Abstract
Background: There are several recommendations for the role of a physiotherapy program (PTP) in patients with COVID-19. However, the role of PTP in COVID-19 patients with mild to moderate severity during their hospital stay remains limited. In addition, there are lack of studies on the effects of telerehabilitation in COVID-19 after discharge from the hospital. Thus, these are the reason for the current study. Objectives: 1) to determine the feasibility, safety, and effect of PTP programs in acute phase of COVID-19 patients, and 2) to investigate the effect of home-based telerehabilitation (HBT) in COVID-19 patients after discharge from the hospital. Study design: This research was a quasi-experimental study design Methods: This study comprised of two phases. Phase I (In-patient phase): Fifty-two participants were equally assigned into two groups matched on gender and age (1:1 ratio). Most of participants were identified as mild to moderate severity of disease. Experimental Group one (Ex-G1) and Experimental Group two (Ex-G2) received 1-2 times and once a day of PTP, respectively. Outcome measures included the survival and mortality rates, length of hospitalization (LoH), referrals to the intensive care unit (ICU), in-hospital complications, adverse events for patients and the physiotherapists Phase II (Out-patient phase): Participants in the control group (n = 26) were instructed to perform stretching exercises, breathing exercises, and their preferred general exercise program. Participants in experimental group (HBT) (n = 25) received aerobic exercise combined with resisted exercise and breathing exercise for 3 months. Participants in control and experimental group were called by the physiotherapists one time/ month, and one time/ week, respectively for monitoring their exercise program. The outcome measurement comprised of six minutes walk test (6MWT), one minute sit to stand (1MSTS), pulmonary function test (PFT), hand grip dynamometer, body composition, and quality of life (SF-36). Results: Phase I (In-patient phase): The overall survival rate was 98%. There was no difference in LoH between groups. One participant from the Ex-G2 was referred to the ICU. Two and four of the participants had complications in Ex-G1 and Ex-G2, respectively. There were no participants who had serious adverse events during and immediately after PTP. None of the physiotherapists tested positive for COVID-19 after performed bedside PTP. Phase II (Out-patient phase): None of participants of both groups reported of any adverse events during performed their exercise at home. There were no physical fitness components found significant differences between the group. 6MWT, and 1MSTS, were significantly increased compared to the baseline of both groups. Conclusions Phase I: The PTP is safe and feasible for COVID-19 patients in the acute phase, and safe for physiotherapists. A randomized controlled group should be confirmed the beneficial effects in the future. Phase II: The HBT is safe and feasible for patients with mild to moderate severity of COVID- 19. The higher degree of COVID-19 severity might have seen the differences in outcome measurements.
