Evaluating the Efficiency of Breathing Exercises via Telemedicine in Post-Covid-19 Patients: Randomized Controlled Study

Abstract

The aim of the study was to evaluate the effectiveness of breathing exercises given by telemedicine in post-Covid-19 dyspneic individuals. Individuals in the intervention group (n: 26) were asked to perform breathing exercise three times a day for 5 weeks (one session performed via telemedicine each week). Individuals in the control group (n: 26) were given a brochure explaining the exercises. The St George’s Respiratory Questionnaire, Pulmonary function tests, and six-minute-walk-tests were administered to all individuals at the beginning and end of the study. The posttest FEV1, FVC, MVV values were significantly higher than the pretest values in the intervention group (p₂ < .001) whereas no significant differences were found in the control group. Six-minute-walk-distance increased by 54.27 m in the intervention group and 4.69 m in the control group. With breathing exercise training applied through telemedicine, improvements were observed in the pulmonary functions, quality of life, and exercise capacities of dyspneic post-Covid-19 individuals.

Keywords

breathing exercise Covid-19 nursing telemedicine

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References

Akinci

A. C.

Olgun

(2011). The effectiveness of nurse-led, home-based pulmonary rehabilitation in patients with COPD in Turkey. Rehabilitation Nursing, 36(4), 159–165. https://doi.org/10.1002/j.2048-7940.2011.tb00084.x

Al Chikhanie

Veale

Schoeffler

Pépin

J. L.

Verges

Hérengt

(2021). Effectiveness of pulmonary rehabilitation in COVID-19 respiratory failure patients post-ICU. Respiratory Physiology & Neurobiology, 287, 103639. https://doi.org/10.1016/j.resp.2021.103639

Alison

J. A.

McKeough

Z. J.

Johnston

McNamara

R. J.

Spencer

L. M.

Jenkins

S. C.

Hill

C. J.

McDonald

V. M.

Frith

Cafarella

Brooke

Cameron-Tucker

H. L.

Candy

Cecins

Chan

A. S. L.

Dale

M. T.

Dowman

L. M.

Granger

Halloran

Holland

A. E.

; On behalf of the Lung Foundation Australia and the Thoracic Society of Australia and New Zealand. (2017). Australian and New Zealand pulmonary rehabilitation guidelines. Respirology, 22(4), 800–819. https://doi.org/10.1111/resp.13025

American Thoracic Society. (2002). American Thoracic Society Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories ATS statement: Guidelines for the six–minute walk test. American Journal of Respiratory and Critical Care Medicine, 166(1), 111–1117. https://doi.org/10.1164/ajrccm.166.1.at1102

Bestall

J. C.

Paul

E. A.

Garrod

Garnham

Jones

P. W.

Wedzicha

J. A.

(1999). Usefulness of the Medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax, 54(7), 581–586. https://doi.org/10.1136/thx.54.7.581

Bryant

M. S.

Fedson

S. E.

Sharafkhaneh

(2020). Using telehealth cardiopulmonary rehabilitation during the COVID-19 pandemic. Journal of Medical Systems, 44(7), 125. https://doi.org/10.1007/s10916-020-01593-8

Chen

K. Y.

Gong

F. H.

Zhang

J. S.

X. K.

(2020). Predictors of health-related quality of life and influencing factors for COVID-19 patients, a follow-up at one month. Frontiers in Psychiatry, 11, 668. https://doi.org/10.3389/fpsyt.2020.00668

Daynes

Gerlis

Briggs-Price

Jones

Singh

S. J.

(2021). COPD assessment test for the evaluation of COVID-19 symptoms. Thorax, 76(2), 185–187. https://doi.org/10.1136/thoraxjnl-2020-215916

Figarska

S. M.

Boezen

H. M.

Vonk

J. M.

(2012). Dyspnea severity, changes in dyspnea status and mortality in the general population: The Vlagtwedde/Vlaardingen study. European Journal of Epidemiology, 27(11), 867–876. https://doi.org/10.1007/s10654-012-9736-0

10.

Gattinoni

Chiumello

Rossi

(2020). COVID-19 pneumonia: ARDS or not? Critical Care, 24(1), 1–3. https://doi.org/10.1186/s13054-020-02880-z

11.

Gonzalez-Gerez

J. J.

Saavedra-Hernandez

Anarte-Lazo

Bernal-Utrera

Perez-Ale

Rodriguez-Blanco

(2021). Short-term effects of a respiratory telerehabilitation program in confined COVID-19 patients in the acute phase: A pilot study. International Journal of Environmental Research and Public Health, 18(14), 7511. https://doi.org/10.3390/ijerph18147511

12.

Graham

B. L.

Steenbruggen

Miller

M. R.

Barjaktarevic

I. Z.

Cooper

B. G.

Hall

G. L.

Hallstrand

T. S.

Kaminsky

D. A.

McCarthy

McCormack

M. C.

Oropez

C. E.

Rosenfeld

Stanojevic

Swanney

M. P.

Thompson

B. R.

(2019). Standardization of spirometry 2019 update. An official American Thoracic Society and European Respiratory Society Technical Statement. American Journal of Respiratory and Critical Care Medicine, 200(8), e70–e88. https://doi.org/10.1164/rccm.201908-1590ST

13.

Greenhalgh

Knight

A’Court

Buxton

Husain

(2020). Management of post-acute covid-19 in primary care. BMJ, 370(3026), 1–8. https://doi.org/10.1136/bmj.m3026

14.

Hsu

K. Y.

Lin

J. R.

Lin

M. S.

Chen

Y. J.

Yan

Y. H.

(2013). The modified Medical Research Council dyspnoea scale is a good indicator of health-related quality of life in patients with chronic obstructive pulmonary disease. Singapore Medical Journal, 54(6), 321–327. https://doi.org/10.11622/smedj.2013125

15.

Hui

Tsang

(2008). SARS: Sequelae and implications for rehabilitation. In Peiris

Anderson

L. J.

Osterhaus

A. D. M. E.

Stohr

Yuen

(Eds.), Severe acute respiratory syndrome (pp. 36–41). Blackwell.

16.

Jones

P. W.

Quirk

F. H.

Baveystock

C. M.

(1991). The St George’s respiratory questionnaire. Respiratory Medicine, 85, 25–31. https://doi.org/10.1016/s0954-6111(06)80166-6

17.

Jones

P. W.

Quirk

F. H.

Baveystock

C. M.

Littlejohns

(1992). A self-complete measure of health status for chronic airflow limitation. The St. George’s Respiratory Questionnaire. American Review of Respiratory Disease, 145(6), 1321–1327. https://doi.org/10.1164/ajrccm/145.6.1321

18.

Kako

Kajiwara

(2020). Scoping review: What is the role of nurses in the era of the Global COVID-19 pandemic? Journal of Palliative Medicine, 23(12), 1566–1567. https://doi.org/10.1089/jpm.2020.0439

19.

Xia

Zhan

Liu

Yin

Wang

Chong

Zheng

Fang

Cheng

Reinhardt

J. D.

(2021). A telerehabilitation programme in post-discharge COVID-19 patients (TERECO): A randomised controlled trial. Thorax. Advance online publication. https://doi.org/10.1136/thoraxjnl-2021-217382

20.

Liu

Zhang

Yang

Zhang

Chen

(2020). Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complementary Therapies in Clinical Practice, 39, 101166. https://doi.org/10.1016/j.ctcp.2020.101166

21.

Moriyama

Takeshita

Haruta

Hattori

Ezenwaka

C. E.

(2015). Effects of a 6-month nurse-led self-management program on comprehensive pulmonary rehabilitation for patients with COPD receiving home oxygen therapy. Rehabilitation Nursing, 40(1), 40–51. https://doi.org/10.1002/rnj.119

22.

Ong

K. C.

A. W.

Lee

L. S.

Kaw

Kwek

S. K.

Leow

M. K.

Earnest

(2005). 1-year pulmonary function and health status in survivors of severe acute respiratory syndrome. Chest, 128(3), 1393–1400. https://doi.org/10.1378/chest.128.3.1393

23.

Ren

Wang

Liu

Mou

Tang

Tan

Zuo

(2021). The effects of a comprehensive rehabilitation program involving traditional Chinese medicine in severe and critical COVID-19 patients: A clinical study. Research Square. Preprint. https://doi.org/10.21203/rs.3.rs-541774/v1

24.

Ringbaek

T. J.

Lavesen

Lange

(2016). Tablet computers to support outpatient pulmonary rehabilitation in patients with COPD. European Clinical Respiratory Journal, 3, 31016. https://doi.org/10.3402/ecrj.v3.31016

25.

Rodríguez-Blanco

Bernal-Utrera

Anarte-Lazo

Saavedra-Hernandez

De-La-Barrera-Aranda

Serrera-Figallo

M. A.

Gonzalez-Martin

Gonzalez-Gerez

J. J.

(2022). Breathing exercises versus strength exercises through telerehabilitation in coronavirus disease 2019 patients in the acute phase: A randomized controlled trial. Clinical Rehabilitation, 36, 486–497. https://doi.org/10.1177/02692155211061221

26.

Santus

Tursi

Croce

Di Simone

Frassanito

Gaboardi

Airoldi

Pecis

Negretto

Radovanovic

(2020). Changes in quality of life and dyspnoea after hospitalization in COVID-19 patients discharged at home. Multidisciplinary Respiratory Medicine, 15(1), 713. https://doi.org/10.4081/mrm.2020.713

27.

Shirvani

(2020). Exercise and COVID-19 as an infectious disease. Iranian Journal of Medical Sciences, 45(4), 311–312. https://doi.org/10.30476/ijms.2020.86010.1566

28.

Tang

Jiang

Shen

You

Liu

Chen

Wang

Zhou

Feng

(2021). Liuzijue is a promising exercise option for rehabilitating discharged COVID-19 patients. Medicine, 100(6), e24564. https://doi.org/10.1097/MD.0000000000024564

29.

Tansey

C. M.

Louie

Loeb

Gold

W. L.

Muller

M. P.

de Jager

Cameron

J. I.

Tomlinson

Mazzulli

Walmsley

S. L.

Rachlis

A. R.

Mederski

B. D.

Silverman

Shainhouse

Ephtimios

I. E.

Avendano

Downey

Styra

Yamamura

. . .Herridge

M. S.

(2007). One-year outcomes and health care utilization in survivors of severe acute respiratory syndrome. Archive of Internal Medicine, 167(12), 1312–1320. https://doi.org/10.1001/archinte.167.12.1312

30.

Ubolnuar

Tantisuwat

Thaveeratitham

Lertmaharit

Kruapanich

Mathiyakom

(2019). Effects of breathing exercises in patients with chronic obstructive pulmonary disease: Systematic review and meta-analysis. Annals of Rehabilitation Medicine, 43(4), 509–523. https://doi.org/10.5535/arm.2019.43.4.509

31.

Vasilopoulou

Papaioannou

A. I.

Kaltsakas

Louvaris

Chynkiamis

Spetsioti

Kortianou

Genimata

S. A.

Palamidas

Kostikas

Koulouris

N. G.

Vogiatzis

(2017). Home-based maintenance tele-rehabilitation reduces the risk for acute exacerbations of COPD, hospitalisations and emergency department visits. European Respiratory Journal, 49(5), 1602129. https://doi.org/10.1183/13993003.02129-2016

32.

Venkatesan

(2021). NICE guideline on long COVID. The Lancet Respiratory Medicine, 9(2), 129. https://doi.org/10.1016/S2213-2600(21)00031-X

33.

Wootton

S. L.

King

Alison

J. A.

Mahadev

Chan

(2020). COVID-19 rehabilitation delivered via a telehealth pulmonary rehabilitation model: A case series. Respirology Case Reports, 8(8), e00669. https://doi.org/10.1002/rcr2.669

34.

Wootton

S. L.

L. W. C.

McKeough

Z. J.

Jenkins

Hill

Eastwood

P. R.

Hillman

D. R.

Cecins

Spencer

L. M.

Jenkins

Alison

J. A.

(2014). Ground-based walking training improves quality of life and exercise capacity in COPD. European Respiratory Journal, 44(4), 885–894. https://doi.org/10.1183/09031936.00078014

35.

World Health Organization. (2017). WHO | Enhancing the role of community health nursing for universal health coverage. Who (Issue 18). http://apps.who.int/iris/bitstream/handle/10665/255047/9789241511896-eng.pdf;jsessionid=83BED59085651F480EA7AB72F0338A6E?sequence=1

36.

World Health Organization. (2021a). Coronavirus disease (COVID-19): Post COVID-19 condition. https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-(covid-19)-post-covid-19-condition

37.

World Health Organization. (2021b). Support for rehabilitation: Self-management after COVID-19-related illness (No. WHO/EURO: 2021-855-40590-59892). https://apps.who.int/iris/handle/10665/344472

38.

World Health Organization. (2021c). WHO coronavirus disease (COVID-19) dashboard. https://covid19.who.int/

39.

Xie

Tong

Guan

Qiu

Slutsky

A. S.

(2020). Critical care crisis and some recommendations during the COVID-19 epidemic in China. Intensive Care Medicine, 46(5), 837–840. https://doi.org/10.1007/s00134-020-05979-7

40.

Yang

L. L.

Yang

(2020). Pulmonary rehabilitation for patients with coronavirus disease 2019 (COVID-19). Chronic Diseases and Translational Medicine, 6(2), 79–86. https://doi.org/10.1016/j.cdtm.2020.05.002