https://doi.org/10.4081/monaldi.2021.1975

Respiratory rehabilitation for patients with COVID-19 infection and chronic respiratory failure: a real-life retrospective study by a Lombard network

Vol. 92 No. 3 (2022)
Submitted: June 14, 2021
Accepted: December 20, 2021
Published: December 28, 2021
disability, chronic respiratory failure, post COVID-19
Abstract Views: 1967
PDF: 784
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Michele Vitacca
michele.vitacca@icsmaugeri.it
https://orcid.org/0000-0002-9389-7915
Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS), Italy.
Beatrice Salvi
Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS), Italy.
Marta Lazzeri
Department of Cardiothoracic and Vascular Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Elisabetta Zampogna
Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Tradate (VA), Italy.
Giancarlo Piaggi
Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Montescano (PV) , Italy.
Piero Ceriana
Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Pavia, Italy.
Serena Cirio
Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Pavia, Italy.
Luigino Rizzello
Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Milan, Italy.
Grazia Lacala
Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Milan, Italy.
Angelo Longoni
ASST Lariana – P.O. Sant’Antonio Abate, Cantù (MO), Italy.
Vittoria Galimberti
Hospital San Giuseppe, Milan, Italy.
Patrizia D'Ambrosio
Hospital San Giuseppe, Milan, Italy.
Enrica Pavesi
Hospital Santa Marta, Rivolta d’Adda (CR), Italy.
Giuseppe La Piana
Hospital Santa Marta, Rivolta d’Adda (CR), Italy.
Antonella Sanniti
Casa di Cura Ancelle della Carità, Fondazione Teresa Camplani, Cremona, Italy.
Alessandro Morandi
Casa di Cura Ancelle della Carità, Fondazione Teresa Camplani, Cremona, Italy.
Manoel Vallet
Casa di Cura Ancelle della Carità, Fondazione Teresa Camplani, Brescia, Italy.
Mara Paneroni
Respiratory Rehabilitation, ICS Maugeri IRCCS, Institute of Lumezzane (BS), Italy.

The Lombardy region has been one of the areas most affected by the COVID-19 pandemic since the first months of 2020, providing real-life experiences in the acute phase. It is unclear how the respiratory rehabilitation network responded to this emergency. The aims of this retrospective study were: i) to analyze clinical, functional, and disability data at admission; ii) describe assessment tools and rehabilitative programs; iii) evaluate improvement after rehabilitation. The study was conducted on data collected from ten pulmonary rehabilitation centers in Lombardy, between the period of March 1st 2020 to March 1st 2021, in patients with respiratory failure recovering from COVID-19 both at admission and discharge. The study included demographics, comorbidities, nutritional status, risk of falls, disability status (Barthel index; Short Physical Performance Battery (SPPB); 6 minutes walking test (6MWT), symptoms (dyspnoea with Barthel Dyspnoea and MRC Dyspnoea Scale), length of stay, discharge destination, need for mechanical ventilation, respiratory function, assessment/outcomes indices, and prescribed rehabilitative programs. 413 patients were analyzed. Length of stay in acute and rehabilitative units was less than 30 days. Fifty % of patients used non-invasive ventilation during their stay. Functional status was mildly compromised for forced volumes and oxygenation, while severely compromised for diffusion capacity. Independency was low while physical performance status very low.  At discharge, 318 (77%) patients were sent home, 83 (20.1%) were transferred to an acute unit and 12 (2.9%) passed away. Barthel Index and 6MWT were the most used, while MRC score was the least used outcome parameter. The 5 main rehabilitative activities were walking (90.8 %), transfer from bed to armchair (77.5%), limb mobilization in bed (76%), balance (71.2%), and cycle-ergometer or treadmill (43.1%). A huge difference was found in admission, discharge, and delta change among different rehabilitative centers. When available, all outcomes showed a significant improvement. With the limitation of a retrospective study with a clear amount of missing data, COVID-19 subjects admitted to rehabilitative centers presented a reduced physical performance, symptoms of dyspnoea, and severe disability. The 6MWT and Barthel index were the most used measurement.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021;397:220-32. DOI: https://doi.org/10.1016/S0140-6736(20)32656-8
Wang Z, Deng H, Ou C, Liang J, et al. Clinical symptoms, comorbidities and complications in severe and non-severe patients with COVID-19: A systematic review and meta-analysis without cases duplication. Medicine (Baltimore) 2020;99 e23327. DOI: https://doi.org/10.1097/MD.0000000000023327
Paneroni M, Simonelli C, Saleri M, et al. Muscle strength and physical performance in patients without previous disabilities recovering from COVID-19 pneumonia. Am J Phys Med Rehabil 2021;100:105-9. DOI: https://doi.org/10.1097/PHM.0000000000001641
Lazzeri M, Lanza A, Bellini R, 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;90:1285. DOI: https://doi.org/10.4081/monaldi.2020.1285
Vitacca M, Carone M, Clini EM, et al. Joint statement on the role of respiratory rehabilitation in the COVID-19 crisis: the Italian position paper. Respiration 2020;99:493-9.
Spruit MA, Holland AE, Singh SJ, et al. COVID-19: interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society and American Thoracic Society coordinated international task force. Eur Respir J 2020;56:2002197. DOI: https://doi.org/10.1183/13993003.02197-2020
Zampogna E, Paneroni M, Belli S, et al. Pulmonary rehabilitation in patients recovering from COVID-19. Respiration 2021;100:416-22. DOI: https://doi.org/10.1159/000514387
Ceriana P, Vitacca M, Paneroni M, et al. Usefulness of step down units to manage survivors of critical Covid-19 patients. Eur J Intern Med 2021;88:126-8. DOI: https://doi.org/10.1016/j.ejim.2021.03.002
Liu K, Zhang W, Yang Y, et al. Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complement Ther Clin Pract 2020;39:101166. DOI: https://doi.org/10.1016/j.ctcp.2020.101166
Vitacca M, Migliori GB, Spanevello A, et al. Management and outcomes of post-acute COVID-19 patients in Northern Italy. Eur J Intern Med 2020;78:159-60. DOI: https://doi.org/10.1016/j.ejim.2020.06.005
Ceriana P, Nava S, Vitacca M, et al. Noninvasive ventilation during weaning from prolonged mechanical ventilation. Pulmonology 2019;25:328–33. DOI: https://doi.org/10.1016/j.pulmoe.2019.07.006
Maestri R, Bruschi C, Fracchia C, et al. Physiological and clinical characteristics of patients with COPD admitted to an inpatient pulmonary rehabilitation program: a real-life study. Pulmonology 2019;25:71–8. DOI: https://doi.org/10.1016/j.pulmoe.2018.07.001
Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc 1968;16:622-6. DOI: https://doi.org/10.1111/j.1532-5415.1968.tb02103.x
Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel index for stroke rehabilitation. J Clin Epidemiol 1989;42:703–9. DOI: https://doi.org/10.1016/0895-4356(89)90065-6
Bernabeu-Mora R, Medina-Mirapeix F, Llamazares-Herran E, et al. The short physical performance battery is a discriminative tool for identifying patients with COPD at risk of disability. Int J Chron Obstruct Pulmon Dis 2015;10:2619-26. DOI: https://doi.org/10.2147/COPD.S94377
Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol 1994;49:M85-94. DOI: https://doi.org/10.1093/geronj/49.2.M85
Holland AE, Spruit MA, Troosters T, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J 2014;44:1428-46. DOI: https://doi.org/10.1183/09031936.00150314
Vitacca M, Paneroni M, Baiardi P, et al. Development of a Barthel Index based on dyspnea for patients with respiratory diseases. Int J Chron Obstruct Pulmon Dis 2016;11:1199-206. DOI: https://doi.org/10.2147/COPD.S104376
Bestall JC, Paul EA, Garrod R, et al. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999;54 581-6. DOI: https://doi.org/10.1136/thx.54.7.581
Vitacca M, Carone M, Clini EM, et al. Joint statement on the role of respiratory rehabilitation in the COVID-19 crisis: the Italian position paper. Respiration 2020;99:493–9. DOI: https://doi.org/10.1159/000508399
Borg G. Psychophysical basis of perceived exertion. Med Sci Sports Exerc 1982;14:377-81. DOI: https://doi.org/10.1249/00005768-198205000-00012
Belli S, Balbi B, Prince I, et al. Low physical functioning and impaired performance of activities of daily life in COVID-19 patients who survived hospitalisation. Eur Respir J 2020;56:2002096. DOI: https://doi.org/10.1183/13993003.02096-2020
Curci C, Pisano F, Bonacci E, et al. Early rehabilitation in post-acute COVID-19 patients: data from an Italian COVID-19 Rehabilitation Unit and proposal of a treatment protocol. Eur J Phys Rehabil Med 2020;56:633-41. DOI: https://doi.org/10.23736/S1973-9087.20.06339-X
Curci C, Negrini F, Ferrillo M, et al. Functional outcome after inpatient rehabilitation in post-intensive care unit COVID-19 patients: findings and clinical implications from a real-practice retrospective study. Eur J Phys Rehabil Med 2021;57:443-50. DOI: https://doi.org/10.23736/S1973-9087.20.06660-5
Zampogna E, Migliori GB, Centis R, et al. Functional impairment during post-acute COVID-19 phase: Preliminary finding in 56 patients. Pulmonology 2021;27:452-5. DOI: https://doi.org/10.1016/j.pulmoe.2020.12.008
Perera S, Mody SH, Woodman RC, Studenski SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc 2006;54:743–9. DOI: https://doi.org/10.1111/j.1532-5415.2006.00701.x
Vitacca M, Paneroni M, Peroni R, et al. Effects of a multidisciplinary care program on disability, autonomy, and nursing needs in subjects recovering from acute respiratory failure in a chronic ventilator facility. Respir Care 2014;59:1863-71. DOI: https://doi.org/10.4187/respcare.03030

How to Cite

Vitacca, Michele, Beatrice Salvi, Marta Lazzeri, Elisabetta Zampogna, Giancarlo Piaggi, Piero Ceriana, Serena Cirio, et al. 2021. “Respiratory Rehabilitation for Patients With COVID-19 Infection and Chronic Respiratory Failure: A Real-Life Retrospective Study by a Lombard Network”. Monaldi Archives for Chest Disease 92 (3). https://doi.org/10.4081/monaldi.2021.1975.
Copyright (c) 2021 The Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.


Similar Articles

1 2 3 4 5 6 7 8 9 10 > >> 

You may also start an advanced similarity search for this article.