Telerehabilitation Intervention in Patients with COVID-19 after Hospital Discharge to Improve Functional Capacity and Quality of Life. Study Protocol for a Multicenter Randomized Clinical Trial

Abstract

COVID-19 can cause important sequels in the respiratory system and frequently presents loss of strength, dyspnea, polyneuropathies and multi-organic affectation. Physiotherapy interventions acquire a fundamental role in the recovery of the functions and the quality of life. Regarding the recovery phases after hospital discharge, the current evidence available is very preliminary. Telerehabilitation is presented as a promising complementary treatment method to standard physiotherapy. The main objective of this research is to evaluate the effectiveness of a personalized telerehabilitation intervention after discharge from hospital for the improvement of functional capacity and quality of life compared to a program of health education and/or care in a rehabilitation center. As secondary objectives, to identify the satisfaction and perception of patients with the telerehabilitation intervention and the presence of barriers to its implementation, as well as to evaluate the cost-effectiveness from the perspective of the health system. This study protocol will be carried out through a single blind multicenter randomized clinical trial in the south of Spain. We hypothesize that the implementation of a telerehabilitation program presents results not inferior to those obtained with the current standard intervention. If the hypothesis is confirmed, it would be an opportunity to define new policies and interventions to address this disease and its consequences. Trial registration NCT04742946.

Safety, feasibility and initial efficacy of an app-facilitated telerehabilitation (AFTER) programme for COVID-19 survivors: a pilot randomised study

“…The multicomponent programme allowed several interventions to be considered and evaluated in the virtual setting in individuals after COVID-19 hospitalisation but may have diminished the effects of any single intervention. While multicomponent telerehabilitation programmes have been proposed,10 47 48 to our knowledge, no published study has tested a supervised multicomponent telerehabilitation programme versus an active control group in individuals after COVID-19. Given our wide variety of potential interventions (table 1), substantial differences in impairments following COVID-19,1 49 and the biobehavioural approach of our study valuing participants’ autonomy and goals, the treatment programmes varied substantially among participants.…”

Systematic Review of COVID-19-Related Physical Activity-Based Rehabilitations: Benefits to Be Confirmed by More Robust Methodological Approaches

“…The underlying systemic inflammation contributes to muscle atrophy indirectly (lung obstruction and forced inactivity) or directly (increased muscle wasting, necrosis, fibrosis and autophagy, and mitochondrial dysfunction), while viral antigen mimicry might cause muscle denervation in peripheral nerves. While physical activity (PA) has been identified as a predictive and protective factor against severe forms of COVID-19 [ 17 , 18 , 19 , 20 ], it has also been suggested as a key factor for rehabilitation [ 21 , 22 , 23 ], both for the acute and long-term consequences of this new global disease. According to a survey questioning the specific rehabilitation needs reported by post-COVID-19 patients themselves [ 24 ], exercise guidance appears to be a primary concern.…”

Pulmonary telerehabilitation and efficacy among discharged COVID‐19 patients: Rational and design of a prospective real‐world study

“…Recent rapid advance in information and communication technologies together with wearable devices has made it possible to implement digital remote rehabilitation for patients with chronic pulmonary diseases, the efficacy and safety of which have been proven non‐inferior to those of traditional approaches 17 . Several studies have demonstrated the benefit effects of telerehabilitation in improving the physical and psychological condition among patients with COVID‐19, 15,25–27 and some studies are on the way 28,29 . More importantly, telerehabilitation can significantly increase accessibilities of medical service and reduce transmission risk of the virus.…”