Pulmonary Rehabilitation in COVID-19 patients: A scoping review of current practice and its application during the pandemic

Abstract

The novel coronavirus-2019 (COVID-19) pandemic primarily affects the respiratory system. Elderly individuals with comorbidity are severely affected. Survivors weaned from mechanical ventilation are at a higher risk of developing post-intensive care syndrome (PICS). This scoping review, based on 40 recent publications, highlights pulmonary rehabilitation (PR) in COVID-19. There is a paucity of high-quality research on this topic. However, rehabilitation societies including the Turkish Society of Physical Medicine and Rehabilitation have issued PR recommendations in COVID-19 pneumonia with productive cough can benefit from diaphragmatic breathing, pursed-lip breathing, and resistance-breathing training. Besides, those in mechanical ventilation and post-PICS COVID-19 cases, oxygen therapy, early mobilization, airway clearance, aerobic exercise, gradual-graded limb muscle resistance exercise, nutritional and psychological interventions should be consideration. During PR, careful evaluation of vital signs and exercise-induced symptoms is also required. When in-person PR is not possible, telerehabilitation should be explored. However, the long-term effects of PR in COVID-19 need further evaluation.

Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments

“…Even persons with similar conditions to long COVID (Table 3) may not always respond favourably to physical rehabilitation, which includes patients with postural orthostatic tachycardia syndrome (POTS) or myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) with post-exertional malaise [178][179][180]. Therefore, reviews have emphasised that more RCTs are needed to determine which rehabilitation program would work best for specific groups of long COVID, including those with POTS or ME/CFS [181,182]. The non-pharmaceutical treatment approaches to POTS and ME/CFS may also be repurposed for long COVID cases that share symptoms of POTS and ME/CFS (Table 3).…”

Respiratory Rehabilitation in the Covid-19 Patient Care Journey: Summary of International Recommendations

“…When in-person pulmonary rehabilitation is not possible, tele rehabilitation should be explored. However, the long-term effects of PR in COVID-19 need further evaluation [12].…”

Spa therapy interventions for post respiratory rehabilitation in COVID-19 subjects: does the review of recent evidence suggest a role?

“…Indeed, although in most cases (80%) the infection proceeds asymptomatically or with mild symptoms, 13.8% of cases have severe disease and 6.1% are critical and require hospitalization in the Intensive Care Unit for significant respiratory involvement (Vermund and Pitzer 2020 ). Respiratory symptoms include dyspnea, reduced blood oxygen saturation, and respiratory failure, requiring mechanical ventilation primarily in patients with comorbidities such as obesity, diabetes mellitus, ischaemic heart disease, cancer, and chronic obstructive pulmonary disease (COPD) (Siddiq et al 2020 ). Patients with mechanical ventilation may also develop acute respiratory distress syndrome (ARDS), pulmonary oedema, atelectasis, and pulmonary embolism with right-sided heart failure (Boyer et al 2015 ).…”