Long-term results of rehabilitation of patients with new coronavirus infection on the southern coast of Crimea

Authors:

Dudchenko Leyla Shamilevna – Grand PhD in Medical sciences (Dr. Med. Sci.), Head of the Research Department of Pulmonology, Academic Research Institute of Physical Methods of Treatment, Medical Climatology and Rehabilitation named after I. M. Sechenov, 10/3 Mukhina Street, 298603 Yalta, Russian Federation; Associate Professor, Department of Medical Rehabilitation, Privolzhsky Research Medical University, 10/1 Minina i Pozharskogo Square, 603005 Nizhny Novgorod, Russian Federation; е-mail: vistur@mail.ru; https://orcid.org/0000-0002-1506-4758.

Solovyova Elena Alexandrovna – research fellow of the Research Department of Pulmonology, Academic Research Institute of Physical Methods of Treatment, Medical Climatology and Rehabilitation named after I. M. Sechenov, 10/3 Mukhina Street, 298603 Yalta, Russian Federation; е-mail: elenasolovjova0507@gmail.com; https://orcid.org/0000-0001-7882-8885.

Beylaeva Svetlana Nikolaevna – PhD in Medical sciences (Cand. Med. Sci.), Senior Researcher of the Research Department of Pulmonology, Academic Research Institute of Physical Methods of Treatment, Medical Climatology and Rehabilitation named after I. M. Sechenov, 10/3 Mukhina Street, 298603 Yalta, Russian Federation; e-mail: belyaeva-sveta@mail.ru; http://orcid.org/0000-0002-6161-6058.

Maslikova Galina Georgievna – PhD in Medical sciences (Cand. Med. Sci.), Senior Researcher of the Research Department of Pulmonology, Academic Research Institute of Physical Methods of Treatment, Medical Climatology and Rehabilitation named after I. M. Sechenov, 10/3 Mukhina Street, 298603 Yalta, Russian Federation; e-mail: klinii@list.ru.

Andreeva Galina Nikolaevna – research fellow of the Department of Pulmonology, Academic Research Institute of Physical Methods of Treatment, Medical Climatology and Rehabilitation named after I.M. Sechenov, 10/3 Mukhina Street, 298603 Yalta, Russian Federation; e-mail: galinaandreeva2901@internet.ru; https://orcid.org/0000-0002-1876-0011.

Annotation:

Introduction. The long-term and diverse consequences of the transferred CQronaVirus Disease 2019 (COVID-19) in the form of postCOVID syndrome significantly reduce the quality of life of patients, are not sufficiently studied, are of scientific interest and need rehabilitation. For an objective assessment of the recovery of patients, it is necessary to assess not only the immediate, but also the long-term result of the effect of rehabilitation on the return of the baseline health level.

Aim. To assess the persistence of the achieved effect after the rehabilitation of patients who have undergone a new Coronavirus infection in the conditions of the climatic resort of the southern coast of Crimea in terms of the level of quality of life.

Materials and methods. 149 patients who underwent COVID-19 and underwent rehabilitation in the climate resort of the southern coast of Crimea were monitored. Inclusion criteria: patients who have undergone COVID-19 with lung damage, received comprehensive rehabilitation in a climate resort and signed an informed consent to participate in the study. Rehabilitation methods included climatotherapy, respiratory therapy, therapeutic breathing exercises, massage, physiotherapy and medication support for indications. Study methods: standardized SF-36 – Short Form-36 and EOSD – European Quality of Life Questionnaire were used. The survey was conducted before, after rehabilitation and after 6 months by sending letters to patients with a question list and forms SF-36 and EQ-SD. Statistical analysis of the material was performed.

Results. Upon admission to rehabilitation, the analysis of the quality of life of patients who underwent COVID-19 revealed a decrease in all analyzed scales of the SF-36 questionnaire, to a greater extent the role of physical and emotional problems, according to the questionnaire EQ-SD, a moderate decrease in the quality of life detected. After the rehabilitation course, a statistically and clinically significant improvement in quality of life indicators was achieved, with the exception of the most reduced initially levels of scales of physical and emotional problems, for which only a tendency towards normalization of indicators was noted. After 6 months, the achieved effect was preserved, which was consistent with the patients’ answers to questions about their well-being, maintaining a physical activity regime, adherence to breathing exercises after a course of rehabilitation, and a low level of intercurrent infections.

Discussion. To date, there are no large-scale clinical trials or generally accepted treatment for postCOVID syndrome, and current recommendations for managing such patients are based on the pathophysiological mechanisms of COVID-19 and postCOVID syndrome. PostCOVID syndrome, as a multisymptomatic pathological condition, has a negative impact on all aspects of a patient’s life.
The use of rehabilitation technologies with a focus on respiratory therapy has proven to be effective. However, the insufficient duration of follow-up for these patients does not allow for assessing the long-term outcomes of rehabilitation measures.
The conducted study demonstrated the results of rehabilitation six months after the completion of the course. An analysis of the long-term results showed that the effect of medical rehabilitation in a sanatorium-resort facility in a climatic resort on the southern coast of Crimea had a long-lasting positive effect: the achieved level was maintained for most indicators, despite the reliable and persistent positive effect.

Conclusion. Patients who have undergone COViD-19 with persistent symptoms of postCOVID syndrome need longterm monitoring by specialists and rehabilitation, the purpose of which is to improve the quality of life of patients. The study demonstrated a low level of quality of life upon admission to rehabilitation, an increase in the level during rehabilitation, and preservation of the effect for 6 months. However, the quality of life did not reach normal values, which confirmed the need for further monitoring of patients and repeated courses of rehabilitation.

List of cited literature:

1. COVID-19: profilaktika i reabilitacija. 2-e izd., pod red. akad. V.I. Starodubceva [COVID-19: prevention and rehabilitation. 2nd ed. Ed. by VI Starodubtsev]. Moskva: Nauka [Moscow: Science], 2021. 160 p. (In Russian).

2. Greenhalgh T, Knight M, A’Court C, Buxton M et al. Management of post-acute COVID-19 in primary care. BMJ. 2020; 370 :m3026. DOI:10.1136/bmj.m3026.

3. Kapsultanova DA, Zhangelova ShB, Gappar GE, Tauyekel MM et al. International recommendations «post-covid syndrome». What’s new? Medicus. 2023;1(49):59-62.

4. Huang C, Huang L, Wang Y, Li X et al. 6-month consequences of COVID19 in patients discharged from hospital: a cohort study. The Lancet. 2021;397(10270):220-32. DOI: 10.1016/ S0140-6736(20)32656-8.

5. Ramana B, Cassara MP, Tunnicliffe EM, Filippini N et al. Medium-term effects of SARSCoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. EClinicalMedicine. 2021;31:100683. DOI: 10.1016/j.eclinm.2020.100683.

6. Rajpal S, Tong MS, Borchers J, Zareba KM et al. Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection. JAMA Cardiology. 2021;1(6):116-8. DOI: 10.1001/jamacardio.2020.4916.

7. Troyer EA, Kohn JN, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain, Behavior, and Immunity. 2020;(87):34-9. DOI: 10.1016/j. bbi.2020.04.027.

8. Salvio G, Gianfelice C, Firmani F, Lunetti S et al. Bone Metabolism in SARS-CoV-2 Disease: Possible Osteoimmunology and Gender Implications. Clinical Reviews in Bone and Mineral Metabolism. 2020 ;4( 18) :51 – 7. DOI: 10.1007/s12018-020-09274-3.

9. Ayoubkhani D, Khunti K, Nafilyan V, Maddox T, et al. Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study. BMJ. 2021;372:693. DOI:10.1136/bmj.n693.

10. Raghu G, Wilson KC. COViD-19 interstitial pneumonia: monitoring the clinical course in survivors. Lancet Respir. Med. 2020;8(9):839-42. DOI: 10.1016/ S2213-2600(20)30349-0.

11. Afrin, L, Weinstock L, Molderings G. Covid-19 hyperinflammation and post-Covid-19 illness may be rooted in mast cell activation syndrome. Int J Infect Dis. 2020;100:327-32. DOI:10.1016/j.ijid.2020.09.016.

12. Yong SJ. Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infect Dis (Lond). 2021;53(10):737-54. DOI:10.1080/2
3744235.2021.1924397.