EFFECTIVENESS AND FEASIBILITY OF VIRTUAL REHABILITATION IN PATIENTS WITH COVID-19: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RCTS

A.A. Seid¹, S.B. Aychiluhm², A.A. Mohammed¹

¹Samara University, College of Medicine and Health Science, Department of Nursing, Samara, Ethiopia, ²Samara University, College of Medicine and Health Science, Department of Public Health, Samara, Ethiopia

Background: COVID-19 is a highly infectious respiratory disease, which leads to respiratory, physical, and psychological dysfunctions. Virtual rehabilitation plays an important role in the recovery of patients from COVID-19 disease. Since the occurrence of the pandemic, original studies have been published regarding virtual rehabilitation in patients with COVID-19.

Purpose: The purpose of this study was to determine the pooled effectiveness and feasibility of virtual rehabilitation in patients with COVID-19.

Methods: This systematic review was performed and reported according to The PRISMA (Preferred Reporting Item for Systematic Review and Meta-analysis) guideline. PubMed, CINHAL, Science Direct, PEDro, Google Scholar, and Cochrane Library databases were systematically searched to the end of March 2022. RCTs investigating the effects of virtual rehabilitation in the management of COVID-19 patients were included. The outcomes of interest were functional capacity, cardiopulmonary exercise tests, quality of life, and other variables where data are available. Two reviewers screened, extracted data and performed methodological quality assessment independently. The revised Cochrane Risk of Bias tool was used to assess the risk of bias. Review Manager V.5.4 and Stata V.14.0 software was used for statistical analysis. Mean difference (MD) with 95% CI and the corresponding P-value were used to determine the treatment effect between groups.

Results: Four studies with 334 COVID-19 patients were included. The interventions focused on breathing control, thoracic expansion, aerobic and Lower Muscle strength (LMS) exercises for 6 weeks duration in one trial and breathing exercises based on an active cycle of breathing technique (ACBT) for one and two weeks duration in two trials. Specific resistance and strength tonic exercises for the one-week duration were delivered in another trial. The control groups received education in one study and no specified interventions in three studies. Follow up data was assessed and reported in only one study after 28 weeks. The pooled result of virtual rehabilitation showed statistically significant improvement on 6 minute walking test (MD 89.25; 95% CI 62.44 to 116.06; P<0.0001) 30 30-secondSit to Stand test (MD 1.76; 95% CI 1.47 to 2.04; P<0.0001) exercise intensity-Borg Scale (MD 2.68; 95% CI 2.20 to 3.16; P<0.0001) and level of dyspnea (MD 6.06; 95% CI 5.42 to 7.10; P<0.0001). The overall treatment completion rate was 88.46% and the most common reasons for withdrawal after randomization was lost to follow-up or uncooperativeness.

Conclusions: The findings showed that virtual rehabilitation interventions could improve functional capacity and exercise perception among patients affected by COVID-19 and can be implemented with a high completion rate and minimal adverse events.

Implications: Virtual rehabilitation with its many components can be used as an alternative means to patients with COVID-19. However, a large number of studies are required to investigate the effects of virtual rehabilitation on cardiopulmonary function, quality of life, anxiety, depression, and other variables.

Funding acknowledgements: None.

Keywords:
COVID-9
Virtual rehabilitation
Systematic review

Topics:
COVID-19

Did this work require ethics approval? No

Reason: Ethical approval is not required because this systematic review and meta-analysis is based on previously published data.