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      Role of Inspiratory Muscle Training on Pulmonary Rehabilitation in Patients with COVID-19: A Pilot Study

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          Abstract

          Background:

          Inspiratory muscle training has been introduced as one of the effective methods in pulmonary rehabilitation, and attention to this technique in patients with COVID-19 is still being studied.

          Materials and Methods:

          In the present study 52 patients who have undergone the period of the COVID-19 disease were randomly divided into two groups. In the control group, in addition to the routine treatment prescribed by a specialist physician, rehabilitation was performed by performing diaphragmatic breathing exercises, pursed-lips breathing, chest expansion, and simple stretching exercises. In the intervention group in addition to the rehabilitation program provided to the control group, patients used an inspiratory muscle training device. This pulmonary rehabilitation program was performed twice a day and 30 repetitions each time with a two-minute rest after every 10 exercises. After 4 weeks, patients in both groups were referred to the hospital for reassessment of the distance of the 6-minute walk test, SF-12 questionnaire results, dyspnea, and S-index. To compare quantitative variables between the two groups we utilized a student t-test. Type one error was put at P≤0.05.

          Results:

          The comparison of 6MWT values shows that the mean of this index in the intervention group is significantly higher than the control group (p = 0.002). Also, the S-index of the two groups showed a significant difference (p=0.024). Results show a significant increase in the SF-12 quality of life questionnaire in patients using IMT (p=0.001).

          Conclusion:

          IMT improves pulmonary functions, 6MWT, and SF-12 Questionnaire in recovered COVID-19 patients.

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          Most cited references18

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          Persistent Symptoms in Patients After Acute COVID-19

          This case series describes COVID-19 symptoms persisting a mean of 60 days after onset among Italian patients previously discharged from COVID-19 hospitalization.
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            The Stanford Hall consensus statement for post-COVID-19 rehabilitation

            The highly infectious and pathogenic novel coronavirus (CoV), severe acute respiratory syndrome (SARS)-CoV-2, has emerged causing a global pandemic. Although COVID-19 predominantly affects the respiratory system, evidence indicates a multisystem disease which is frequently severe and often results in death. Long-term sequelae of COVID-19 are unknown, but evidence from previous CoV outbreaks demonstrates impaired pulmonary and physical function, reduced quality of life and emotional distress. Many COVID-19 survivors who require critical care may develop psychological, physical and cognitive impairments. There is a clear need for guidance on the rehabilitation of COVID-19 survivors. This consensus statement was developed by an expert panel in the fields of rehabilitation, sport and exercise medicine (SEM), rheumatology, psychiatry, general practice, psychology and specialist pain, working at the Defence Medical Rehabilitation Centre, Stanford Hall, UK. Seven teams appraised evidence for the following domains relating to COVID-19 rehabilitation requirements: pulmonary, cardiac, SEM, psychological, musculoskeletal, neurorehabilitation and general medical. A chair combined recommendations generated within teams. A writing committee prepared the consensus statement in accordance with the appraisal of guidelines research and evaluation criteria, grading all recommendations with levels of evidence. Authors scored their level of agreement with each recommendation on a scale of 0–10. Substantial agreement (range 7.5–10) was reached for 36 recommendations following a chaired agreement meeting that was attended by all authors. This consensus statement provides an overarching framework assimilating evidence and likely requirements of multidisciplinary rehabilitation post COVID-19 illness, for a target population of active individuals, including military personnel and athletes.
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              Medium-term impact of COVID-19 on pulmonary function, functional capacity and quality of life

              Background Coronavirus disease 2019 (COVID-19) has spread worldwide determining a dramatic impact on the healthcare system. Aim of this study is to evaluate mid-term clinical impact of COVID-19 on respiratory function. Methods 379 patients were evaluated 4 months after SARS-COV-2 diagnosis. Patients were divided in two groups based on the presence of pneumonia during COVID. Clinical conditions, quality of life, symptomatology, 6-min walking test, pulmonary function test with spirometry and diffusing capacity of carbon monoxide were analysed. Data were compared to clinical evolution during COVID (development of acute respiratory distress syndrome [ARDS], needing of invasive mechanical ventilation [IMV], partial oxygen saturation/ fraction of inspired oxygen [SpO2/FiO2] ratio and pneumonia severity index [PSI]). Results After a median of 135 days, 260 (68.6%) of 379 patients referred almost one symptom. Patients who developed pneumonia during COVID-19 showed lower SpO2 at rest (p<0.001), SpO2 during 6-min walking test (p<0.001), total lung capacity (p<0.001), airway occlusion pressure after 0.1 s [P0.1] (p=0.02), P0.1/maximal inspiratory pressure [MIP] ratio (p=0.005) and higher Borg category-ratio scale (p=0.006) and modified Medical Research Council breathlessness scale (p=0.003), compared to patients without pneumonia. SpO2/FiO2 ratio and PSI during SARS-COV-2 pneumonia were directly associated with mid-term alteration of partial oxygen saturation at rest (p<0.001), SpO2 during 6-min walking test (p<0.001), residual volume (p<0.001), total lung capacity (respectively p<0.001 and p=0.003) and forced vital capacity (respectively p=0.004, p=0.03). Conclusion Lung damage during COVID-19 correlates to the reduction of pulmonary function after 4 months from acute infection.
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                Author and article information

                Journal
                Tanaffos
                Tanaffos
                Tanaffos
                Tanaffos
                National Research Institute of Tuberculosis and Lung Disease
                1735-0344
                2345-3729
                April 2022
                : 21
                : 4
                : 466-471
                Affiliations
                [1 ] Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,
                [2 ] Physiotherapy Research Center, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
                Author notes
                Correspondence to: Fakharian A, Address: Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran, Email address: atefehfakharian2020@ 123456gmail.com
                Article
                Tanaffos-21-466
                10423869
                a7118302-77e0-4624-9d03-d2cca70795f7
                Copyright© 2022 National Research Institute of Tuberculosis and Lung Disease

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 23 November 2021
                : 13 July 2022
                Categories
                Original Article

                covid-19,inspiratory muscle training (imt),pulmonary rehabilitation,respiratory disorders

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