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长新冠综合征患者不同康复方案的长期结局:一项队列前瞻性研究。

Long-term outcomes of different rehabilitation programs in patients with long COVID syndrome: a cohort prospective study.

作者信息

Grishechkina Irina A, Lobanov Andrey A, Andronov Sergei V, Rachin Andrey P, Fesyun Anatoliy D, Ivanova Elena P, Masiero Stefano, Maccarone Maria Chiara

机构信息

National Medical Research Center, Moscow.

National Medical Research Center, Moscow, Russia; Moscow State University of Food Production, Moscow.

出版信息

Eur J Transl Myol. 2023 Apr 13;33(2):11063. doi: 10.4081/ejtm.2023.11063.

Abstract

After the resolution of the acute SARS-COV-2 infection, an important percentage of patients do not fully recover and continue to present several symptoms. Nevertheless, there is a lack of data in the literature on the effects of rehabilitation programs on medium- and long-term long COVID symptoms. Therefore, the aim of this study was to evaluate the long-term outcomes after rehabilitation programs in long COVID syndrome patients. A prospective cohort study was conducted from August 2021 to March 2022, involving 113 patients with long COVID syndrome. The patients in the experimental group (EG, n=25) received a tailored and multidisciplinary rehabilitative program, involving aquatic exercises, respiratory and motor exercises, social integration training and neuropsychologic sessions, LASER therapy and magnetotherapy. Patients in the other three comparison groups received eastern medicine techniques (CG1), balneotherapy and physiotherapy (group CG2), self-training and home-based physical exercise (CG3). Once the several rehabilitation protocols had been performed, a structured telephone contact was made with the patients after 6 months ± 7 days from the end of the rehabilitation treatment, in order to record the frequency of hospital ad-missions due to exacerbation of post-exacerbation syndrome, death or disability, and the need for other types of care or drugs. The patients in the comparison groups were more likely to request therapeutic care for emerging long COVID symptoms (χ2=6.635, p=0.001; χ2=13.463, p=0.001; χ2=10.949, p=0.001, respectively), as well as more likely to be hospitalized (χ2=5.357, p=0.021; χ2=0.125, p=0.724; χ2=0.856, p=0.355, respectively) when compared to the patients of the EG. The relative risk (RR) of hospital admissions in the observed cohort was 0.143 ±1,031 (СI: 0.019; 1.078); 0.580±1,194 (CI: 0.056; 6.022); 0,340±1,087 (CI: 0.040; 2.860). The RR of hospital admissions for patients with long COVID syndrome was reduced by 85.7%; 42.0% and 66.0%, respectively, when the experimental rehabilitation technique was employed. In conclusion, a tailored and multidisciplinary rehabilitative program seems to have a better preventive effect not only in the short term, but also over the next 6 months, avoiding the new onset of disabilities and the use of medicines and specialist advice, than other rehabilitative programs. Future studies will need to further investigate these aspects to identify the best rehabilitation therapy, also in terms of cost-effectiveness, for these patients.

摘要

在急性SARS-CoV-2感染消退后,相当一部分患者并未完全康复,仍持续出现多种症状。然而,文献中缺乏关于康复计划对新冠后中长期症状影响的数据。因此,本研究的目的是评估新冠后综合征患者接受康复计划后的长期结果。2021年8月至2022年3月进行了一项前瞻性队列研究,纳入了113例新冠后综合征患者。实验组(EG,n = 25)的患者接受了量身定制的多学科康复计划,包括水上运动、呼吸和运动锻炼、社交融合训练以及神经心理治疗、激光治疗和磁疗。其他三个对照组的患者分别接受中医疗法(CG1)、浴疗和物理治疗(CG2组)、自我训练和家庭体育锻炼(CG3)。在执行了几种康复方案后,在康复治疗结束后6个月±7天与患者进行了结构化电话联系,以记录因后急性感染综合征加重、死亡或残疾而住院的频率,以及对其他类型护理或药物的需求。与EG组患者相比,对照组患者更有可能因新出现的新冠后症状而寻求治疗护理(χ2分别为6.635,p = 0.001;χ2为13.463,p = 0.001;χ2为10.949,p = 0.001),也更有可能住院(χ2分别为5.357,p = 0.021;χ2为0.125,p = 0.724;χ2为0.856,p = 0.355)。观察队列中住院的相对风险(RR)为0.143±1.031(CI:0.019;1.078);0.580±1.194(CI:0.056;6.022);0.340±1.087(CI:0.040;2.860)。当采用实验性康复技术时,新冠后综合征患者住院的RR分别降低了85.7%、42.0%和66.0%。总之,与其他康复计划相比,量身定制的多学科康复计划似乎不仅在短期内,而且在接下来的6个月内都具有更好的预防效果,可避免残疾的新发以及药物使用和专科建议。未来的研究需要进一步调查这些方面,以确定针对这些患者的最佳康复治疗方法,包括成本效益方面。

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