Can the Effectiveness of Telerehabilitation Exercise Program Be Evaluated with Performance Tests in COVID 19 Patients? Pilot Study

Yıl 2021, Cilt: 3 Sayı: 1, 1 - 7, 15.02.2021

Esra Pehlivan , Sibel Gayretli Altan İsmail Palalı , Demet Turan , Halit Çınarka , Erdoğan Çetinkaya

Öz

Aim: Covid 19 is an infection with multisystemic negative effects. Especially respiratory and musculoskeletal effects affect the physical performance of patients negatively and physiotherapy applications may be required for these patients. Physical performance evaluation is one of the main evaluation parameters in physiotherapy programs. Standard exercise capacity measurements may not be made in telerehabilitation exercise programs. In our study, the effectiveness of some performance tests performed online in Covid 19 cases in showing the physical performance changes of the cases was examined.
Method: The subjects who have technological facilities suitable for smartphone access and who do not have health problems that may prevent them from exercising were randomly divided into 2 groups as Study Group (SG, n = 11) and Control Group (CG, n = 10). Online exercise program was applied to the study group for 6 weeks, 3 days a week. The exercise content consisted of breathing exercises, active breathing cycle techniques, range of motion and light aerobic exercise. Simple exercises that can be done at home and a brochure containing information about the disease were given to the control group. Study outcome measures were: Brief Physical Performance Battery (SPPB) scores, 30-Second Sitting and Standing Test (30STS) repetation, Visual analog scale fatigue score (VASf), and modified Medical Research Council (mMRC) dyspnea score.
Results: Twenty-one patients, 81% male, with a mean age of 45.95 years were included in the study. Baseline data and demographic characteristics of the groups were similar except for mMRC. The baseline dyspnea level of the study group was higher (p = .012). There was a significant increase in SG's repetation count of 30STS at the end of 6 weeks (p = .016). Although there were numerical improvements in other parameters, no statistical difference was observed between the groups.
Conclusion: The online exercise program has a positive effect on the physical performance status of Covid 19 cases. One of the performance tests, a significant improvement was detected in the 30STS duration. Despite the improvements in fatigue and dyspnea, no difference was observed in SPPB, which causes questioning the suitability of the test battery. On the other hand, the study is a pilot study. In order to obtain more meaningful results, studies involving more cases and evaluating different performance tests are needed.

Anahtar Kelimeler

exercise, physiotherapy, Physical Functional Performance, sit to stand test

COVID 19 Hastalarında Telerehabilitasyon Egzersiz Programının Etkinliği Performans Testleri ile Değerlendirilebilir mi? Pilot Çalışma

Öz

Amaç: Covid 19, multisistemik negatif etkileri olan bir enfeksiyondur. Özellikle solunum ve kas-iskelet sistemi etkileri hastaların fiziksel performansını olumsuz yönde etkilemekte, bu hastalara fizyoterapi uygulamaları gerekebilmektedir. Fizyoterapi programlarında fiziksel performans değerlendirmesi ana değerlendirme parametrelerindendir. Fakat telerehabilitasyon egzersiz programlarında standart egzersiz kapasitesi ölçümleri yapılamayabilmektedir. Çalışmamızda Covid 19 olgularında online olarak gerçekleştirilen bazı performans testlerinin, olguların fiziksel performans değişimlerini göstermedeki etkinliği incelenmiştir.
Gereç-yöntemler: Akıllı telefon erişimine uygun teknolojik imkanları olan ve egzersiz yapmalarını engelleyebilecek sağlık sorunları olmayan olgular rastgele Çalışma Grubu (ÇG, n=11) ve Kontrol Grubu (KG, n=10) olmak üzere 2 gruba ayrıldı. Çalışma grubuna çevrimiçi egzersiz programı 6 hafta boyunca, haftada 3 gün olacak biçimde uygulandı. Egzersiz içeriği nefes egzersizleri, aktif nefes döngüsü teknikleri, hareket açıklığı ve hafif aerobik egzersizden oluşmaktaydı. Kontrol grubuna ise evde yapılabilecek basit egzersizler ve hastalıkla ilgili bilgilendirme içerikli bir broşür verildi. Çalışma sonuç ölçütleri: Kısa Fiziksel Performans Bataryası (KFPB) puanı, 30 saniye otur kalk testi (30SOK) tekrar sayısı, Vizüel analog skalası yorgunluk puanı (VASy) ve modifiye Medical Research Council dispne skoru idi.
Bulgular: Çalışmaya yaş ortalaması 45,95 yıl olan ve%81'i erkek olan 21 hasta dahil edildi. Grupların başlangıç verileri ve demografik özellikleri mMRC dışında benzerdi. Çalışma grubunun başlangıç dispne seviyesi daha yüksekti (p=.012). Altı haftanın sonunda ÇG’nin 30SOK tekrar sayısında artış vardı (p=.016). Diğer parametrelerde sayısal iyileşmeler olmakla birlikte, gruplar arasında istatistiksel bir fark gözlemlenmedi.
Sonuç: Online egzersiz programının Covid 19 vakalarının fiziksel performansları üzerinde olumlu etkileri vardır. Performans testlerinden 30SOK süresinde anlamlı gelişme tespit edilmiştir. Yorgunluk ve dispnedeki iyileşmelere rağmen KSPB de bir fark gözlemlenmemiş olması, test bataryasının uygunluğunun sorgulanmasına neden olmaktadır. Diğer taraftan çalışma bir pilot çalışmadır. Daha anlamlı sonuçların elde edilebilmesi için daha fazla sayıda olgunun yer aldığı ve farklı performans testlerinin de değerlendirildiği çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

egzersiz, fizyoterapi, fiziksel fonksiyonel performans, otur kalk test, yorgunluk

Kaynakça

• 1. Bhandari S, Bhargava A, Sharma S, Keshwani P, Sharma R, Banerjee S. Clinical Profile of Covid-19 Infected Patients Admitted in a Tertiary Care Hospital in North India. J Assoc Physicians India 2020;68(5):13-7.
• 2. Türkiye Fizyoterapistler Derneği. COVID-19 enfeksiyonunda fizyoterapi ve rehabilitasyon.https://drive.google.com/file/d/1iwzxxxVVCMUI27Ug74Wl1bRPb09EkYni/view. Erişim Tarihi: 9 Nisan 2020.
• 3. De Biase S, Cook L, Skelton DA, Witham M, Ten Hove R. The COVID-19 Rehabilitation Pandemic. Age Ageing 2020; 1-5.
• 4. Neto MLR, Almeida HG, Esmeraldo JD, Nobre CB, Pinheiro WR, de Oliveira CRT, et al. When health professionals look death in the eye: the mental health of professionals who deal daily with the 2019 coronavirus outbreak. Psychiatry Res2020;288:112972.
• 5. Sahu D, Rathod V. Telerehabilitation during COVID 19: Shoulder rehabilitation. J Shoulder Elbow Surg 2020.
• 6. Ganapathy K. Telemedicine and Neurological Practice in the COVID-19 Era. Neurol India 2020;68(3):555-9.
• 7. Holland AE, Cox NS. Telerehabilitation for COPD: Could pulmonary rehabilitation deliver on its promise? Respir 2017;22(4):626-7.
• 8. Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport 1999;70(2):113-9.
• 9. Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med 1995;332(9):556-61.
• 10. Hayes MH. Experimental developement of the graphics rating method. Physiol Bull 1921;18:98-9.
• 11. Mahler DA, Wells CK. Evaluation of clinical methods for rating dyspnea. Chest 1988;93(3):580-6.
• 12. Tan YK, Goh C, Leow AST, Tambyah PA, Ang A, Yap ES, et al. COVID-19 and ischemic stroke: a systematic review and meta-summary of the literature. J Thromb Thrombolysis 2020; 1:(1-9).
• 13. Masroor S. Collateral damage of COVID-19 pandemic: Delayed medical care. J Card Surg 2020;35(6):1345-7.
• 14. Valenzuela PL, Joyner M, Lucia A. Early mobilization in hospitalized patients with COVID-19. Ann Phys Rehabil Med 2020;63(4):384-5.
• 15. Lazzeri M, Lanza A, Bellini R, Bellofiore A, Cecchetto S, Colombo A, et al. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis 2020;90(1).
• 16. Thomas P BC, Bissett B, Boden I, Gosselink R, Granger CL. . Physiotherapy management for COVID-19 in the acute hospital setting: recommendations to guide clinical practice. J Physiother 2020 66(2):73-82.
• 17. Vitacca M CM, Clini E, Paneroni M, Lazzeri M, Lanza A,et al. Joint statement on the role of respiratory rehabilitation in the COVID-19 crisis: the Italian position paper. www.aiponet.it, 2020. Erişim Tarihi: 30 Mart 2020.
• 18. Spruit MA HA, Singh SJ, Troosters T. . Report of an AdHoc International Task Force to develop an expert-based opinion on early and short-term rehabilitative interventions (after the acute hospital setting) in COVID-19 survivors. https://ers.app. box.com/s/npzkvigtl4w3pb0vbsth4y0fxe7ae9z9. Erişim Tarihi: 1 Nisan 2020.
• 19. Cottrell MA, Russell TG. Telehealth for musculoskeletal physiotherapy. Musculoskelet Sci Pract 2020;48:102193.
• 20. Chae SH, Kim Y, Lee KS, Park HS. Development and Clinical Evaluation of a Web-Based Upper Limb Home Rehabilitation System Using a Smartwatch and Machine Learning Model for Chronic Stroke Survivors: Prospective Comparative Study. JMIR Mhealth Uhealth 2020;8(7):e17216.
• 21. Brouwers RW, Kraal JJ, Traa SC, Spee RF, Oostveen LM, Kemps HM. Effects of cardiac telerehabilitation in patients with coronary artery disease using a personalised patient-centred web application: protocol for the SmartCare-CAD randomised controlled trial. BMC Cardiovasc Disord 2017;17(1):46.
• 22. Bhatt SP, Patel SB, Anderson EM, Baugh D, Givens T, Schumann C, et al. Video Telehealth Pulmonary Rehabilitation Intervention in Chronic Obstructive Pulmonary Disease Reduces 30-Day Readmissions. Am J Respir Crit Care Med 2019;200(4):511-3.
• 23. Ozcan Kahraman B, Ozsoy I, Akdeniz B, Ozpelit E, Sevinc C, Acar S, et al. Test-retest reliability and validity of the timed up and go test and 30-second sit to stand test in patients with pulmonary hypertension. Int J Cardiol 2020;304:159-63.
• 24. Zhang Q, Li YX, Li XL, Yin Y, Li RL, Qiao X, et al. A comparative study of the five-repetition sit-to-stand test and the 30-second sit-to-stand test to assess exercise tolerance in COPD patients. Int J Chron Obstruct Pulmon Dis 2018;13:2833-9.
• 25. Cheuy VA, Loyd BJ, Hafner W, Kittelson AJ, Waugh D, Stevens-Lapsley JE. Influence of Diabetes Mellitus on the Recovery Trajectories of Function, Strength, and Self-Report Measures After Total Knee Arthroplasty. Arthritis Care Res 2019;71(8):1059-67.
• 26. Esra Pehlivan AB, Lütfiye Kılıç , Esra Yazar. Is it possible to use the timed performance tests in lung transplantation candidates to determine the exercise capacity? TurkThoracJ 2019;1(1).
• 27. Costigan FA, Rochwerg B, Molloy AJ, McCaughan M, Millen T, Reid JC, et al. I SURVIVE: inter-rater reliability of three physical functional outcome measures in intensive care unit survivors. Can J Anaesth 2019;66(10):1173-83.
• 28. Larsson P, Borge CR, Nygren-Bonnier M, Lerdal A, Edvardsen A. An evaluation of the short physical performance battery following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease. BMC Res Notes 2018;11(1):348.