Physical activity, psychosocial status, and sleep quality in COVID-19 survivors following telerehabilitation: A prospective intervention and follow-up study

Abstract

Purpose: Coronavirus disease (COVID-19) has a negative impact on physical activity, anxiety, depression, sleep, and overall quality of life (QoL). Tele-rehabilitation offers an alternative when rehabilitation is not possible. The study was aimed to explore the impact of telerehabilitation on the physical activity, psychosocial status, sleep quality, QoL, and daily activities of living (ADLs) of COVID-19 survivors. Methods: During the pandemic, twenty individuals who were hospitalized due to COVID-19 and subsequently discharged participated in a 12-week telerehabilitation program that included an exercise brochure and telephone calls. The data were collected using Google Forms at discharge and at the 1st, 2nd, 3rd, and 6th months after discharge. The International PA Questionnaire (IPAQ) was used to assess physical activity, while the Hospital Anxiety and Depression Scale (HADS) was used to determine psychosocial status. For sleep quality assessment, the Pittsburgh Sleep Quality Index (PSQI) was used. The Nottingham Health Profile (NHP) was used to assess QoL and the Barthel Index (BI) for ADLs. Results: There was a significant increase in IPAQ total score after telerehabilitation [discharge vs. 3rd month (p=0.006)], with the similarity in IPAQ total score at 3rd vs. 6th months (p>0.007). The HADS anxiety score decreased significantly over its time course compared with the discharge (p<0.007). The PSQI global score significantly decreased after telerehabilitation (p<0.05). NHP and BI scores were not different among assessment periods (p>0.007). Conclusion: In individuals hospitalized due to COVID-19, a 12-week telerehabilitation program after discharge may have contributed to an increase in physical activity levels and helped maintain these levels during the following three months. Our findings suggest that telerehabilitation may be potentially beneficial in supporting physical activity, reducing symptoms of anxiety and depression, and improving sleep quality in COVID-19 survivors. However, further studies including a control group are needed to validate these results.

Keywords

• COVID-19
• Quality of life
• Physical activity
• Sleep quality
• Telerehabilitation

COVID-19 geçirenlerde telerehabilitasyon sonrası fiziksel aktivite, psikososyal durum ve uyku kalitesi: Prospektif müdahale ve izlem çalışması

Abstract

Amaç: Koronavirüs hastalığı (COVID-19), fiziksel aktivite, anksiyete, depresyon, uyku ve genel yaşam kalitesi üzerinde olumsuz etkilere neden olur. Telerehabilitasyon, yüz yüze rehabilitasyonun bir alternatifi olabilir. Bu çalışmada, COVID-19 nedeni ile hastaneye yatırılan bireylerde, taburculuk sonrası uygulanan telerehabilitasyonun fiziksel aktivite, psikososyal durum, uyku kalitesi, yaşam kalitesi ve günlük yaşam aktiviteleri (GYA) üzerindeki etkisini araştırmayı amaçlandı. Yöntem: Pandemi sırasında, COVID-19 nedeni ile hastaneye yatan ve taburcu olan yirmi kişi, egzersiz broşürü ve telefon görüşmeleri kullanılarak gerçekleştirilen 12 haftalık telerehabilitasyon programına dahil edildi. Veriler, taburculukta ve taburculuk sonrası 1., 2., 3. ve 6. aylarda Google Formlar kullanılarak toplandı. Fiziksel aktivite Uluslararası Fiziksel Aktivite Anketi (IPAQ); psikososyal durum Hastane Anksiyete ve Depresyon Ölçeği (HADS) ile değerlendirildi. Uyku kalitesinin değerlendirilmesinde Pittsburgh Uyku Kalitesi Endeksi (PSQI) kullanıldı. Yaşam kalitesi Nottingham Sağlık Profili (NHP); GYA Barthel İndeksi (BI) ile değerlendirildi. Bulgular: Telerehabilitasyon sonrası IPAQ toplam puanı 3. ayda taburculuğa göre anlamlı olarak artarken (p=0,006), 3. ve 6. ay IPAQ toplam puanları benzerdi (p>0,007). HADS anksiyete puanı, taburculuğa göre zaman içinde anlamlı olarak azaldı (p<0,007). PSQI global puanı, telerehabilitasyon sonrası anlamlı olarak azaldı (p<0,05). NHP ve BI skorları açısından değerlendirme dönemleri arasında farklılık saptanmadı (p>0,007). Sonuç: COVID-19 nedeni ile hastaneye yatırılan bireylerde, taburculuk sonrası uygulanan 12 haftalık telerehabilitasyon programı, fiziksel aktivite düzeyinde artış sağlayarak, bunu takip eden üç ay boyunca fiziksel aktivite düzeyinin korunmasına katkıda bulunmuş olabilir. Bulgularımız, telerehabilitasyonun COVID-19 geçiren bireylerde fiziksel aktiviteyi destekleme, anksiyete ve depresyon semptomlarını azaltma ve uyku kalitesini artırma açısından faydalı olabileceğini göstermektedir. Elde edilen bu sonuçların doğrulanabilmesi için kontrol grubu dahil edilerek yapılacak ileri çalışmalara ihtiyaç vardır.

Keywords

• COVID-19
• Yaşam kalitesi
• Fiziksel aktivite
• Uyku kalitesi
• Telerehabilitasyon

References

1. 1. T.C. Sağlık Bakanlığı. [COVID-19 (SARS-CoV2 Enfeksiyonu) Rehberi 2020. Erişim tarihi: 16 Temmuz 2020.
2. 2. Cortes-Telles A, Lopez-Romero S, Figueroa-Hurtado E, et al. Pulmonary function and functional capacity in COVID-19 survivors with persistent dyspnoea. Respir Physiol Neurobiol. 2021;288:103644.
3. 3. Inal-Ince D, Vardar-Yagli N, Saglam M, et al. COVID-19 enfeksiyonunda akut ve post-akut fizyoterapi ve rehabilitasyon. Turk J Physiother Rehabil. 2020;31:81-93.
4. 4. Ambrosino N, Fracchia C. The role of tele-medicine in patients with respiratory diseases. Expert Rev Respir Med. 2017;11:893-900.
5. 5. Galea MD. Telemedicine in rehabilitation. Phys Med Rehabil Clin. 2019;30:473-483.
6. 6. World Health Organization. Global recommendations on physical activity for health. 2010.
7. 7. Peçanha T, Goessler KF, Roschel H, et al. Social isolation during the COVID-19 pandemic can increase physical inactivity and the global burden of cardiovascular disease. Am J Physiol Heart Circ Physiol. 2020;318:1441-1446.
8. 8. Altena E, Baglioni C, Espie CA, et al. Dealing with sleep problems during home confinement due to the COVID-19 outbreak: Practical recommendations from a task force of the European CBT-I Academy. J Sleep Res. 2020;29:e13052.

9. 9. Vitacca M, Carone M, Clini EM, et al. Joint statement on the role of respiratory rehabilitation in the COVID-19 crisis: The Italian position paper. Respiration. 2020;99:493-499.
10. 10. World Health Organization. Living guidance for clinical management of COVID-19: living guidance. Erişim tarihi: 23 Kasım 2021.
11. 11. Bestall JC, Paul EA, Garrod R, et al. Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax. 1999;54:581-586
12. 12. Craig CL, Marshall AL, Sjostrom M, et al. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc. 2003;35:1381-1395.
13. 13. Saglam M, Arikan H, Savci S, et al. International physical activity questionnaire: reliability and validity of the Turkish version. Percept Mot Skills. 2010;111:278-284.
14. 14. Abate Daga F, Agostino S, Peretti S, et al. COVID-19 nationwide lockdown and physical activity profiles among North-western Italian population using the International Physical Activity Questionnaire (IPAQ). Sport Sci Health. 2021;17:1-6.
15. 15. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361-370.
16. 16. Aydemir O. Hastane Anksiyete ve Depresyon Ölçeği Türkçe formunun geçerlilik ve güvenilirliği. Turk Psikiyatri Derg. 1997;8:187-280.
17. 17. Agargun M. Pittsburgh Uyku Kalitesi İndeksinin geçerliği ve güvenirliği. Turk Psikiyatri Derg. 1996;7:107-115.
18. 18. Kücükdeveci A, McKenna S, Kutlay S, et al. The development and psychometric assessment of the Turkish version of the Nottingham Health Profile. Int J Rehabil Res. 2000;23:31-38.
19. 19. Kucukdeveci AA, Yavuzer G, Tennant A, et al. Adaptation of the modified Barthel Index for use in physical medicine and rehabilitation in Turkey. Scand J Rehabil Med. 2000;32:87-92.
20. 20. Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J. 1965;14:61-65.
21. 21. Pehlivan E, Palali I, Gayretli-Atan S,et al. The effectiveness of post-discharge telerehabilitation practices in COVID-19 patients: Tele-COVID study-randomized controlled trial. Ann Thorac Med. 2022;17:110-117
22. 22. Li J, Xia W, Zhan C, et al. A telerehabilitation programme in post-discharge COVID-19 patients (TERECO): A randomised controlled trial. Thorax. 2022;77:697-706.
23. 23. Lundell S, Holmner Å, Rehn B, Nyberg A, Wadell K. Telehealthcare in COPD: A systematic review and meta-analysis on physical outcomes and dyspnea. Respir Med. 2015;109:11-26.
24. 24. McDonough DJ, Helgeson MA, Liu W, et al. Effects of a remote, YouTube-delivered exercise intervention on young adults' physical activity, sedentary behavior, and sleep during the COVID-19 pandemic: Randomized controlled trial. J Sport Health Sci. 2022;11:145-156.
25. 25. Lai C-Y, Lin C-H, Chao T-C, et al. Effectiveness of a 12-week telerehabilitation training in people with long COVID: A randomized controlled trial. Ann Phys Rehabil Med. 2024;67:101853.
26. 26. Chiang S-L, Shen C-L, Lee M-S, et al. Effectiveness of a 12-week tele-exercise training program on cardiorespiratory fitness and heart rate recovery in patients with cardiometabolic multimorbidity. Worldviews Evid Based Nurs. 2023;20:339-350.
27. 27. Jennings G, Monaghan A, Xue F, et al. A systematic review of persistent symptoms and residual abnormal functioning following acute COVID-19: Ongoing symptomatic phase vs. post-COVID-19 syndrome. J Clin Med. 2021;10:5913.
28. 28. Carek PJ, Laibstain SE, Carek SM. Exercise for the treatment of depression and anxiety. Int J Psychiatry Med. 2011;41:15-28.
29. 29. Viana RB, de Lira CAB. Exergames as coping strategies for anxiety disorders during the COVID-19 quarantine period. Games Health J. 2020;9:147-149.
30. 30. De Araujo Furtado PL, do Socorro Brasileiro-Santos M, de Mello BLC, et al. The effect of telerehabilitation on physical fitness and depression/anxiety in post-COVID-19 patients: A randomized controlled trial. Int J Telerehabil. 2023;15:e6560.
31. 31. Bricca A, Harris LK, Jäger M, et al. Benefits and harms of exercise therapy in people with multimorbidity: A systematic review and meta-analysis of randomised controlled trials. Ageing Res Rev. 2020;63:101166.
32. 32. Dalbosco-Salas M, Torres-Castro R, Rojas Leyton A, et al. Effectiveness of a primary care telerehabilitation program for Post-COVID-19 patients: A feasibility study. J Clin Med. 2021;10.
33. 33. Nambi G, Abdelbasset WK, Alrawaili SM, et al. Comparative effectiveness study of low versus high-intensity aerobic training with resistance training in community-dwelling older men with post-COVID 19 sarcopenia: A randomized controlled trial. Clin Rehabil. 2022;36:59-68.
34. 34. Amdal CD, Taylor K, Kulis D, et al. Health-related quality of life in patients with COVID-19; international development of a patient-reported outcome measure. J Patient Rep Outcomes. 2022;6:26.
35. 35. Belli S, Balbi B, Prince I, et al. Low physical functioning and impaired performance of activities of daily life in COVID-19 patients who survived hospitalisation. Eur Respir J. 2020;56.
36. 36. Curci C, Negrini F, Ferrillo M, et al. Functional outcome after inpatient rehabilitation in postintensive care unit COVID-19 patients: findings and clinical implications from a real-practice retrospective study. Eur J Phys Rehabil Med. 2021;57:443-450.
37. 37. Calik Kutukcu E, Cakmak A, Kinaci E, et al. Reliability and validity of the Turkish version of Post-COVID-19 Functional Status Scale. Turk J Med Sci. 2021;51:2304-2310.
38. 38. Klok FA, Boon G, Barco S, et al. The Post-COVID-19 Functional Status scale: a tool to measure functional status over time after COVID-19. Eur Respir J. 2020;56.