Post-COVID-19 Telerehabilitation Program Improves Dyspnea, QOL, and More

A telemedicine post-COVID-19 rehabilitation program using dyspnea control techniques and mindfulness was linked to improvements in arterial blood oxygen saturation, respiratory rate (RR), heart rate (HR), dyspnea, anxiety, and quality of life. These were among study findings published in Therapeutic Advances in Respiratory Disease.

Investigators in Spain conducted a quasi-experimental, prospective, longitudinal, nonrandomized study of the effectiveness of the Respiratory Telerehabilitation Program, a program led by a specialized physical therapy professional via a web platform during the COVID-19 pandemic. The study was conducted in Spain in April 2020, before COVID-19 vaccines were available.

All study participants were in the postinfection phase of COVID-19, experiencing a dyspnea sensation, and were 10 days from the last positive polymerase chain reaction test. Participants in the intervention group (n=50) were asked to use the program’s web platform 3 times per week for 10 total online sessions as part of a group of 20 participants.

Outcome measures included RR, HR, and percutaneous oxygen saturation (SpO₂), measured with a pulse oximeter. Mahler’s Dyspnea Index (MDI) was used to measure functional dyspnea, anxiety was assessed with the State-Trait Anxiety Inventory (STAI), and quality of life was assessed with the European Quality-of-Life 5 dimensions questionnaire (EQ-5D).

The investigators compared program participants’ outcomes to a control group of patients (n=50) on the program’s waiting list, who were given the opportunity to take part in the program after the study was over. Study participants had a median age of 49 years (interquartile range, 38-55.75), and 69% were women. The youngest participant was aged 22 years, and the oldest was 80 years old.

Regarding pre-post comparative analyses in the intervention and control groups, participants in the control group improved in all variables, although the differences were not statistically significant except for functional dyspnea (P =.001) and quality of life (P =.043).

In pre–post comparative analyses in the intervention group, statistically significant improvement occurred in all variables, including state anxiety (P <.001), trait anxiety (P =.004), quality of life (P <.001), functional dyspnea (P <.001), RR (P <.001), SpO₂ (P <.001), and HR (P <.001). Dyspnea was rated 7 to 10 points postintervention.

When the percentage changes in pre-post intervention were compared between the 2 groups, statistically significant differences were found in all outcomes in favor of the intervention group. The largest percentage change was for RR (-33.33% for intervention group vs -4.76% in the control group). The median percentage change in dyspnea was 30.95% in the intervention group vs 10% in the control group, and the change in quality of life was 26.19 in the intervention group vs 0 in the control group. For the control group, the median percentage change was 0 for trait anxiety, state anxiety, quality of life, and SpO₂.

Study limitations included lack of disease stratification; inclusion of only postacute patients with mild to critical disease; and lack of assessment of exercise capacity and other variables requiring an in-person presence.

“Our results show that participants who completed the telerehabilitation program based on dyspnea control techniques and mindfulness statistically improved the variables of arterial blood oxygen saturation, RR, heart rate, dyspnea, anxiety, and quality of life,” the study authors concluded. “Telemedicine provides adequate care for patients, transcending local health care systems’ limitations, social distance, and reaching remote environments with no easy access to this specialized attention,” stated the researchers.