-term disabling illness at any stage of COVID-19 infection. [1] The rehabilitation of individuals with COVID-19 includes screening for the need for rehabilitation, participation of a multi-disciplinary team to evaluate and manage the individual's disabilities, use of four evidence based classes for rehabilitation (exercise, practice, psychosocial support and education), as well as individualised interventions for other problems. [1]

Contents

Scope

The range of problems suffered by individuals after COVID-19 have, as of January 2021, not yet been well described in scientific literature. [1] Individuals with COVID-19 have developed several complications, such as respiratory failure, renal failure, myocarditis, [2] encephalitis, impaired immunologic response and blood clotting disorders. [1] However, COVID-19 can affect any organ system, and can therefore have any symptoms and signs. Individuals with COVID-19 can also have psychological conditions such as anxiety or depression. [3] People who required mechanical ventilation while they had COVID-19 may have injury to the airways, weakened muscles, delirium [4] and post-traumatic stress disorder. [5] [6] Those with COVID-19 can have reduced ability to perform activities of daily living.[ citation needed ]

Approach

There is limited data regarding rehabilitation after COVID-19 due to the recent nature of the disease. [3] The general pulmonary rehabilitation method based on 4S principle (simple, safe, satisfy, save) has been proposed in China for pulmonary rehabilitation, particularly in individuals who were admitted to ICU. A recent study concluded that a six-week respiratory rehabilitation program improves respiratory function and quality of life as well as decreases anxiety in older individuals with COVID-19. [7] Early active mobilization has been recommended by one study for improving muscle strength and mobility after discharge from hospital in individuals with COVID-19. [8]

For individuals experiencing post-COVID fatigue, an approach based upon recommendations for chronic fatigue syndrome is recommended. [9] There is some early support for this approach. For example, a 7-week virtual rehabilitation course developed by Bradford District Care NHS Foundation Trust supported people to improve their sleep, manage energy levels (e.g. by striking a balance between rest and activity using pacing), optimise their breathing and manage stress. A study evaluating the service found that patients completing the course significantly improved their quality of life. [10] However, although quality of life was improved, it did not return to pre-COVID levels for the majority of patients. These findings suggest that post-COVID syndrome is likely to be a long-term condition that requires ongoing rehabilitation.

Challenges

In the context of the pandemic, face-to-face interactions are likely to be minimised. Therefore, tele-rehabilitation systems could be used to address the difficulties associated with the ongoing pandemic. [3] The limitations of virtual care are technical malfunctions, lack of availability of equipment and limited scope for physical examination. [3] The pandemic situation has reduced the ability to meet the typical needs in rehabilitation such as social interaction and human contact among caregivers and family members, thereby limiting the available options for multidisciplinary rehabilitation. [3]

See also

Related Research Articles

Delirium is a specific state of acute confusion attributable to the direct physiological consequence of a medical condition, effects of a psychoactive substance, or multiple causes, which usually develops over the course of hours to days. As a syndrome, delirium presents with disturbances in attention, awareness, and higher-order cognition. People with delirium may experience other neuropsychiatric disturbances, including changes in psychomotor activity, disrupted sleep-wake cycle, emotional disturbances, disturbances of consciousness, or, altered state of consciousness, as well as perceptual disturbances, although these features are not required for diagnosis.

<span class="mw-page-title-main">Coxsackie B virus</span> Virus that causes digestive upset and sometimes heart damage

Coxsackie B is a group of six serotypes of coxsackievirus (CVB1-CVB6), a pathogenic enterovirus, that trigger illness ranging from gastrointestinal distress to full-fledged pericarditis and myocarditis.

<span class="mw-page-title-main">Post-polio syndrome</span> Human disease

Post-polio syndrome is a group of latent symptoms of poliomyelitis (polio), occurring at about a 25–40% rate. These symptoms are caused by the damaging effects of the viral infection on the nervous system. Symptoms typically occur 15 to 30 years after an initial acute paralytic attack. Symptoms include decreasing muscular function or acute weakness with pain and fatigue. The same symptoms may also occur years after a nonparalytic polio (NPP) infection.

<span class="mw-page-title-main">Myocarditis</span> Inflammation of the heart muscle

Myocarditis, also known as inflammatory cardiomyopathy, is an acquired cardiomyopathy due to inflammation of the heart muscle. Symptoms can include shortness of breath, chest pain, decreased ability to exercise, and an irregular heartbeat. The duration of problems can vary from hours to months. Complications may include heart failure due to dilated cardiomyopathy or cardiac arrest.

<span class="mw-page-title-main">Postural orthostatic tachycardia syndrome</span> Abnormally high heart rate when standing

Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon sitting up or standing. POTS is a disorder of the autonomic nervous system that can lead the individual to experience a variety of symptoms. Symptoms may include lightheadedness, brain fog, blurred vision, weakness, fatigue, headaches, heart palpitations, exercise intolerance, nausea, diminished concentration, tremulousness (shaking), syncope (fainting), coldness or pain in the extremities, chest pain and shortness of breath. Other conditions associated with POTS include Ehlers–Danlos syndrome, mast cell activation syndrome, irritable bowel syndrome, insomnia, chronic headaches, chronic fatigue syndrome, fibromyalgia, and amplified musculoskeletal pain syndrome. POTS symptoms may be treated with lifestyle changes such as increasing fluid and salt intake, wearing compression stockings, gentler and slow postural changes, avoiding prolonged bedrest, medication and physical therapy.

<span class="mw-page-title-main">Exercise intolerance</span> Medical condition

Exercise intolerance is a condition of inability or decreased ability to perform physical exercise at the normally expected level or duration for people of that age, size, sex, and muscle mass. It also includes experiences of unusually severe post-exercise pain, fatigue, nausea, vomiting or other negative effects. Exercise intolerance is not a disease or syndrome in and of itself, but can result from various disorders.

<span class="mw-page-title-main">Anakinra</span> Pharmaceutical drug

Anakinra, sold under the brand name Kineret, is a biopharmaceutical medication used to treat rheumatoid arthritis, cryopyrin-associated periodic syndromes, familial Mediterranean fever, and Still's disease. It is a slightly modified recombinant version of the human interleukin 1 receptor antagonist protein. It is marketed by Swedish Orphan Biovitrum. Anakinra is administered by subcutaneous injection.

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease that affects the central nervous system (CNS). Several therapies for it exist, although there is no known cure.

Guillain–Barré syndrome (GBS) is a rapid-onset muscle weakness caused by the immune system damaging the peripheral nervous system. Typically, both sides of the body are involved, and the initial symptoms are changes in sensation or pain often in the back along with muscle weakness, beginning in the feet and hands, often spreading to the arms and upper body. The symptoms may develop over hours to a few weeks. During the acute phase, the disorder can be life-threatening, with about 15% of people developing weakness of the breathing muscles and, therefore, requiring mechanical ventilation. Some are affected by changes in the function of the autonomic nervous system, which can lead to dangerous abnormalities in heart rate and blood pressure.

Treatment of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is variable and uncertain, and the condition is primarily managed rather than cured.

<span class="mw-page-title-main">Influenza-like illness</span> Medical diagnosis

Influenza-like illness (ILI), also known as flu-like syndrome or flu-like symptoms, is a medical diagnosis of possible influenza or other illness causing a set of common symptoms. These include fever, shivering, chills, malaise, dry cough, loss of appetite, body aches, nausea, and sneezing typically in connection with a sudden onset of illness. In most cases, the symptoms are caused by cytokines released by immune system activation, and are thus relatively non-specific.

Pulmonary rehabilitation, also known as respiratory rehabilitation, is an important part of the management and health maintenance of people with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment. It is a broad therapeutic concept. It is defined by the American Thoracic Society and the European Respiratory Society as an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. In general, pulmonary rehabilitation refers to a series of services that are administered to patients of respiratory disease and their families, typically to attempt to improve the quality of life for the patient. Pulmonary rehabilitation may be carried out in a variety of settings, depending on the patient's needs, and may or may not include pharmacologic intervention.

<span class="mw-page-title-main">Chronic fatigue syndrome</span> Medical condition

Chronic fatigue syndrome (CFS), also called myalgic encephalomyelitis (ME) or ME/CFS, is a complex, debilitating, long-term medical condition. Core symptoms are lengthy flare-ups of the illness following ordinary minor physical or mental activity, known as post-exertional malaise (PEM); greatly diminished capacity to do tasks that were routine before the illness; and sleep disturbances. The US Centers for Disease Control and Prevention's (CDC) diagnostic criteria also require orthostatic intolerance and/or impaired memory or attention. Frequently and variably, other symptoms occur involving numerous body systems, and chronic pain is very common. The often incapacitating fatigue in ME/CFS is different from that caused by normal strenuous exertion, is not significantly relieved by rest, and is not due to a previous medical condition. Diagnosis is based on the person's symptoms because no confirmed diagnostic test is available.

<span class="mw-page-title-main">Post viral cerebellar ataxia</span> Medical condition

Post-viral cerebellar ataxia also known as acute cerebellitis and acute cerebellar ataxia (ACA) is a disease characterized by the sudden onset of ataxia following a viral infection. The disease affects the function or structure of the cerebellum region in the brain.

<span class="mw-page-title-main">COVID-19</span> Contagious disease caused by SARS-CoV-2

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by the virus SARS-CoV-2. The first known case was identified in Wuhan, China, in December 2019. The disease quickly spread worldwide, resulting in the COVID-19 pandemic.

<span class="mw-page-title-main">Convalescent plasma</span> Blood plasma from disease survivor

Convalescent plasma is the blood plasma collected from a survivor of an infectious disease. This plasma contains antibodies specific to a pathogen and can be used therapeutically by providing passive immunity when transfusing it to a newly infected patient with the same condition. Convalescent plasma can be transfused as it has been collected or become the source material for the hyperimmune serum which consists largely of IgG but also includes IgA and IgM. or as source material for anti-pathogen monoclonal antibodies, Collection is typically achieved by apheresis, but in low-to-middle income countries, the treatment can be administered as convalescent whole blood.

<span class="mw-page-title-main">Symptoms of COVID-19</span> Overview of the symptoms of COVID-19

The symptoms of COVID-19 are variable depending on the type of variant contracted, ranging from mild symptoms to a potentially fatal illness. Common symptoms include coughing, fever, loss of smell (anosmia) and taste (ageusia), with less common ones including headaches, nasal congestion and runny nose, muscle pain, sore throat, diarrhea, eye irritation, and toes swelling or turning purple, and in moderate to severe cases, breathing difficulties. People with the COVID-19 infection may have different symptoms, and their symptoms may change over time. Three common clusters of symptoms have been identified: one respiratory symptom cluster with cough, sputum, shortness of breath, and fever; a musculoskeletal symptom cluster with muscle and joint pain, headache, and fatigue; and a cluster of digestive symptoms with abdominal pain, vomiting, and diarrhea. In people without prior ear, nose, or throat disorders, loss of taste combined with loss of smell is associated with COVID-19 and is reported in as many as 88% of symptomatic cases.

Although several medications have been approved in different countries as of April 2022, not all countries have these medications. Patients with mild to moderate symptoms who are in the risk groups can take nirmatrelvir/ritonavir or remdesivir, either of which reduces the risk of serious illness or hospitalization. In the US, the Biden Administration COVID-19 action plan includes the Test to Treat initiative, where people can go to a pharmacy, take a COVID test, and immediately receive free Paxlovid if they test positive.

Long COVID or long-haul COVID is a group of health problems persisting or developing after an initial COVID-19 infection. Symptoms can last weeks, months or years and are often debilitating. The World Health Organization defines long COVID as starting three months after infection, but other definitions put the start of long COVID at four weeks.

<span class="mw-page-title-main">Impact of the COVID-19 pandemic on neurological, psychological and other mental health outcomes</span> Effects of the COVID-19 pandemic and associated lockdowns on mental health

There is increasing evidence suggesting that COVID-19 causes both acute and chronic neurologicalor psychological symptoms. Caregivers of COVID-19 patients also show a higher than average prevalence of mental health concerns. These symptoms result from multiple different factors.

References

  1. 1 2 3 4 Wade, Derick T (July 2020). "Rehabilitation after COVID-19: an evidence-based approach" (PDF). Clinical Medicine. 20 (4): 359–365. doi:10.7861/clinmed.2020-0353. PMC   7385804 . PMID   32518105 . Retrieved 10 January 2021.
  2. Rathore, Sawai Singh; Rojas, Gianpier Alonzo; Sondhi, Manush; Pothuru, Suveenkrishna; Pydi, Reshma; Kancherla, Neeraj; Singh, Romil; Ahmed, Noman Khurshid; Shah, Jill; Tousif, Sohaib; Baloch, Unaiza Tariq (2021). "Myocarditis associated with COVID-19 disease: A systematic review of published case reports and case series". International Journal of Clinical Practice. 75 (11): e14470. doi: 10.1111/ijcp.14470 . ISSN   1742-1241. PMID   34235815. S2CID   235768792.
  3. 1 2 3 4 5 Demeco, A.; Marotta, N.; Barletta, M.; Pino, I.; Marinaro, C.; Petraroli, A.; Moggio, L.; Ammendolia, Antonio (25 August 2020). "Rehabilitation of patients post-COVID-19 infection: a literature review". Journal of International Medical Research. 48 (8): 1–10. doi: 10.1177/0300060520948382 . PMC   7450453 . PMID   32840156.
  4. Velásquez-Tirado, Juan D.; Trzepacz, Paula T.; Franco, José G. (2021-04-12). "Etiologies of Delirium in Consecutive COVID-19 Inpatients and the Relationship Between Severity of Delirium and COVID-19 in a Prospective Study With Follow-Up". The Journal of Neuropsychiatry and Clinical Neurosciences. 33 (3): 210–218. doi:10.1176/appi.neuropsych.20100251. ISSN   0895-0172. PMID   33843248. S2CID   233212822.
  5. "COVID-19 rehabilitation for fatigue, breathing, and mental health". www.medicalnewstoday.com. 17 November 2020. Retrieved 10 January 2021.
  6. Huff, Charlotte (1 July 2020). "Delirium, PTSD, brain fog: The aftermath of surviving COVID-19". www.apa.org. Retrieved 10 January 2021.
  7. Liu, Kai; Zhang, Weitong; Yang, Yadong; Zhang, Jinpeng; Li, Yunqian; Chen, Ying (May 2020). "Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study". Complementary Therapies in Clinical Practice. 39: 101166. doi:10.1016/j.ctcp.2020.101166. PMC   7118596 . PMID   32379637.
  8. Simpson, Robert; Robinson, Larry (April 2020). "Rehabilitation following critical illness in people with COVID-19 infection". American Journal of Physical Medicine & Rehabilitation. 99 (6): 470–474. doi:10.1097/PHM.0000000000001443. PMC   7253039 . PMID   32282359.
  9. "Overview | COVID-19 rapid guideline: managing the long-term effects of COVID-19 | Guidance | NICE". www.nice.org.uk. 18 December 2020. Retrieved 2022-10-22.
  10. Harenwall, Sari; Heywood-Everett, Suzanne; Henderson, Rebecca; Godsell, Sherri; Jordan, Sarah; Moore, Angela; Philpot, Ursula; Shepherd, Kirsty; Smith, Joanne; Bland, Amy Rachel (2021). "Post-COVID-19 Syndrome: Improvements in Health-Related Quality of Life Following Psychology-Led Interdisciplinary Virtual Rehabilitation". Journal of Primary Care & Community Health. 12: 215013192110676. doi:10.1177/21501319211067674. ISSN   2150-1319. PMC   8721676 . PMID   34939506.