Covid-19 is a disease that has spread and is still spreading rapidly on a global scale. The sequelae of infection cannot be overlooked, as patients often complain of complaints such as dyspnea, reduced physical, pulmonary and cardiac capacity, reduced strength and worsening quality of life. In a situation where minimizing sources of infection is a must, technology comes to our aid. In fact, telerehabilitation or remote virtual assistance allows us to deliver rehabilitation services in total safety and achieve the set therapeutic goals. The objective of this thesis is to analyze the evolution and modification of the parameters obtained from the Barthel Dyspnea Index (dyspnea and muscle fatigue) and the 30-sec Chair Stand Test, of post-hospitalization Covid patients (intensive care unit (ICU), sub-intensive care unit, medicine and community hospital or emergency room) undergoing the Home Covid Rehab and telerehabilitation protocol, over a 5-week post-discharge time frame. Population and setting: In Azienda ULSS 2 - Marca Trevigiana, District of Pieve di Soligo, O.U. of Vittorio Veneto and Conegliano, 293 patients were recruited from April 2020 to August 2022, of whom 78 were excluded because they did not meet eligibility criteria. During the course, 15 patients dropped out of the rehabilitation program due to medical reasons or the need for outpatient care, so finally, data from 200 people were analyzed, divided according to gender (119 males and 81 females) and admission (172 NO ICU, 28 in ICU). Intervention: the "Home-Covid Rehab" (HCR) protocol, a total-body exercise program involving a warm-up phase, active mobilizations to the 4 limbs, aerobic exercises, and a step of defatigue and stretching, was administered. Outcomes: the Barthel Dyspnea Index and the 30-second chair stand test were chosen. Weekly follow-ups were performed for a total of 4 weeks. Results: The average 30-second chair stand at discharge was 10.55 (+/-3.49). With the start of follow-ups and telematics meetings, the measurements were respectively at: T1, 11.71 (+/-3.68); T2, 12.92 (+/-3.83), T3, 13.83 (+/- 4.21), T4, 14.49 (+/- 4.41), T5, 15.04 (+/- 4.48), with p-value at paired t-test <0.001. The mean scores at the Barthel Dyspnea Index are respectively at: T0, 81.61 (+/-9.8); T1, 89.16 (+/- 8.75); T5, 95.48 (+/- 5.83), with p-value at paired t-test <0.001. Discussions and conclusions: the clinical picture of patients with post-covid symptoms treated with the Home Covid Rehab rehabilitation protocol for 4 weeks improved physical capacity and dyspnea during daily life.
Il Covid-19 è una malattia che si è diffusa e si sta ancora diffondendo velocemente su scala mondiale. Le sequele dell'infezione non possono essere trascurate, dato che i pazienti lamentano spesso disturbi come dispnea, ridotta capacità fisica, polmonare e cardiaca, riduzione della forza e peggioramento della qualità di vita. In una situazione dove è d'obbligo ridurre al minimo le fonti di contagio, la tecnologia ci viene incontro. La teleriabilitazione o assistenza virtuale a distanza ci permette infatti di erogare servizi riabilitativi in totale sicurezza e raggiungere gli obiettivi terapeutici prefissati. L'obiettivo della tesi è analizzare l’evoluzione e modificazione dei parametri ricavati dalla Barthel Dyspnea Index (dispnea e fatica muscolare) e dal 30 sec Chair Stand Test, dei pazienti Covid post-ospedalizzazione (terapia intensiva (TI), sub-intensiva, medicine e ospedale di comunità o pronto soccorso) sottoposti al protocollo Home Covid Rehab e tele-riabilitazione, nell’arco di tempo di 5 settimane post dimissione. Popolazione e setting: Nell’Azienda ULSS 2 – Marca Trevigiana, Distretto di Pieve di Soligo, U.O. di Vittorio Veneto e Conegliano sono stati reclutati 293 pazienti da Aprile 2020 ad Agosto 2022, di cui 78 sono stati esclusi, perché non rispettavano i criteri di eleggibilità. Durante il percorso, 15 pazienti sono usciti dal programma di riabilitazione per motivi medici o per necessità di assistenza ambulatoriale, perciò infine sono stati analizzati i dati di 200 persone, divisi in base al genere (119 maschi e 81 femmine) e al ricovero (172 NO TI, 28 in TI). Intervento: è stato somministrato il protocollo “Home-Covid Rehab” (HCR), un programma di esercizi total body che prevede una fase di riscaldamento, delle mobilizzazioni attive ai 4 arti, esercizi aerobici e una fase di defaticamento e stretching. Outcomes: sono stati scelti la Barthel Dyspnea Index e il 30-second chair stand test. Sono stati eseguiti follow-up settimanali per un totale di 4 settimane. Risultati: alla dimissione, la media di alzate dalla sedia in 30 secondi è stata di 10.55 (+/-3,49). Con l’inizio dei follow up e degli incontri telematici, le misurazioni sono state rispettivamente a: T1, 11.71 (+/-3,68); T2, 12.92 (+/-3,83), T3, 13.83 (+/- 4,21), T4, 14.49 (+/- 4,41), T5, 15.04 (+/- 4,48), con p-value al t test appaiato <0.001. La media dei punteggi alla Barthel Dyspnea Index sono rispettivamente a: T0, 81,61 (+/-9,8); T1, 89,16 (+/- 8,75); T5, 95,48 (+/- 5,83), con p-value al t test appaiato <0.001. Discussioni e conclusioni: il quadro clinico dei pazienti con sintomi post-covid trattati con il protocollo riabilitativo Home Covid Rehab per 4 settimane, migliora in termini di capacità fisica e dispnea durante la vita quotidiana.
Effetti del protocollo Home Covid Rehab sul quadro clinico di pazienti Covid post ospedalizzazione: studio longitudinale retrospettivo
PASTORIN, GIOELE
2021/2022
Abstract
Covid-19 is a disease that has spread and is still spreading rapidly on a global scale. The sequelae of infection cannot be overlooked, as patients often complain of complaints such as dyspnea, reduced physical, pulmonary and cardiac capacity, reduced strength and worsening quality of life. In a situation where minimizing sources of infection is a must, technology comes to our aid. In fact, telerehabilitation or remote virtual assistance allows us to deliver rehabilitation services in total safety and achieve the set therapeutic goals. The objective of this thesis is to analyze the evolution and modification of the parameters obtained from the Barthel Dyspnea Index (dyspnea and muscle fatigue) and the 30-sec Chair Stand Test, of post-hospitalization Covid patients (intensive care unit (ICU), sub-intensive care unit, medicine and community hospital or emergency room) undergoing the Home Covid Rehab and telerehabilitation protocol, over a 5-week post-discharge time frame. Population and setting: In Azienda ULSS 2 - Marca Trevigiana, District of Pieve di Soligo, O.U. of Vittorio Veneto and Conegliano, 293 patients were recruited from April 2020 to August 2022, of whom 78 were excluded because they did not meet eligibility criteria. During the course, 15 patients dropped out of the rehabilitation program due to medical reasons or the need for outpatient care, so finally, data from 200 people were analyzed, divided according to gender (119 males and 81 females) and admission (172 NO ICU, 28 in ICU). Intervention: the "Home-Covid Rehab" (HCR) protocol, a total-body exercise program involving a warm-up phase, active mobilizations to the 4 limbs, aerobic exercises, and a step of defatigue and stretching, was administered. Outcomes: the Barthel Dyspnea Index and the 30-second chair stand test were chosen. Weekly follow-ups were performed for a total of 4 weeks. Results: The average 30-second chair stand at discharge was 10.55 (+/-3.49). With the start of follow-ups and telematics meetings, the measurements were respectively at: T1, 11.71 (+/-3.68); T2, 12.92 (+/-3.83), T3, 13.83 (+/- 4.21), T4, 14.49 (+/- 4.41), T5, 15.04 (+/- 4.48), with p-value at paired t-test <0.001. The mean scores at the Barthel Dyspnea Index are respectively at: T0, 81.61 (+/-9.8); T1, 89.16 (+/- 8.75); T5, 95.48 (+/- 5.83), with p-value at paired t-test <0.001. Discussions and conclusions: the clinical picture of patients with post-covid symptoms treated with the Home Covid Rehab rehabilitation protocol for 4 weeks improved physical capacity and dyspnea during daily life.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/38689