Akademik Veri Yönetim Sistemi
The 2nd International Congress of Physiotherapy , Priştine, Kosova, 5 - 06 Mayıs 2023, ss.45-46
Introduction: Long COVID is defined as continuation of symptoms three months after the initial infection. The most common symptoms in long-term COVID patients are fatigue and shortness of breath. In addition to persistent symptoms, clinical complications related to the disease are also present. A patient with long COVID has been referred at Gazi University Faculty of Health Sciences Cardiopulmonary Rehabilitation Unit.
Methods: Case: A 47-year-old male patient, 168 cm tall, with a body weight of 100 kg and a body mass index of 35.4 kg/m 2 having complaints of dyspnoea and fatigue after two years of testing positive for Covid-19. Post-COVID-19 Functional Status (PCFS) scale was 3 points, he had mild intermittent asthma based on Global Initiative for Asthma classification (GINA), Modified Medical Research Council (MMRC) dyspnoea score was 2 points, both obstructive and restrictive type of pulmonary function abnormality (FVC: 66%, FEV 1 :67%, FEV 1 /FVC: 82.43, PEF: 136%, FEF 25-75% : 69%). Although his inspiratory muscle strength was above 80% of the predicted value he had expiratory muscle weakness, peripheral muscle strength was not impaired. Six minute walk distance (6MWD) was 537m (97%) of the expected value but had severe desaturation during the test (SpO 2 =88%). The patient was physically inactive and had no fatigue. His quality of life was impaired St. George Total score 55 points, The London Chest Activity of Daily Living (LCADL) scale was (32 points), his activities of daily living were affected by dyspnoea. Pulmonary intervention: Education on dyspnoea-reduction positions and Energy Conservation Techniques, Thoracic expansion exercises, Respiratory muscle training (PowerBreathe ® 50% of MIP 15min. twice/day 7 day/week), Aerobic Exercise (moderate-intensity continuous training 60-80% of Maximal heart rate, 40- 45 min/day, 3-5 day/week), Strength training (free weights/elastic band once/day 3-5day/week). In addition to pulmonary rehabilitation the patient has been encouraged to increase his physical activity levels by installing a step count app (the goal up to 10000 steps/day).
Results: After 8 weeks of rehabilitation: PCFS (0-5) 0 point, MMRC dyspnoea score was 1 point, pulmonary function test increased (FVC: 72%, FEV 1 :74%, FEV 1 /FVC: 85.68, PEF: 138%, FEF 25-75% : 89%), MIP increased 37cmH 2 O and MEP increased 17cmH2O (Minimal clinically important difference (MCID) ≥13cmH 2 O), peripheral muscle strength increased. 6MWD was 550.8m but his functional exercise capacity was decreased due to desaturation, general body and leg fatigue. His saturation, daily steps and average MET increased (8632 steps/day, MET=1.6 MET/day), fatigue decreased to 14 points, St. George quality of life total score increased 11.8 points (MCID ≥4 points), LCDAL score was 19 (MCID ≥3 points).
Discussion and Conclusion: Dyspnoea during effort, cough and fatigue were the major complaints of the patient. Pulmonary function test, respiratory muscle strength and exercise capacity together with quality of life were impaired. The patient had severe desaturation during functional exercise testing. His muscle strength was not impaired but he was physically inactive. After pulmonary rehabilitation intervention pulmonary function test, respiratory muscle strength, exercise capacity, desaturation, peripheral muscle strength, physical activity level and quality of life improved while fatigue decreased. Aerobic exercises, respiratory muscle training, thoracic expansion exercises, education on dyspnoea-reduction positions and energy conservation techniques have shown good results. Patients should be included in cardiopulmonary rehabilitation to improve the long term effects of COVID-19.