Authors (including presenting author) :
Chung MTK(1), Wong HL(1), Yu DTW(1), Chan ACM(1), Wu TC(2)
Affiliation :
(1) Physiotherapy Department, Queen Elizabeth Hospital (2) Department of Medicine, Queen Elizabeth Hospital
Introduction :
COVID-19 pandemic led to huge surge in clinical service demand to public hospitals in Hong Kong. Patients may present with respiratory distress and exercise intolerance secondary to prolonged immobilization, rehabilitation thus become essential after hospital discharge. As the possible impact of disease remained uncertain, comprehensive evaluation of patient condition would be significant in establishing the structure of pulmonary rehabilitation.
Objectives :
1.To evaluate pulmonary and musculoskeletal functions in COVID-19 patients. 2.To explore potential components that constitute pulmonary rehabilitation for COVID-19 patients.
Methodology :
Prospective longitudinal design was adopted. COVID-19 patients, who attended Medical Infectious Disease Clinic of Queen Elizabeth Hospital at 4-week and 12-week follow-up after hospital discharge, underwent multi-dimensional assessments performed by physiotherapists for aerobic capacity using 6-Minute Walk Test (6MWT), muscle strength by handgrip strength (HGS) and 30-second sit-to-stand test (30STST), plethysmography analysis, and respiratory-specific health-related quality of life by St. George’s Respiratory Questionnaire (SGRQ). Paired t-tests were employed for statistical analysis.
Result & Outcome :
From April to November 2020, 158 patients (mean age 40.5±14.9 years) attended the clinic. Insignificant increment in 6MWT distance from 515 meters to 522 meters was observed (p = 0.29). Both genders covered mean distance lower than the age-matched norms, which implied the declination of aerobic capacity after the disease. Lower limbs strength was significantly deteriorated by 2 repetitions in 30STST with time (p < 0.01). Insignificant increase in HGS for dominant and non-dominant hands by 2.61kgF and 1.33kgF with time was retrieved (p = 0.10, 0.19). HGS of both hands for male in 4-week follow-up and female at both time points were lower than the age-matched norms, only those for male at 12-week follow-up were able to meet the norms. Meanwhile, despite significant weight gain by 0.93kg (p < 0.01), significant decrease in total muscle mass of 0.73kg was observed (p < 0.01). Significant improvement of respiratory symptoms (p < 0.01) and impacts on functioning and psychological disturbance (p = 0.02) were revealed from SGRQ. Patients reported no significant difference in activities induced breathlessness (p = 0.20). Despite the subjective improvement, all patients demonstrated deterioration in aerobic capacity with progressive muscle wasting when compared to the age-matched healthy ones. These may be suggestive for incorporation of aerobic and strengthening exercise in the COVID-19 physiotherapy pulmonary rehabilitation.
