Impacto da reabilitação abrangente na capacidade funcional, fadiga e qualidade de vida entre sobreviventes de COVID-19 de longo prazo em ambientes com recursos limitados - um ensaio clínico randomizado
DOI:
https://doi.org/10.17267/2238-2704rpf.2024.e5840Palavras-chave:
Tolerância ao Exercício, Fadiga, Qualidade de Vida Relacionada à Saúde, COVID LongaResumo
INTRODUÇÃO: Meses ou mesmo anos após a infecção por COVID 19, os pacientes sofriam de sintomas persistentes. O presente estudo teve como objetivo avaliar o impacto da reabilitação abrangente na capacidade funcional, fadiga e qualidade de vida em sobreviventes de longo prazo da COVID-19 em ambientes com recursos limitados. MATERIAIS E MÉTODOS: Reabilitação abrangente composta por exercícios aeróbicos, de força, de equilíbrio, de flexibilidade, de exercícios respiratórios e de educação foi administrada em ambientes de poucos recursos a pacientes com idade entre 25 e 60 anos com diagnóstico de COVID longa neste ensaio clínico randomizado. Capacidade funcional (avaliada pelo teste de caminhada de seis minutos), fadiga (avaliada pela escala de gravidade da fadiga) e qualidade de vida (avaliada pelo EQ-5D-5L) foram documentadas no início do estudo e após seis semanas de intervenção (n=19) e grupos controle (n=19). As variáveis categóricas foram relatadas como porcentagens e as variáveis contínuas como média e desvio padrão (DP). O teste t independente foi utilizado para comparação entre grupos e o teste t pareado para comparação dentro do grupo para estabelecer a significância estatística. Um valor de p < 0,05 foi considerado estatisticamente significativo. Foram realizadas análises de tamanho de efeito e poder post hoc. Os tamanhos de efeito foram interpretados de acordo com a classificação de Cohen. RESULTADOS: Melhorias significativas foram observadas na fadiga (p = 0,006, tamanho do efeito = -1,23), pontuações do índice EQ-5D-5L (p = 0,007, tamanho do efeito = -0,73), pontuações da escala visual analógica EQ-5D (p = 0,002, tamanho do efeito = 1,09) e distância percorrida no teste de caminhada de seis minutos (p < 0,0001, tamanho do efeito = 1,37) após o programa de reabilitação. CONCLUSÃO: A reabilitação abrangente em ambientes com poucos recursos melhora efetivamente a qualidade de vida, reduz a fadiga e melhora a capacidade funcional entre os sobreviventes de longa prazo da COVID-19.
Downloads
Referências
(1) Nalbandian A, Sehgal K, Gupta A, Madhavan MV, McGroder C, Stevens JS, et al. Post-acute COVID-19 syndrome. Nat Med. 2021;27(4):601-15. https://doi.org/10.1038/s41591-021-01283-z DOI: https://doi.org/10.1038/s41591-021-01283-z
(2) Fernández-de-Las-Peñas C, Palacios-Ceña D, Gómez-Mayordomo V, Florencio LL, Cuadrado ML, Plaza-Manzano G, et al. Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis. Eur J Intern Med. 2021;92:55-70. https://doi.org/10.1016/j.ejim.2021.06.009 DOI: https://doi.org/10.1016/j.ejim.2021.06.009
(3) Huang L, Li X, Gu X, Zhang H, Ren L, Guo L, et al. Health outcomes in people 2 years after surviving hospitalisation with COVID-19: a longitudinal cohort study. Lancet Respir Med. 2022;10(9):863-76. https://doi.org/10.1016/S2213-2600(22)00126-6 DOI: https://doi.org/10.1016/S2213-2600(22)00126-6
(4) Westerlind E, Palstam A, Sunnerhagen KS, Persson HC. Patterns and predictors of sick leave after Covid-19 and long Covid in a national Swedish cohort. BMC Public Health. 2021;21(1):1023. https://doi.org/10.1186/s12889-021-11013-2 DOI: https://doi.org/10.1186/s12889-021-11013-2
(5) Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol. 2023;21(3):133-46. https://doi.org/10.1038/s41579-022-00846-2 DOI: https://doi.org/10.1038/s41579-022-00846-2
(6) Bonilla H, Peluso MJ, Rodgers K, Aberg JA, Patterson TF, Tamburro R, et al. Therapeutic trials for long COVID-19: A call to action from the interventions taskforce of the RECOVER initiative. Front Immunol. 2023;14:1129459. https://doi.org/10.3389/fimmu.2023.1129459 DOI: https://doi.org/10.3389/fimmu.2023.1129459
(7) Nopp S, Moik F, Klok FA, Gattinger D, Petrovic M, Vonbank K, et al. Outpatient Pulmonary Rehabilitation in Patients with Long COVID Improves Exercise Capacity, Functional Status, Dyspnea, Fatigue, and Quality of Life. Respiration. 2022;101(6):593-601. https://doi.org/10.1159/000522118 DOI: https://doi.org/10.1159/000522118
(8) Mammi P, Ranza E, Rampello A, Ravanetti D, Cavaldonati A, Moretti S, et al. Post-COVID-19 Ongoing Symptoms and Health-Related Quality of Life: Does Rehabilitation Matter?: Preliminary Evidence. Am J Phys Med Rehabil. 2023;102(3):241-44. https://doi.org/10.1097/PHM.0000000000002089 DOI: https://doi.org/10.1097/PHM.0000000000002089
(9) Paul BS, Singh A, Jain D, et al. Assessment of fatigue in Parkinson's disease: Indian perspective. Ann Indian Acad Neurol. 2016;19(4):451-55. https://doi.org/10.4103/0972-2327.194419 DOI: https://doi.org/10.4103/0972-2327.194419
(10) EuroQol. EQ-5D-5L [Internet]. EuroQol; 2023. Available from: https://euroqol.org/information-and-support/euroqol-instruments/eq-5d-5l/.
(11) Holland AE, Spruit MA, Troosters T, Puhan MA, Pepin V, Saey D, et al. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1428-46. https://doi.org/10.1183/09031936.00150314 DOI: https://doi.org/10.1183/09031936.00150314
(12) Vaish H, Chorsiya V. Influence of parity on six-minute walk test in Indian females. Health Care Women Int. 2023;44(6):753-63. https://doi.org/10.1080/07399332.2022.2129642 DOI: https://doi.org/10.1080/07399332.2022.2129642
(13) Chandrasekaran B, Reddy KC. Six-Minutemwalk test as a guide for walking prescription for patients with chronic obstructive pulmonary diseases. Indian J Respir Care. 2018;7(2):73-6. https://doi.org/10.4103/ijrc.ijrc_19_17 DOI: https://doi.org/10.4103/ijrc.ijrc_19_17
(14) Lung Foundation Australia. Location of Training Program | Pulmonary Rehabilitation Toolkit [Internet]. Lung Foundation Austrália; 2009. Available from: https://pulmonaryrehab.com.au/
(15) Wiskemann J, Dreger P, Schwerdtfeger R, Bondong A, Huber G, Kleindienst N, et al. Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation. Blood. 2011;117(9):2604-13. https://doi.org/10.1182/blood-2010-09-306308 DOI: https://doi.org/10.1182/blood-2010-09-306308
(16) Borghetti P, Branz J, Volpi G, Pancera S, Buraschi R, Bianchi LNC, et al. Home-based pulmonary rehabilitation in patients undergoing (chemo)radiation therapy for unresectable lung cancer: a prospective explorative study. Radiol Med. 2022;127(12):1322-32. https://doi.org/10.1007/s11547-022-01562-w DOI: https://doi.org/10.1007/s11547-022-01562-w
(17) Sullivan GM, Feinn R. Using Effect Size-or Why the P Value Is Not Enough. J Grad Med Educ. 2012 Sep;4(3):279-82. https://doi.org/10.4300/jgme-d-12-00156.1 DOI: https://doi.org/10.4300/JGME-D-12-00156.1
(18) Ramanathan RP, Chandrasekaran B. Reference equations for 6-min walk test in healthy Indian subjects (25-80 years). Lung India. 2014;31(1):35-38. https://doi.org/10.4103/0970-2113.125892 DOI: https://doi.org/10.4103/0970-2113.125892
(19) mMRC (Modified Medical Research Council). Dyspnea Scale [Internet]. mMRC; 2023. Available from: https://www.mdcalc.com/calc/4006/mmrc-modified-medical-research-council-dyspnea-scale.
(20) Sheoran M, Vaish H. Thirty second sit to stand test performance in community dwelling geriatric population: a cross-sectional study. J Physiother Res. 2022;12:e4600. https://doi.org/10.17267/2238-2704rpf.2022.e4600 DOI: https://doi.org/10.17267/2238-2704rpf.2022.e4600
(21) Podder V, Nagarathna R, Anand A, Patil SS, Singh AK, Nagendra HR. Physical Activity Patterns in India Stratified by Zones, Age, Region, BMI and Implications for COVID-19: A Nationwide Study. Ann Neurosci. 2020;27(3-4):193-203. https://doi.org/10.1177/0972753121998507 DOI: https://doi.org/10.1177/0972753121998507
(22) Wootton SL, Ng LWC, McKeough ZJ, Jenkins S, Hill K, Eastwood PR, et al. Ground-based walking training improves quality of life and exercise capacity in COPD. Eur Respir J. 2014;44(4):885-94. https://doi.org/10.1183/09031936.00078014 DOI: https://doi.org/10.1183/09031936.00078014
(23) Bohannon RW, Crouch R. Minimal clinically important difference for change in 6-minute walk test distance of adults with pathology: a systematic review. J Eval Clin Pract. 2017;23(2):377–81. https://doi.org/10.1111/jep.12629 DOI: https://doi.org/10.1111/jep.12629
(24) Frisk B, Jürgensen M, Espehaug B, Njøten KL, Søfteland E, Aarli BB, et al. A safe and effective micro-choice based rehabilitation for patients with long COVID: results from a quasi-experimental study. Sci Rep. 2023;13(9423):1-10. https://doi.org/10.1038/s41598-023-35991-y DOI: https://doi.org/10.1038/s41598-023-35991-y
(25) Goërtz YMJ, Van Herck M, Delbressine JM, Vaes AW, Meys R, Machado FVC, et al. Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome?. ERJ Open Res. 2020;6(4):1-10. https://doi.org/10.1183/23120541.00542-2020 DOI: https://doi.org/10.1183/23120541.00542-2020
(26) Yang Y, Wei L, Wang S, Ke L, Zhao H, Mao J, et al. The effects of pursed lip breathing combined with diaphragmatic breathing on pulmonary function and exercise capacity in patients with COPD: a systematic review and meta-analysis. Physiother Theory Pract. 2022;38(7):847-57. https://doi.org/ 10.1080/09593985.2020.1805834 DOI: https://doi.org/10.1080/09593985.2020.1805834
(27) Vaish H. Is Digital Technology the Solution for Pulmonary Rehabilitation in Developing Countries During the COVID-19 Pandemic?. Turk Thorac J. 2021;22(2):186-7. https://doi.org/10.5152/TurkThoracJ.2021.2022 DOI: https://doi.org/10.5152/TurkThoracJ.2021.20224
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2024 Digvijay Sharma, Hina Vaish
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
Esta obra está licenciada com uma Licença Creative Commons Atribuição 4.0 Internacional.
