Pollini Elisa, Lazzarini Stefano Giuseppe, Cordani Claudio, Del Furia Matteo Johann, Kiekens Carlotte, Negrini Stefano, Arienti Chiara
University of Brescia, Brescia, Italy.
IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
Arch Phys Med Rehabil. 2024 Jan;105(1):138-149. doi: 10.1016/j.apmr.2023.08.023. Epub 2023 Oct 5.
To evaluate the effectiveness of rehabilitation interventions for adults with COVID-19 and post COVID-19 condition (PCC) in all settings.
PubMed, EMBASE, CINAHL, Scopus, Web of Science, and Physiotherapy Evidence Database were searched from inception to December 31st, 2021. PROSPERO registration number: CRD42021258553.
We included randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSI) according to the University of Alberta Evidence-based Practice Center.
One author extracted data using a predetermined Excel form.
The meta-analysis indicates uncertain evidence about the effect of pulmonary rehabilitation and self-activities on exercise capacity (MD 65.06, 95% CI 42.87 to 87.25), respiratory function (forced expiratory volume in the first second [FEV1]: MD 0.16, 95% CI 0.05 to 0.28; FEV1/forced vital capacity [FVC]: MD 0.05, 95% CI 0.01 to 0.09; FVC: MD 0.19, 95% CI -0.03 to 0.42) and anxiety (MD -12.03, 95% CI -21.16 to -2.90) in mild COVID-19 and PCC patients. According to the narrative synthesis, including RCTs and NRSI, prone positioning seems to show improvements in vital parameters in severe COVID-19 post intensive care unit (ICU) discharge, pulmonary rehabilitation in activities of daily living, and qigong exercise and acupressure rehabilitation program, and "twist and raise" walking technique in reducing dyspnea and weakness in any degree of severity of COVID-19 and PCC. Functional electrical stimulation-cycling or early rehabilitation programs seem to support a faster recovery in patients with moderate COVID-19 after ICU discharge. Yoga and naturopathy, Mandala coloring, and respiratory exercise seem to reduce anxiety and depression in patients with moderate and mild COVID-19. Cognitive motor training seems to improve cognitive function in PCC patients.
There is very uncertain evidence about the effect of pulmonary rehabilitation on exercise capacity and respiratory function in patients with mild COVID-19 and PCC. Further high-quality research is required to improve the certainty of evidence available to support rehabilitation's crucial role in managing COVID-19.
评估在所有环境下针对新冠肺炎成年患者及新冠后状况（PCC）的康复干预措施的有效性。
检索了从起始到2021年12月31日的PubMed、EMBASE、CINAHL、Scopus、Web of Science和物理治疗证据数据库。PROSPERO注册号：CRD42021258553。
根据阿尔伯塔大学循证实践中心的标准，纳入随机对照试验（RCT）和干预措施的非随机研究（NRSI）。
一位作者使用预先确定的Excel表格提取数据。
荟萃分析表明，关于肺部康复和自我活动对轻度新冠肺炎和PCC患者运动能力（平均差65.06，95%置信区间42.87至87.25）、呼吸功能（第一秒用力呼气量[FEV1]：平均差0.16，95%置信区间0.05至0.28；FEV1/用力肺活量[FVC]：平均差0.05，95%置信区间0.01至0.09；FVC：平均差0.19，95%置信区间-0.03至0.42）和焦虑（平均差-12.03，95%置信区间-21.16至-2.90）的影响，证据不明确。根据叙述性综合分析，包括RCT和NRSI，俯卧位似乎能改善重症新冠肺炎患者重症监护病房（ICU）出院后的生命体征参数，肺部康复对日常生活活动有帮助，气功锻炼和穴位按摩康复计划以及“扭转并抬高”步行技术可减轻任何严重程度的新冠肺炎和PCC患者的呼吸困难和虚弱。功能性电刺激循环或早期康复计划似乎有助于中度新冠肺炎患者ICU出院后更快恢复。瑜伽和自然疗法、曼陀罗填色以及呼吸锻炼似乎能减轻中度和轻度新冠肺炎患者的焦虑和抑郁。认知运动训练似乎能改善PCC患者的认知功能。
关于肺部康复对轻度新冠肺炎和PCC患者运动能力和呼吸功能的影响，证据非常不明确。需要进一步开展高质量研究，以提高现有证据的确定性，从而支持康复在管理新冠肺炎中的关键作用。
