M. Javaherian1, N. Dabbaghipour1, A. Shadmehr1, E. Ahmadi2, A. Razavi1, A.-A. Keshtkar3, M.T. Beyg Mohammadi4, B. Attarbashi Moghaddam1
1Tehran University of Medical Sciences, Physiotherapy, Tehran, Iran, 2University of Antwerp, Antwerp, Belgium, 3Tehran University of Medical Sciences, Tehran, Iran, 4Tehran University of Medical Sciences, Anesthesiology, Tehran, Iran
Background: In recent months, many people were hospitalized and even died due to pneumonia caused by Severe Acute Respiratory Syndrome Coronavirus-2 infection worldwide. Pulmonary physiotherapy (PP) has been shown as an effective intervention in the management of patients admitted to hospitals due to pulmonary disorders. The efficacy of PP techniques has not been evaluated in patients with coronavirus disease 2019 (COVID-19) pneumonia.
Purpose: The aim of this study is to assess the efficacy of PP techniques on respiratory and aerobic functions, dyspnea, quality of life and mortality rate in COVID-19 patients with moderate to severe stage severity. Our secondary aim is to recommend a protocol for PP clinical decision making in the management of sub-acute, non-intubated pneumonia patients with COVID-19.
Methods: This study was a prospective, randomized, assessor-blinded, controlled trial with allocation concealment and intention-to-treat analysis. Forty adult hospitalized, non-intubated COVID-19 pneumonia patients with O2 saturation<88% were recruited. Participants were randomly allocated to intervention or control groups. Patients in control group received single advice session by physiotherapist and incentive spirometry. The patients in intervention group received incentive spirometry plus six sessions PP during three days (twice daily). Progressive inspiratory hold techniques with emphasis on diaphragmatic controlled breathing and airway clearance techniques (if excessive pulmonary secretion was present based on physiotherapist diagnosis) were utilized. Also, patients were trained to walk until 6 minutes after third session. The primary outcome measurements were mixed venous O2 (PVO2) and CO2 (PVCO2), O2 saturation after two-minutes free air inspiration, three-minute walk test distance and level of dyspnea which were assessed before and after of interventions. Secondary outcome measurements included Health related quality of life by short-form 36 questionnaire and mortality rate which were evaluated after one month.
Results: Compared with the control group, all outcome measurements were statistically significantly better in intervention group at the end of three days except PVCO2. Also, the results of ANCOVA test presents that patients with worse condition can benefit more from PP program. Physical function domain and physical component summary score of SF-36 were significantly higher in participants allocated in intervention group than control group. The mortality rate was lower in intervention group than control group significantly (Odds ratio= .22).
Conclusion(s): Based on our knowledge, this is the first randomized controlled trial study to evaluate the efficacy of PP program in patients with COVID-19 pneumonia. Based on the result it seems PP can be considered as an effective therapeutic intervention in both COVID-19 patients with and without excessive pulmonary secretion. It seems that PP can impact on patient’s functional movement after discharge from hospital.
Implications: The most important clinical message of this study is efficiency of PP on patients with COVID-19 pneumonia. Our second clinical message is that it seems airway clearance techniques are not only suitable techniques for these patients. They can benefit from inspiratory hold and breathing control techniques if don’t have any excessive pulmonary secretions.
Funding, acknowledgements: This study was funded by Tehran University of Medical Sciences.
Keywords: Pulmonary Physiotherapy, Coronavirus Disease, Critical Care
Topic: COVID-19
Did this work require ethics approval? Yes
Institution: Tehran University of Medical Sciences
Committee: Vice-Chancellor in Research Affairs-Tehran University of Medical Sciences
Ethics number: IR.TUMS.VCR.REC.1399.205
All authors, affiliations and abstracts have been published as submitted.
