Can the Effectiveness of Telerehabilitation Exercise Program Be Evaluated with Performance Tests in COVID 19 Patients? Pilot Study

Abstract

Aim: Covid 19 is an infection with multisystemic negative effects. Especially respiratory and musculoskeletal effects affect the physical performance of patients negatively and physiotherapy applications may be required for these patients. Physical performance evaluation is one of the main evaluation parameters in physiotherapy programs. Standard exercise capacity measurements may not be made in telerehabilitation exercise programs. In our study, the effectiveness of some performance tests performed online in Covid 19 cases in showing the physical performance changes of the cases was examined. Method: The subjects who have technological facilities suitable for smartphone access and who do not have health problems that may prevent them from exercising were randomly divided into 2 groups as Study Group (SG, n = 11) and Control Group (CG, n = 10). Online exercise program was applied to the study group for 6 weeks, 3 days a week. The exercise content consisted of breathing exercises, active breathing cycle techniques, range of motion and light aerobic exercise. Simple exercises that can be done at home and a brochure containing information about the disease were given to the control group. Study outcome measures were: Brief Physical Performance Battery (SPPB) scores, 30-Second Sitting and Standing Test (30STS) repetation, Visual analog scale fatigue score (VASf), and modified Medical Research Council (mMRC) dyspnea score. Results: Twenty-one patients, 81% male, with a mean age of 45.95 years were included in the study. Baseline data and demographic characteristics of the groups were similar except for mMRC. The baseline dyspnea level of the study group was higher (p = .012). There was a significant increase in SG's repetation count of 30STS at the end of 6 weeks (p = .016). Although there were numerical improvements in other parameters, no statistical difference was observed between the groups. Conclusion: The online exercise program has a positive effect on the physical performance status of Covid 19 cases. One of the performance tests, a significant improvement was detected in the 30STS duration. Despite the improvements in fatigue and dyspnea, no difference was observed in SPPB, which causes questioning the suitability of the test battery. On the other hand, the study is a pilot study. In order to obtain more meaningful results, studies involving more cases and evaluating different performance tests are needed.

Keywords

• exercise
• physiotherapy
• Physical Functional Performance
• sit to stand test

COVID 19 Hastalarında Telerehabilitasyon Egzersiz Programının Etkinliği Performans Testleri ile Değerlendirilebilir mi? Pilot Çalışma

Öz

Amaç: Covid 19, multisistemik negatif etkileri olan bir enfeksiyondur. Özellikle solunum ve kas-iskelet sistemi etkileri hastaların fiziksel performansını olumsuz yönde etkilemekte, bu hastalara fizyoterapi uygulamaları gerekebilmektedir. Fizyoterapi programlarında fiziksel performans değerlendirmesi ana değerlendirme parametrelerindendir. Fakat telerehabilitasyon egzersiz programlarında standart egzersiz kapasitesi ölçümleri yapılamayabilmektedir. Çalışmamızda Covid 19 olgularında online olarak gerçekleştirilen bazı performans testlerinin, olguların fiziksel performans değişimlerini göstermedeki etkinliği incelenmiştir. Gereç-yöntemler: Akıllı telefon erişimine uygun teknolojik imkanları olan ve egzersiz yapmalarını engelleyebilecek sağlık sorunları olmayan olgular rastgele Çalışma Grubu (ÇG, n=11) ve Kontrol Grubu (KG, n=10) olmak üzere 2 gruba ayrıldı. Çalışma grubuna çevrimiçi egzersiz programı 6 hafta boyunca, haftada 3 gün olacak biçimde uygulandı. Egzersiz içeriği nefes egzersizleri, aktif nefes döngüsü teknikleri, hareket açıklığı ve hafif aerobik egzersizden oluşmaktaydı. Kontrol grubuna ise evde yapılabilecek basit egzersizler ve hastalıkla ilgili bilgilendirme içerikli bir broşür verildi. Çalışma sonuç ölçütleri: Kısa Fiziksel Performans Bataryası (KFPB) puanı, 30 saniye otur kalk testi (30SOK) tekrar sayısı, Vizüel analog skalası yorgunluk puanı (VASy) ve modifiye Medical Research Council dispne skoru idi. Bulgular: Çalışmaya yaş ortalaması 45,95 yıl olan ve%81'i erkek olan 21 hasta dahil edildi. Grupların başlangıç verileri ve demografik özellikleri mMRC dışında benzerdi. Çalışma grubunun başlangıç dispne seviyesi daha yüksekti (p=.012). Altı haftanın sonunda ÇG’nin 30SOK tekrar sayısında artış vardı (p=.016). Diğer parametrelerde sayısal iyileşmeler olmakla birlikte, gruplar arasında istatistiksel bir fark gözlemlenmedi. Sonuç: Online egzersiz programının Covid 19 vakalarının fiziksel performansları üzerinde olumlu etkileri vardır. Performans testlerinden 30SOK süresinde anlamlı gelişme tespit edilmiştir. Yorgunluk ve dispnedeki iyileşmelere rağmen KSPB de bir fark gözlemlenmemiş olması, test bataryasının uygunluğunun sorgulanmasına neden olmaktadır. Diğer taraftan çalışma bir pilot çalışmadır. Daha anlamlı sonuçların elde edilebilmesi için daha fazla sayıda olgunun yer aldığı ve farklı performans testlerinin de değerlendirildiği çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• egzersiz
• fizyoterapi
• fiziksel fonksiyonel performans
• otur kalk test
• yorgunluk

Kaynakça

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