Short and long term functional impact of a SARS-Cov2 infection

L’étude des conséquences fonctionnelles d’une infection au SARS-CoV-2 est nécessaire pour diagnostiquer, soigner et prévenir les limitations d’activités et restrictions de participation qui en résultent. Ce travail de thèse s’inscrit dans un contexte de progression des connaissances d’une maladie émergente. Il avait pour objectif de préciser la population d’étude et les éléments d’interprétations, et de proposer des déficiences caractéristiques post COVID.Les études observationnelles ont porté sur des patients hospitalisés en phase aiguë infectieuse. Les patients, recrutés dans les unités de Médecine Physique et de Réadaptation (MPR), ont été comparés avec les patients sortis à domicile en première vague. Cette étude, publiée dans Biology, a montré le caractère plus sévère de l’infection initiale et une plus grande fragilité des patients adressés en MPR.L’amélioration de la prise en charge aiguë a posé la question d’un impact de ces évolutions sur les conséquences fonctionnelles. L’étude comparative à 6 mois d’une admission en soins intensif en 1ère et 2eme vague n’a pas mis en évidence de différence. Cette étude, publiée dans le Journal of Rehabilitation Medicine, soulève la question des analogies entre les symptômes post COVID et les Post Intensive Care Syndrome (PICS).L’étude des conséquences cognitives à 6 mois et 1 an de l’infection montre une haute prévalence d’atteintes, touchant majoritairement les processus attentionnels. L’atteinte cognitive à 1 an serait indépendante de la sévérité de l’infection initiale, avec un possible impact positif de la durée totale d’oxygénothérapie.Les associations de symptômes, souvent subjectifs, et l’hétérogénéité des personnes observées influencent l’interprétation des résultats. La confrontation des données et des avancées scientifiques fait penser qu’il existe non pas un syndrome post COVID mais des syndromes post COVID. Les analyses de la cohorte CAPACoV-19 s’attarderont à rechercher ces différents clusters.The study of the functional consequences of a SARS-CoV-2 infection is necessary to diagnose, treat and prevent the resulting activity limitations and participation restrictions. This thesis takes place in a context of progress in knowledge of an emerging disease. The objective was to specify the study population and factors influencing interpretations, and to propose characteristic of post-COVID deficiencies.Our studies focused on hospitalized patients in the acute infectious phase. The patients, recruited in the Physical and Rehabilitation Medicine (PRM) departement, were compared with the patients discharged at home during the first wave. This study, published in Biology, showed the more severe infection in acute phase and greater fragility of patients referred to PRM.The improvement in acute care has raised the question of the impact of these changes on functional consequences. The comparative study 6 months after admission in intensive care during the 1st and 2nd waves did not show any difference. This study, published in the Journal of Rehabilitation Medicine, raises the question of analogies between post COVID symptoms and Post Intensive Care Syndrome (PICS).The study of the cognitive consequences at 6 months and 1 year of the infection showed a significant prevalence of cognitive impairment, mainly affecting attentional processes. Cognitive impairment at 1 year would be independent of the severity of the initial infection, with a possible positive impact of the total duration of oxygen therapy.The associations of symptoms, often subjective, and the heterogeneity of the study populations influence the interpretation of results. The confrontation of data and scientific advances suggests that there is not a post COVID syndrome but several post COVID syndromes. The analyses of the CAPACoV-19 cohort will focus on these different clusters

Typologie des patients admis en MPR après une infection au SARS-Cov2 (première vague)

peer reviewe

Characteristics of COVID-19 Inpatients in Rehabilitation Units during the First Pandemic Wave: A Cohort Study from a Large Hospital in Champagne Region

International audienceBackground: Data describing patients hospitalized in medical rehabilitation wards after the acute phase of COVID-19 could help to better understand the rehabilitation needs in the current pandemic situation. Methods: Cohort including all patients with COVID-19 hospitalized in a single, large university hospital in Northeast France from 25 February to 30 April 2020. Results: 479 patients were admitted with COVID-19 during the study period, of whom 128 died (26.7%). Among the 351 survivors, 111 were referred to rehabilitation units, including 63 (17.9%) referred to physical and rehabilitation medicine (PRM) units. The median age of patients referred to rehabilitation units was 72 years. Patients who had been in intensive care, or who had had a long hospital stay, required referral to PRM units. Two biomarkers were associated with referral to rehabilitation units, namely, elevated troponin (p = 0.03) and impaired renal function (p = 0.03). Age was associated with referral to PRM units (p = 0.001). Conclusions: Almost one-third of COVID-19 patients required post-acute care, but only one-fifth had access to PRM units. The optimal strategy for post-acute management of COVID-19 patients remains to be determined. The need for rehabilitation wards during a pandemic is a primary concern in enabling the long-term functioning of infected patients

Pulmonary rehabilitation after severe exacerbation of COPD: a nationwide population study

Abstract Background Acute exacerbations of chronic obstructive pulmonary disease (COPD) lead to a significant reduction in quality of life and an increased mortality risk. Current guidelines strongly recommend pulmonary rehabilitation (PR) after a severe exacerbation. Studies reporting referral for PR are scarce, with no report to date in Europe. Therefore, we assessed the proportion of French patients receiving PR after hospitalization for COPD exacerbation and factors associated with referral. Methods This was a national retrospective study based on the French health insurance database. Patients hospitalized in 2017 with COPD exacerbation were identified from the exhaustive French medico-administrative database of hospitalizations. In France, referral to PR has required as a stay in a specialized PR center or unit accredited to provide multidisciplinary care (exercise training, education, etc.) and admission within 90 days after discharge was assessed. Multivariate logistic regression was used to assess the association between patients’ characteristics, comorbidities according to the Charlson index, treatment, and PR uptake. Results Among 48,638 patients aged ≥ 40 years admitted for a COPD exacerbation, 4,182 (8.6%) received PR within 90 days after discharge. General practitioner’s (GP) density (number of GPs for the population at regional level) and PR center facilities (number of beds for the population at regional level) were significantly correlated with PR uptake (respectively r = 0.64 and r = 0.71). In multivariate analysis, variables independently associated with PR uptake were female gender (aOR 1.36 [1.28–1.45], p < 0.0001), age (p < 0.0001), comorbidities (p = 0.0013), use of non-invasive ventilation and/or oxygen therapy (aOR 1.52 [1.41–1.64], p < 0.0001) and administration of long-acting bronchodilators (p = 0.0038). Conclusion This study using the French nationally exhaustive health insurance database shows that PR uptake after a severe COPD exacerbation is dramatically low and must become a high-priority management strategy

Exploring quality of life in people with slowly-progressive neuromuscular disease

International audienc

THE QUALITY OF LIFE IN GENETIC NEUROMUSCULAR DISEASEQUESTIONNAIRE: RASCH VALIDATION OF THE FRENCH VERSION

International audienc

Construction of a Quality of Life Questionnaire for slowly progressive neuromuscular disease

International audienc

Whole-Body Vibration Associated with Strength Training on the Lower-Limb Blood Flow and Mobility in Older Adults with Type 2 Diabetes: A Study Protocol for a Randomized Controlled Trial

Vascular endothelium insults caused by high serum glucose levels affect the oxygen supply to tissues, via the microvascular endothelium, resulting in an increased perfusion heterogeneity. These insults may lead to the underuse of blood capillaries, while other vessels are overused and effectively overload their oxygen supply capacity, which eventually causes damages to distal parts of the peripheral nervous system. Therefore, the proprioceptive and exteroceptive feedback information will be gradually lost and contribute to a mobility reduction. This study aims to assess the efficacy of whole-body vibration (WBV) associated with strength training (ST) on lower-limb blood flow and mobility in older adults with type 2 diabetes (DM2). Methods and analyses: This is a protocol (1st version) for Pa single-blind, randomized, controlled clinical trial guided by the SPIRIT guidelines. Our sample will consist of 51 older adults with DM2 randomly allocated to three groups: low frequency WBV (16–26 Hz) associated to ST (G1), WBV sham (G2) and nonintervention control (G3). The study protocol is set for a 12-week (three times per week) schedule. Primary outcomes: skin temperature using infrared thermographic imaging (ITI); mean peripheral arterial blood flow velocity (MBF) by a handheld Doppler ultrasound (DU), and functional mobility by Timed Up and Go (TUG) test. Secondary outcomes: quasi-static posture using the DX100 BTS Smart optoelectronic system, and plantar pressure and body balance using the MPS stabilometric platform. Data will be collected and analyzed at baseline and post-intervention, considering p-value < 0.05 level of significance. The analyses will also be conducted with an intention-to-treat method and effect size. Dissemination: All results will be published in peer-reviewed journals as well as presented in conferences

Cluster analysis unveils a severe persistent respiratory impairment phenotype 3-months after severe COVID-19

International audienceAbstract Background The mid-term respiratory sequelae in survivors of severe COVID-19 appear highly heterogeneous. In addition, factors associated with respiratory sequelae are not known. In this monocentric prospective study, we performed a multidisciplinary assessment for respiratory and muscular impairment and psychological distress 3 months after severe COVID-19. We analysed factors associated with severe persistent respiratory impairment, amongst demographic, COVID-19 severity, and 3-month assessment. Methods Patients with severe SARS-CoV-2 pneumonia requiring ≥ 4L/min were included for a systematic 3-month visit, including respiratory assessment (symptoms, lung function, CT scan), muscular evaluation (body composition, physical function and activity, disability), psychopathological evaluation (anxiety, depression, post-traumatic stress disorder-PTSD) and quality of life. A cluster analysis was performed to identify subgroups of patients based on objective functional measurements: D LCO , total lung capacity and 6-min walking distance (6MWD). Results Sixty-two patients were analysed, 39% had dyspnea on exercise (mMRC ≥ 2), 72% had D LCO < 80%, 90% had CT-scan abnormalities; 40% had sarcopenia/pre-sarcopenia and 31% had symptoms of PTSD. Cluster analysis identified a group of patients (n = 18, 30.5%) with a severe persistent (SP) respiratory impairment (D LCO 48 ± 12%, 6MWD 299 ± 141 m). This SP cluster was characterized by older age, severe respiratory symptoms, but also sarcopenia/pre-sarcopenia, symptoms of PTSD and markedly impaired quality of life. It was not associated with initial COVID-19 severity or management. Conclusions and clinical implication We identified a phenotype of patients with severe persistent respiratory and muscular impairment and psychological distress 3 months after severe COVID-19. Our results highlight the need for multidisciplinary assessment and management after severe SARS-CoV-2 pneumonia. Trial registration The study was registered on ClinicalTrials.gov (May 6, 2020): NCT0437684

Impacts of COVID-19 Pandemic on Sleep Quality Evaluated by Wrist Actigraphy: A Systematic Review

COVID-19 has probably contributed as a risk factor for sleep disturbance. Actigraphy has been used to evaluate sleep complaints in self-isolated populations and frontline doctors during the COVID-19 pandemic. This systematic review aims to summarize the impact of the COVID-19 pandemic on sleep through wrist actigraphy, estimating sleep latency, total sleep time, awakening-after-sleep onset, and sleep efficiency. Searches were conducted of observational studies on the PubMed, Embase, Scopus, Web of Science, and PEDro databases from 1 December 2019 to 31 December 2022. Ninety articles were found, and given the eligibility criteria, fifteen were selected. Six studies were classified by the National Health and Medical Research Council as evidence level IV, two studies as level III-3, and seven studies as level III-2. According to the ACROBAT-NRSI instrument, three studies were classified as having a &ldquo;serious&rdquo; risk of bias, two as having &ldquo;critical&rdquo; risk, four as having &ldquo;moderate&rdquo; risk, and six as having &ldquo;low&rdquo; risk. In the selected publications, various populations were evaluated via actigraphy during the COVID-19 pandemic, with reports of &ldquo;poor&rdquo; sleep quality. Actigraphy may be a relevant tool to assess individual day&ndash;night rhythms and provide recommendations under enduring pandemic conditions. Moreover, as actigraphy presents objective data for sleep evaluations, it is suggested that this method be used in similar pandemics and that actigraphy be included as part of the sleep hygiene strategy