Physical and pulmonary capacities of individuals with severe coronavirus disease after hospital discharge: A preliminary cross-sectional study based on cluster analysis

OBJECTIVE: This study aimed to analyze the physical and pulmonary capacities of hospitalized patients with severe coronavirus disease and its correlation with the time of hospitalization and complications involved. METHODS: A total of 54 patients, aged ≥18 years of both sexes, were evaluated 2-4 months after hospital discharge in São Paulo, Brazil. The physical characteristics analyzed were muscle strength, balance, flexibility, and pulmonary function. The K-means cluster algorithm was used to identify patients with similar physical and pulmonary capacities, related to the time of hospitalization. RESULTS: Two clusters were derived using the K-means algorithm. Patients allocated in cluster 1 had fewer days of hospitalization, intensive care, and intubation than those in cluster 2, which reflected a better physical performance, strength, balance, and pulmonary condition, even 2-4 months after discharge. Days of hospitalization were inversely related to muscle strength, physical performance, and lung function: hand grip D (r=−0.28, p=0.04), Short Physical Performance Battery score (r=−0.28, p=0.03), and forced vital capacity (r=−0.29, p=0.03). CONCLUSION: Patients with a longer hospitalization time and complications progressed with greater loss of physical and pulmonary capacities

Ambulation capacity, age, immunosuppression, and mechanical ventilation are risk factors of in-hospital death in severe COVID-19: a cohort study

Importance: Despite ambulation capacity being associated with a decreased level of physical activity and survival may be influenced by the functional capacity, studies have not addressed the association between ambulation capacity and death in patients hospitalized by COVID-19. Objective: To verify the functional, clinical, and sociodemographic risk factors associated with in-hospital death in individuals with severe COVID-19. Methods: It is a cohort retrospective study performed at a large tertiary hospital. Patients 18 years of age or more, of both sexes, hospitalized due to severe COVID-19 were included. Cases with dubious medical records and/or missing essential data were excluded. Patients were classified according to their ambulation capacity before the COVID-19 infection. Information regarding sociodemographic characteristics, in-hospital death, total hospital stays, Intensive Care Unit (ICU) stays, and the necessity of Mechanical Ventilation (MV) were collected from medical records and registered in a RedCap database. Multiple logistic regression analysis was used to identify possible factors associated with the in-hospital death rate. Results: Data from 1110 participants were included in the statistical analysis. The median age of the patients was 57 (46‒66) years, 58.42% (n = 590) were male, and 61.73% (n = 602) were brown or black. The case fatality rate during hospitalization was 36.0% (n = 363). In-hospital death was associated with ambulation capacity; dependent ambulators (OR = 2.3; CI 95% = 1.2–4.4) and non-functional ambulation (OR = 1.9; CI 95% = 1.1–3.3), age [older adults (OR = 3.0; CI 95% = 1.9‒4.), ICU stays (OR = 1.4; CI 95% = 1.2‒1.4), immunosuppression (OR = 5.5 CI 95% = 2.3‒13.5) and mechanical ventilation (OR = 27.5; CI 95% = 12.0–62.9). Conclusion and relevance: Decreased ambulation capacity, age, length of ICU stay, immunosuppression, and mechanical ventilation was associated with a high risk of in-hospital death due to COVID-19

Effects of the Interactive Video Game Nintendo® Wii Sports in the Upper Limb Motor Function of Individuals with Post-Polio Syndrome: Randomized Clinical Trial of Applicability, Safety and Acceptability

A Síndrome Pós Poliomielite (SPP) refere-se aos sintomas neuromusculares novos que ocorrem em pessoas que apresentaram poliomielite aguda, após ao menos 15 anos da estabilidade da doença. Estudos demostram que a fisioterapia promove melhora motora, porém apesar das evidências científicas sobre os efeitos do videogame interativo em outras populações, não há estudos na SPP. Objetivo: Analisar os efeitos do videogame interativo na função dos membros superiores, destreza, funcionalidade, equilíbrio, fadiga e na dor em pessoas com diagnóstico de SPP, bem como avaliar a aceitabilidade, aplicabilidade e segurança da intervenção. Método: Trata-se de um ensaio clínico aleatorizado, paralelo, simples-cego na qual 39 indivíduos com SPP, de ambos os sexos, com idade entre 40 e 75 anos, foram randomizados entre os grupos fisioterapia convencional (GFC n=20) ou videogame interativo (GVI n=19). Ambos os grupos participaram de duas sessões semanais de 50 minutos de duração, por sete semanas, totalizando 14 sessões. Os participantes foram avaliados antes da intervenção (pré), pós intervenção e após 30 dias de seguimento. O desfecho primário foi a função motora dos membros superiores Escala de Função Motora (MFM-32). Os desfechos secundários foram: (1) destreza (teste Box and Block); (2) funcionalidade (Medida de Independência Funcional); (3) equilíbrio (Teste de Alcance Funcional); (4) fadiga muscular (Escala de Severidade de Fadiga), (5) dor em membros superiores (Escala Visual Analógica de Dor); (6) aceitabilidade (questionário elaborado pelos pesquisadores); (7) aplicabilidade (porcentagem de participantes que completaram as intervenções); (8) segurança (registro de eventos adversos). Para a comparação dos efeitos inter e intra grupos das intervenções foi realizada a ANOVA de Medidas Repetidas (2X3) para os fatores grupo e avaliação e o teste de pós hoc de Bonferroni. Adotou-se o alfa de 0,05. Resultados: Ambos os grupos apresentaram melhora na função motora sem diferença entre os mesmos (efeito de avaliação: lado direito p=0,0001; lado esquerdo p=0,0001). Nos desfechos secundários, ambos os grupos apresentaram melhora na funcionalidade, equilíbrio, dor e fadiga pós intervenção com manutenção no seguimento. Em relação à destreza, houve efeito de interação entre os grupos e o GVI apresentou melhora superior ao GFC. Sobre à aceitabilidade, ambos os grupos demonstraram boa satisfação nas intervenções propostas. O único efeito adverso observado em 15% e 10% dos indivíduos do GVI e GFC, respectivamente, foi a dor muscular tardia nos membros superiores somente após a primeira sessão. Em termos de adesão, 92% dos participantes completaram todas as sessões de intervenção em ambos os grupos. Considerações Finais: Ambas as intervenções com fisioterapia motora convencional e com videogame interativo, promoveram efeitos positivos na função de membros superiores, funcionalidade, destreza, com redução da fadiga e dor. Os videogames interativos por serem seguros e aplicáveis podem ser considerados uma nova intervenção para a SPPPost-Polio Syndrome (PPS) corresponds to new symptoms after 15 years of poliomyelitis stability. Studies have shown that physiotherapy promotes motor improvement, but despite having the scientific evidence of the effects of interactive video games on other populations, there are no studies on PPS. Objective: To analyze the effects of interactive videogame on upper limb function, dexterity, functionality, equilibrium, fatigue and pain in the PPS, as well as to evaluate the acceptability, applicability and safety of the intervention. Method: It is a randomized, parallel and single-blind clinical trial. Thirty-nine individuals with PPS, of both genders among 40 and 75 years were randomized into Conventional Physiotherapy Groups (CPG n=20) or Interactive Video games Groups (IVG n=19). Both groups participated in two weekly sessions of 50 minutes duration for seven weeks, totaling 14 sessions. Participants were assessed before the intervention (pre-intervention), post-intervention and after 30 days of follow-up. The primary outcome was the upper limb motor function (Motor Function Measure (MFM-32). Secondary outcomes were: (1) dexterity (Box and Block test); (2) functionality (Functional Independence Measure); (3) balance (Functional Reach Test); (4) muscle fatigue (Fatigue Severity Scale), (5) upper limb pain (Visual Analog Scale for Pain); (6) acceptability (questionnaire developed by the researchers); (7) applicability (percentage of participants who completed interventions); (8) safety (record of adverse events). In order to compare the inter and intra-group effects of the interventions, it was performed the Repeated Measures ANOVA (2X3) with group and assessment factors and the Post-hoc Bonferroni test. The alpha of 0.05 was adopted. Results: Both groups presented improvement in motor function without any difference between them (assessment effect: right side p=0.0001; left side p=0.0001). In the secondary outcomes, both groups showed improvement in functionality, balance, pain and post-intervention fatigue with maintenance at follow-up. In relation to dexterity, there was an interaction effect between the groups and the IVG showed greater improvement than the CPG. Regarding acceptability, both groups showed good satisfaction with the proposed interventions. The only adverse effect observed in 15% and 10% of individuals of IVG and CPG, respectively, was the delayed onset muscle soreness in upper limbs only after the first session. As for adherence, 92% of participants completed all intervention sessions in both groups. Final Considerations: Both interventions conventional physiotherapy and interactive videogame have promoted positive effects on upper limb function, functionality, dexterity, reducing fatigue and pain. Interactive video games were safe and applicable, our results showed than the interactive video games can be considered as new intervention for PP