Changes in respiratory function and physical performance in middle-aged and old inpatients recovering from COVID-19 after a rehabilitation program

Степень изменений дыхательной функции и физической подготовленности у пациентов, выздоравливающих после COVID-19, представляет интерес для реабилитационных мер. 56 пациентов (67 % - женщины), средний возраст - 64±11 лет, перенесшие COVID-19, прошли курс комплексной реабилитации (16,9±3,8 дня). После курса реабилитации пациенты показали улучшение дыхательной функции: проба Штанге - на 19 % (p=0,006), проба Генчи - на 25 % (p=0,026), улучшение самочувствия по результатам КТ легких (p<0,001); повышение физической подготовленности: скорость привычной ходьбы - на 80 % (р=0,025); толерантности к физической нагрузке: пройденное расстояние до первых признаков утомления - на 227 % (р<0,001), ЧСС в покое - на 1 % (р=0,011). Темпы изменений дыхательной функции и физической подготовленности были значительными и превышали подобные изменения, приводимые в литературе для относительно здоровых пожилых людей, которые приступают к физическим занятиям. Однако абсолютные показатели функции дыхания и физической подготовленности после реабилитационной программы были ниже нормированных значений для данного возраста. Данные результаты могут быть полезны для клиницистов при составлении программы реабилитации пациентов, перенёсших COVID-19. Changes in respiratory and physical performance in geriatric inpatients recovering from COVID-19 are of interest for rehabilitation interventions. 56 inpatients (67 % women), average age 64±11 years recovering from COVID-19 underwent a comprehensive rehabilitation program (16,9±3,8 days). After the rehabilitation program, the patients showed an improvement in respiratory function: voluntary breath-holding after inhalation - by 19 % (p=0,006), breath-holding after exhalation - by 25 % (p=0,026), lungs computed tomography (p<0,001); physical performance: handgrip strength - by 14 % (p=0,083), preferred walking speed - by 80 % (p=0,025); exercise tolerance: distance walked until the first signs of fatigue - by 227 % (p<0,001), resting heart rate - by 1 % (p=0,011). The interaction of rehabilitation time and patient sex was statically nonsignificant across all variables of interest. The rates of changes in respiratory function and physical performance were significant and exceeded similar changes recorded in healthy old people who begin an exercise program. However, in absolute values, respiratory function and physical performance values after the rehabilitation were lower than reference values for this age group. These results can be valuable for clinicians when designing a rehabilitation program for geriatric patients recovering from COVID-19.

Rehabilitation of COVID 19 Patients, Bangladesh Perspective

The global outbreak of COVID 19 has created an unprecedented challenge to the society. America, Europe and India were catastrophic sufferers from this virus next to China. They had highest number of daily morbidity and mortality in the global context. Bangladesh is facing terrible experiences of dealing with this pandemic and making a tremendous turmoil in health and economic sector. Our healthcare system is overburdened with critically ill patients. Disability arising out of neurological, pulmonary, neuromuscular, and cognitive complications, need to be addressed by rehabilitation professionals. Many patients presenting with COVID-19 will have no specific airway clearance needs.There have been no reports of COVID-19 positive patients having high secretion loads that would require intensive chest physiotherapy or postural drainage. In Bangladesh in ICU settings physiatrist or physiotherapists are not directly involve in respiratory care management. In mild to moderate cases advice about a post-acute care breathing exercises, other musculoskeletal exercises, bed positioning and pressure sore care are helpful. In Bangladesh medical care facilities are not adequate in corona care hospitals especially in peripheral medical college or hospital. Many patients are dying of shortage in oxygen supplies and lack of availability of ICU. Post discharged plans of comprehensive rehabilitation are grossly neglected in discharged certificate. Our national guidelines on corona management do not have any instructions on rehabilitation management at any point. The objectives of this fast review article on corona pandemic are to highlight the global scenario and our limitations in the rehabilitation management of COVID 19 patients particularly post discharged patients and patients with long COVID complications. J Bangladesh Coll Phys Surg 2022; 40: 52-56

New approaches to the question of training for the system of comprehensive rehabilitation and habilitation of disabled

The article reveals the issues of personnel training for the formation of a system of comprehensive rehabilitation and habilitation of disabled / disabled children, early assistance to children and their parents, accompanied living, social and vocational rehabilitation, psychological rehabilitation, technical means of rehabilitation of disabled people. The purpose and main task of our research is to study the issues of personnel training from the standpoint of regulatory, scientific, methodological and practice-oriented support. The presented materials are relevant and significant at the present time. In the light of the modernization of federal and regional legislative acts, the need to provide quality assistance to persons with disabilities is increasing, which in turn requires the training of highly qualified personnel. The materials of the article use statistical data on the needs of all constituent entities of the Russian Federation in the preparation of their leaders and leading specialists for the implementation of these types of activities. The study analyzes the need for training personnel for the education system, health care, and social protection. The value of the materials presented will make it possible to develop new technologies and approaches to the personnel training system. The areas of work given in the article are of great practical value and indicate that the technologies offered by Saint-Petersburg Postgraduate Institute of Medical experts, employees are effective and can be multiplied on the territory of the Russian Federation. In the process of further research, it is planned to develop professional standards for specialists in the education system, health care and social protection in the field of comprehensive rehabilitation and habilitation of disabled people / disabled children, early assistance to children and their parents, accompanied by living, social and vocational rehabilitation, psychological rehabilitation, technical means of rehabilitation disabled people.

Effect of a Comprehensive Rehabilitation Program for Community Women with Urinary Incontinence: A Retrospect Cohort Study

Urinary incontinence (UI) is a common problem affecting older adult women globally, but studies regarding combined treatments for all types of UI are still lacking. Here we evaluate the efficacy of a comprehensive rehabilitation program for women with UI. A comprehensive rehabilitation program was introduced that combines pelvic floor muscle (PFM) exercises, functional electrical stimulation, and timely biofeedback during the training process. Data of patients with stress (SUI), urgency (UUI), or mixed (MUI) urinary incontinence who participated in this program between 2016 and 2019 were reviewed retrospectively. Seventy-three subjects (mean age 59.2 ± 12.7 years) were enrolled. After 12 weeks of rehabilitation, vaginal pressure and control accuracy increased in all groups. PFM maximum recruitment increased significantly at week 12 in SUI and UUI, but not in MUI. At week 6, only the SUI group had achieved significant improvements in vaginal pressure, PFM maximum recruitment and control accuracy. The Short-form Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire-7 (IIQ-7) scores declined dramatically after the program started, and significant improvements were maintained to week 48. The comprehensive rehabilitation program is effective and decreases urinary leakage episodes and improves quality of life in women with UI, especially SUI.

Comprehensive Rehabilitation Outcome Measurement Scale (CROMS); Development and Preliminary Validation of An Interdisciplinary Measure for Rehabilitation Outcomes

Introduction: Comprehensive and interdisciplinary measurement of rehabilitation outcome is an essential part in the assessment and prognosis of a patient. This requires input from various disciplines working with the patient and the rehabilitation team. Moreover, the evaluation measures should consider the cultural compatibility, cost, and comprehensiveness of the contextual factors of the region and as of the country.Methods: The new tool was developed through consensus and followed Delphi process incorporating various rehabilitation professionals. The validity, reliability of the tool was tested on 30 patients and their rehabilitation professionals. The tool was also validated in two native languages and back translated considering the semantics. The construct validity was analyzed using interclass correlation co-efficient (ICC), internal consistency was analyzed using Cronbach’s alpha. Results: The final Comprehensive Rehabilitation Outcome Measurement Scale (CROMS) carries 30 items which can be completed by the person with disability and the professional team. The final tool holds an overall ICC of 0.93 with a Cronbach's Alpha of 0.92 for both patient and therapist reported measures. Conclusion: The 30 item CROMS is a reliable and valid tool that can potentially be used to evaluate functional independence of various patient populations.

Features of the organization of medical rehabilitation at the present stage

The development of rehabilitation at the present stage is one of the priorities in the field of health and social development. Not only medical organizations, but also other organizations can take part in carrying out medical rehabilitation activities. A prerequisite for the implementation of rehabilitation activities is the availability of a license for medical activity with an indication of medical rehabilitation work. Of great concern is the issue of staffing of medical organizations, especially primary care, by such specialists as a doctor of physical and rehabilitation medicine, a doctor of medical rehabilitation, a medical speech therapist, an ergorehabilitation specialist, etc. In the absence of these specialists in medical organizations, it is impossible to form interdisciplinary rehabilitation teams, and in their absence, the solution of medical rehabilitation issues is questionable. The article contains an analysis of the current legal framework for medical rehabilitation. The stages of medical rehabilitation in medical organizations are reflected in accordance with the scale of rehabilitation routing. Four groups of medical organizations carrying out medical rehabilitation have been identified. The shortcomings of the current legal framework for medical rehabilitation are indicated, since a comprehensive rehabilitation system is currently being formed in the Russian Federation. For its successful development and implementation in the practical activities of medical organizations and social institutions, a regulatory and legal framework is being developed and improved. The approved Procedure for the organization of medical rehabilitation will allow to systematize and organize this work at a qualitatively new level.

THE INFLUENCE OF COMPREHENSIVE REHABILITATION MEASURES COMBINED WITH THE OSTEOPATHIC TREATMENT ON THE BALANCE FUNCTION COEFFICIENT IN CHILDREN SUFFERING FROM CEREBRAL PALSY

The article highlights the study records on the infl uence of comprehensive rehabilitation measures combined with osteopathic treatment on the balance function quality in children suff ering from cerebral palsy. The study involved children aged 7 to 12 with spastic diplegia (level II according to GMFCS), intact intelligence, and the ability to move independently without technical devices. The study showed that, if the osteopathic treatment was included in the set of rehabilitation measures, the quality of life and postural control in the upright position improved in children, the latter manifested itself in an increased indicator of the balance function quality.