Group-based pulmonary telerehabilitation is feasible, safe, beneficial and well-received in patients that have been hospitalised with Covid-19

Introduction Covid-19 has caused worldwide mass hospitalisation. The need for multi-disciplinary post-hospitalisation rehabilitation is becoming increasingly apparent and telerehabilitation has been endorsed. The aim of study was to investigate the feasibility and efficacy of pulmonary telerehabilitation for Covid-19 survivors.Methods A single centre, mixed-methods, fast-track (wait-list), randomised controlled trial of telerehabilitation for patients who have been hospitalised with Covid-19.Participants Forty patients discharged from two University Teaching Hospitals in the North of England. Interventions: Telerehabilitation consisted of twelve exercise classes, six education events and opportunity for peer support. Patients commenced telerehabilitation 14 days after randomisation in the fast-track group and 56 days after randomisation in the wait-list group.Outcome measures and results Descriptive and statistical improvements were noted is several clinical outcome measures. Exercise capacity increased from a median (Q1–Q3) 20 (14–24) sit-to-stand repetitions in one-minute at baseline to 25 (24–30) post-telerehabilitation. Breathlessness rated using the MRC changed from 3.5 (3–4) at baseline to 2 (1.5–3) post-telerehabilitation, with additional favourable outcomes noted in respiratory symptoms measured using numerical rating scales and visual analogue scales (VAS). Quality of life measured using the EQ-VAS improved from 55 (60–70) units at baseline to 70 (55–80) units following telerehabilitation. Improvements in fatigue (FACIT-F) and mood (HADS-D) were also observed. Natural recovery was observed in the wait-list group prior to receiving telerehabilitation, however, improvements were accelerated by early telerehabilitation in the fast-track group.Conclusions We have shown that group-based telerehabilitation is feasible, safe, beneficial and well-received in this population

Telerehabilitation for patients who have been hospitalised with covid-19: a qualitative study

PurposeThe aim of this qualitative study was to explore the views of participants of a group-based, supervised, telerehabilitation programme, following discharge from hospital with Covid-19. This study was part of a single-centre, fast-track (wait-list), randomised, mixed-methods, feasibility trial of telerehabilitation (Registration: Clinicaltrials.gov reference:285205).MethodsSemi-structured interviews were conducted over a virtual teleconference platform with 10 participants who took part in a telerehabilitation programme following Covid-19 after discharge from an acute hospital. Data were transcribed verbatim and analysed using thematic analysis.ResultsFive themes were important from the participant perspective: telerehabilitation programme as part of the Covid-19 journey; the telerehabilitation programme design and delivery; peer aspects; the role of the instructor; and the role of technology and online delivery.ConclusionsOverall, the telerehabilitation programme was a positive experience for participants. The instructors were central to this positive view as was the group nature of the programme. The group aspect was particularly important in supporting the broader perceived wellbeing gains, such as the sense of enjoyment and reduced social isolation. Several participants would have liked to have continued with the exercises beyond the six-week intervention indicating that the programme could be a way to help people sustain a physically active lifestyle.IMPLICATIONS FOR REHABILITATIONParticipants who were recovering from Covid-19 following hospital admission perceived the telerehabilitation to be a positive experience overall.The group aspect of the telerehabilitation programme was important in supporting the broader perceived wellbeing gains such as the sense of enjoyment and reduced social isolation.Telerehabilitation programmes for Covid-19 may need to include pathways for participants to continue to engage in exercise beyond the time-limited six-week intervention to support ongoing self-management

Telerehabilitation for patients who have been hospitalised with covid-19: a qualitative study

Purpose The aim of this qualitative study was to explore the views of participants of a group-based, supervised, telerehabilitation programme, following discharge from hospital with Covid-19. This study was part of a single-centre, fast-track (wait-list), randomised, mixed-methods, feasibility trial of telerehabilitation (Registration: Clinicaltrials.gov reference:285205). Methods Semi-structured interviews were conducted over a virtual teleconference platform with 10 participants who took part in a telerehabilitation programme following Covid-19 after discharge from an acute hospital. Data were transcribed verbatim and analysed using thematic analysis. Results Five themes were important from the participant perspective: telerehabilitation programme as part of the Covid-19 journey; the telerehabilitation programme design and delivery; peer aspects; the role of the instructor; and the role of technology and online delivery. Conclusions Overall, the telerehabilitation programme was a positive experience for participants. The instructors were central to this positive view as was the group nature of the programme. The group aspect was particularly important in supporting the broader perceived wellbeing gains, such as the sense of enjoyment and reduced social isolation. Several participants would have liked to have continued with the exercises beyond the six-week intervention indicating that the programme could be a way to help people sustain a physically active lifestyle. IMPLICATIONS FOR REHABILITATION Participants who were recovering from Covid-19 following hospital admission perceived the telerehabilitation to be a positive experience overall. The group aspect of the telerehabilitation programme was important in supporting the broader perceived wellbeing gains such as the sense of enjoyment and reduced social isolation. Telerehabilitation programmes for Covid-19 may need to include pathways for participants to continue to engage in exercise beyond the time-limited six-week intervention to support ongoing self-management

Tele-rehabilitation for patients who have been hospitalised with Covid-19: a mixed-methods feasibility trial protocol

Background: Tele-rehabilitation has been proposed as a post-hospitalisation rehabilitation pathway for Covid-19 survivors, however patients’ willingness and ability to engage with this online intervention remains unknown. Objectives: The aim of this study is to determine the feasibility of tele-rehabilitation in this population, specifically with regards to recruitment, intervention acceptability and adherence, data quality and primary outcome measure selection. Methods: A protocol for a single centre, fast-track (wait-list), randomised mixed-methods, feasibility trial of tele-rehabilitation for patients that have been hospitalised with Covid-19 is presented. The tele-rehabilitation programme is based on pulmonary rehabilitation principles and will encompass an initial assessment followed by twice-weekly exercise classes and education sessions for 6 weeks. Six educational sessions on the topics of rehabilitation from Covid-19; coping with breathlessness; exercise; nutrition; return to work; and fatigue management will be delivered by a multi-disciplinary team of healthcare professionals. A series of feasibility, clinical and safety outcomes will be quantitively described and patient experiences and opinions explored using thematic analysis of semi-structured interviews. Discussion: We anticipate that results from the study will inform a multi-centre randomised controlled trial for post-Covid-19 tele-rehabilitation and the results from the qualitative analysis may provide guidance to improve participant experience

Constructive methods of invariant manifolds for kinetic problems

The concept of the slow invariant manifold is recognized as the central idea underpinning a transition from micro to macro and model reduction in kinetic theories. We present the Constructive Methods of Invariant Manifolds for model reduction in physical and chemical kinetics, developed during last two decades. The physical problem of reduced description is studied in the most general form as a problem of constructing the slow invariant manifold. The invariance conditions are formulated as the differential equation for a manifold immersed in the phase space (the invariance equation). The equation of motion for immersed manifolds is obtained (the film extension of the dynamics). Invariant manifolds are fixed points for this equation, and slow invariant manifolds are Lyapunov stable fixed points, thus slowness is presented as stability. A collection of methods to derive analytically and to compute numerically the slow invariant manifolds is presented. Among them, iteration methods based on incomplete linearization, relaxation method and the method of invariant grids are developed. The systematic use of thermodynamics structures and of the quasi-chemical representation allow to construct approximations which are in concordance with physical restrictions. The following examples of applications are presented: nonperturbative deviation of physically consistent hydrodynamics from the Boltzmann equation and from the reversible dynamics, for Knudsen numbers Kn similar to 1; construction of the moment equations for nonequilibrium media and their dynamical correction (instead of extension of list of variables) to gain more accuracy in description of highly nonequilibrium, flows; determination of molecules dimension (as diameters of equivalent hard spheres) from experimental viscosity data; model reduction in chemical kinetics; derivation and numerical implementation of constitutive equations for polymeric fluids; the limits of macroscopic description for polymer molecules, etc