Early pulmonary rehabilitation post-COVID-19 aids recovery

 

The results of a small study suggest that the sooner COVID-19 patients start a pulmonary rehabilitation programme after being taken off ventilators, the better the improvement in walking and breathing capabilities, and muscle gain. Despite significant improvements, the average 3 weeks of rehabilitation was not enough for a full recovery [1].

Patients with severe COVID-19 sometimes spend weeks in intensive care on ventilators. As a result, they may suffer from multiple physical (pulmonary and extra‐pulmonary), emotional, and social limitations, which necessitate a comprehensive, interdisciplinary pulmonary rehabilitation programme. PhD student Yara Al Chikhanie (Grenoble Alps University, France) studied the impact of COVID-19 and the effect of pulmonary rehabilitation. Included in the study were 19 patients with a mean age of 71. Each patient had at least 1 comorbidity. Patients spent on average 26 days in intensive care and 13 days in the pulmonary ward before transfer to a French rehabilitation centre.

A 6-minute walk test (6MWT) was used to evaluate the weekly progress of these patients. Most were still unable to walk when they arrived at the rehabilitation centre. At the end of the rehabilitation (21±8 days) the 6MWT increased from 120±141 m to 337±145 m. This was a significant gain but still a serious impairment, as patients reached only 43±24% of the normal predicted distance. Measurement of oxygen saturation during the 6MWT revealed that most patients still had a reduced oxygen saturation (SpO2 85±6%), although patients had no perceived dyspnoea.

The most important finding of the study was that patients who were admitted to pulmonary rehabilitation shortly after leaving intensive care progressed faster than those who spent a longer period in the pulmonary ward. The sooner rehabilitation started and the longer it lasted, the faster and better the improvement in patients’ walking and breathing capacities and muscle gain. Patients who started rehabilitation in the week after being taken off their ventilators progressed faster than those who were admitted after 2 weeks. Despite the significant improvement, the average period of 3 weeks in rehabilitation was not enough to recover completely. Walking ability improved until the end of the rehabilitation. Participants also had a significant recovery of lung volumes and capacities, and leg and handgrip strength, but post-traumatic stress disorder was not resolved in concerned patients.

“These findings suggest that doctors should start rehabilitation as soon as possible and that patients should try to spend as little time as possible being inactive,” Ms Al Chikhanie concluded. ERS President Prof. Thierry Troosters (KU Leuven, Belgium) commented that the results of this study are perfectly in line with a recent statement of the ERS in which a tailored rehabilitation is recommended for COVID-19 patients after the in-hospital phase [2].

 

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   1. Al Chikhanie Y, et al. New insights into determinants of patient-reported outcomes in chronic respiratory diseases. LBA PA938, ERS International Virtual Congress 2020, 7-9 Sept.
   2. Spruit MA, et al. Eur Resp J 2020. DOI: 1183/13993003.02197-2020.

Posted on 29 October 202023 February 2021