КОМБИНИРОВАННАЯ АКТИВНО-ПАССИВНАЯ КИНЕЗИОТЕРАПИИ В РЕАБИЛИТАЦИИ ПОСЛЕ COVID-19 РАЗЛИЧНОЙ ТЯЖЕСТИ ТЕЧЕНИЯ

Abstract

Abstract. Introduction. Rehabilitation is necessary to restore the quality of life of post-COVID-19 patients. Aim of the study is to evaluate effectiveness and safety of the rehabilitation using combined active and passive kinesiotherapy after COVID-19 of varying severity. Materials and Methods. Study design: comparative, prospective, open. The study involved 17 patients after moderate COVID-19 (M_COV19) and 21 patients after severe COVID-19 (S_COV19). The 2-week rehabilitation course consisted of 6 active and 10 passive kinesiotherapy procedures. Active kinesiotherapy included breathing training and physical exercises. Passive kinesiotherapy was carried out using the ORMED-KINESO mechanotherapy device. Passive rhythmic flexion-extension movements were performed in the patient’s thoracic spine with a comfortable frequency of 12-20/min within a 10-minute procedure. The rehabilitation effect was assessed using Baseline and Transition Dyspnea Indices (BDI-TDI), spirography, and the 6-minute walk test (6-MWT). For spirography, individual predicted normal values were calculated using the Global Lung Function Initiative (GLI) equations, and the relative predicted values were calculated by the formula: %predicted = measured value/predicted normal value*100%. The data are given as Median (Quartile1, Quartile3), while changes are presented as Median [95% confidence interval]. Results and Discussion. At baseline, the patients suffered from dyspnea. BDI was 9(6;9) in M_COV19 and 8(6;9) in S_COV19, p=0.89. All patients noted a decrease in dyspnea after rehabilitation. TDI was +6(3.7;6.3) and +4(3.7;6.0), respectively, p=0.53. Spirography showed restrictive limitation of pulmonary function. Vital capacity (VC) was 72.0(67.3;82.3)%predicted in M_COV19 and 59.0(47.0;68.7)%predicted in S_COV19, p<0.001. After rehabilitation, the increase in VC was +6.5[3;10.5]%predicted, p=0.001, and +7.0[3.0;14.0]%predicted, p=0.001, respectively, no difference between groups, p=0.88. Only in M_COV19, forced vital capacity(FVC) increased by +5.5[2.0;10.5]%predicted, p=0.002, and 1 st -second forced expiratory volume (FEV 1 ) increased by +10.0[3.5;23.0]%predicted, p=0.003. After rehabilitation the 6-MWT distance increased from 364(332;431)m to 400(351;495)m, p=0.001, in M_COV19 and it increased from 322(238;347)m to 356(322;381)m, p=0.001, in S_COV19. 6-MWT median gain was +43[26;74]m and +37[21;59] m, respectively, no significant difference, p=0.56. Conclusions. Combined active and passive kinesiotherapy demonstrated comparable rehabilitation effectiveness and safety in patients after both moderate and severe COVID-19. The rehabilitation course reduced dyspnea and increased physical performances in both groups. Pulmonary function improvement was more significant in patients after moderate СOVID-19 compared to severe COVID-19.