A recent randomized control study (April 2020) from China makes a strong case for respiratory rehabilitation for COVID-19 patients. There is also strong evidence for respiratory rehab for managing and improving various symptoms of COVID-19.
Given the evidence for respiratory rehabilitation, it should be an integral part of the treatment process of COVID-19 patients.
As we all know, COVID-19 impacts patients primarily through deterioration of lung function and breathing capabilities, usually manifesting as pneumonia, SARI (Severe Acute Respiratory Illness) and ARDS (Acute Respiratory Distress Syndrome).
Respiratory Rehab for Pneumonia
Respiratory rehabilitation has been shown to be effective for pneumonia cases as shown in this study[1] conducted at Jining No 1 People’s Hospital. Compared to the control group, the group which was administered respiratory rehabilitation showed an additional 11% increase in FEV1/FEVC ratio (for control group this increased from 41.22% to 71.15%, and for experimental group this increased from 39.59% to 82.09%). Similarly, 6 minutes walk distance (6MWD) increased from 214 to 304 meters in control group while in experimental group 6MWD increased from 221 meters to 412 meters.
Respiratory Rehab for Hospital Stay
A study[2] done in Taiwan showed that pulmonary rehabilitation shortens the length of hospital stay for patients from 11.54 days to 6.52 days. Such reduction in hospital stay effectively ensures that the same infrastructure can handle a larger number of patients. Similar conclusions were drawn in this study[3] as well which concluded that early rehabilitation can shorten the duration of mechanical ventilation and shorten the length of stay. A hospital with 100 beds availability could accommodate 260 patients with ALOS of 11.54 d. If the ALOS comes down to 6.53, the same hospital would be able to accommodate 460 patients (a 76% increase).
Respiratory Rehabilitation for Covid-19
The most recent study on respiratory rehabilitation and its impact on COVID-19 patients comes from Hainan General Hospital[4]. This randomized controlled study investigates the effect of a 6 week respiratory rehabilitation program on respiratory function, QOL, mobility and psychological function in elderly patients with COVID-19. In the intervention group (who were provided with respiratory rehabilitation along with conventional treatment), FEV1/FEVC increased from 60.48% to 68.19%, while in control group, this increased from 60.44% to 61.23%. 6MWD increased from 162.7 m to 212.3 m for patients who received respiratory rehab while the increase was 155.7 m to 157.2 m in the group which didn’t receive the rehabilitation. Similar gains were observed in quality of life (SF-36) indicators.
Conclusion: Research evidence for Respiratory Rehab
It is evident that respiratory rehabilitation (or pulmonary rehab) makes a significant improvement in the outcomes for the patients with COVID-19. It may reduce the probability of need for intubation and with potential for reduction in ALOS, it can effectively increase the capacity of existing healthcare infrastructure. Every bed or ventilator which is not used, is an additional resource for another patient.
Research References:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122419/
[2] http://rc.rcjournal.com/content/63/Suppl_10/2960301
