Letter to the Editor
Feasibility of tele-rehabilitation in survivors of COVID-19 pneumonia
M. Paneronia,
, M. Vitaccaa, P. Bernocchib, L. Bertacchinia, S. Scalvinib,c
Corresponding author
mara.paneroni@icsmaugeri.it
Corresponding author at: Istituti Clinici Scientifici Maugeri IRCCS, Via Salvatore Maugeri, 4 - 27100 Pavia, Italy.
Corresponding author at: Istituti Clinici Scientifici Maugeri IRCCS, Via Salvatore Maugeri, 4 - 27100 Pavia, Italy.
a Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
b Istituti Clinici Scientifici Maugeri IRCCS, Continuity of Care of the Institute of Lumezzane, Brescia, Italy
c Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, Brescia, Italy
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Di Paco, S. Mazzoleni, M. Vitacca, L. Comini, N. Ambrosino" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Di Paco" ] 1 => array:2 [ "nombre" => "S." "apellidos" => "Mazzoleni" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Vitacca" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Comini" ] 4 => array:2 [ "nombre" => "N." "apellidos" => "Ambrosino" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2531043721002063?idApp=UINPBA00004E" "url" => "/25310437/0000002800000002/v1_202202260728/S2531043721002063/v1_202202260728/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Feasibility of tele-rehabilitation in survivors of COVID-19 pneumonia" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "152" "paginaFinal" => "154" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "M. Paneroni, M. Vitacca, P. Bernocchi, L. Bertacchini, S. Scalvini" "autores" => array:5 [ 0 => array:4 [ "nombre" => "M." "apellidos" => "Paneroni" "email" => array:1 [ 0 => "mara.paneroni@icsmaugeri.it" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:4 [ "nombre" => "M." "apellidos" => "Vitacca" "email" => array:1 [ 0 => "michele.vitacca@icsmaugeri.it" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:4 [ "nombre" => "P." "apellidos" => "Bernocchi" "email" => array:1 [ 0 => "palmira.bernocchi@icsmaugeri.it" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:4 [ "nombre" => "L." "apellidos" => "Bertacchini" "email" => array:1 [ 0 => "laura.bertacchini@icsmaugeri.it" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:4 [ "nombre" => "S." "apellidos" => "Scalvini" "email" => array:1 [ 0 => "simonetta.scalvini@icsmaugeri.it" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Istituti Clinici Scientifici Maugeri IRCCS, Continuity of Care of the Institute of Lumezzane, Brescia, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Istituti Clinici Scientifici Maugeri IRCCS, Cardiac Rehabilitation of the Institute of Lumezzane, Brescia, Italy" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Istituti Clinici Scientifici Maugeri IRCCS, Via Salvatore Maugeri, 4 - 27100 Pavia, Italy." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2199 "Ancho" => 2500 "Tamanyo" => 351764 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Individual changes in outcome measures between admission (pre-TR) and discharge from (post-TR) the program. Red bar represents the mean data.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Legend: 6MWT = 6 min Walking Distance; 1MSTS = 1 min Sit-to-Stand.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Survivors of COVID-19-associated pneumonia may experience a long-term reduction in functional capacity, exercise tolerance, and muscle strength, regardless of their previous health status or disabilities.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> Telerehabilitation (TR) programs have proven effective in several conditions,<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4–6</span></a> and have been also suggested for patients after COVID-19.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> To date, however, no study has investigated whether early telerehabilitation after hospitalization for COVID-19-associated pneumonia is effective. We report a pilot study investigating the safety, feasibility, and efficacy of a 1-month TR program in individuals discharged after recovery from COVID-19 pneumonia [Ethical Committee approval 2440CE].</p><p id="par0010" class="elsevierStylePara elsevierViewall">The study was conducted from April 1 to June 30, 2020 at the ICS Maugeri Institute of Lumezzane, Italy, a referral centre for pulmonary rehabilitation with a dedicated COVID-19 Unit. Inclusion criteria were: clinical stability; resting hypoxaemia or exercise-induced desaturation (EID) [≥4% decrease in SpO<span class="elsevierStyleInf">2</span> at the 6-min Walking Test (6MWT)<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span>]</a>, or exercise limitation (6MWT: <70% of predicted), availability of home internet and ability to use technologies. Patients with cognitive deficits, severe comorbidities or physical impairment preventing exercise without medical supervision were excluded.</p><p id="par0015" class="elsevierStylePara elsevierViewall">On admission to the program, patients received a pulse oximeter, a brochure illustrating exercises, a diary to record daily activities, and instructions for home exercises. The one-month program consisted of one hour daily of aerobic reconditioning and muscle strengthening and healthy lifestyle education. Twice a week, a physiotherapist (PT) contacted the patient—by video-call via a dedicated platform—to monitor progress. Exercise intensity was based on the Short Physical Performance Battery (SPPB)<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> test and EID and was divided into 4 arbitrary levels (1 = lowest intensity, 4 = highest intensity). Patients with SPPB < 10 or EID were included in the levels 1–2 and performed low-intensity aerobics (walking, free-body exercise, sit-to-stand) and balance exercises. Patients with SPPB ≥ 10 and no EID were included in the levels 3–4 and performed walking session with pedometer, aerobics with cycle ergometer or leg/arm crank, and strengthening exercises with a lightweight band. The intensity of the exercise session was progressively increased according to symptoms and cardio-respiratory parameters evaluation. Programs could be changed only under strict PT control. Chest physiotherapy exercises (lung expansion, strengthening of the respiratory muscles) could be added, if necessary. In addition to physiotherapy monitoring, for the first two weeks nurses tele-monitored patients daily to check their clinical needs; subsequently, patients received one weekly telephone/video call. If any symptoms/problems emerged, patients could always contact nurses (7/7 days) or physicians for a second-opinion consultation.</p><p id="par0020" class="elsevierStylePara elsevierViewall">On admission to TR, anthropometrics, clinical status and lung function were collected <span class="elsevierStyleBold">(</span><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). On admission and discharge, 6MWT,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> 1 min Sit-to-Stand (1MSTS),<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> and Barthel Dyspnoea Index<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> were assessed. Program adherence (i.e. number of performed/scheduled video-calls) was assessed. “Pre” to “post” program differences were analyzed by paired t- or Pearson Chi-square test. The percentage of patients reaching the minimal clinically important difference (MCID) for the measures was evaluated. Pearson correlation analysis assessed the change in outcome measures (observed in video calls) from baseline.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Out of 25 consecutive patients, 24 completed the program. Patients attended 7.2 ± 1.7 out of 8 video-calls scheduled and nurses made 13.4 ± 2.1 phone calls. Patients reported fatigue (70.8%), muscle pain (50.0%), exercise induced dyspnoea (50.0%), and sleep disorders (41.7%). No need for hospitalization or emergency room visits occurred. TR allowed patients to change their exercise capacity passing from an initial intensity level of 1.2 ± 2.1 to a final level of 3.1 ± 1.3. No adverse effect was reported. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> shows the changes in outcome measures. Exercise capacity and Barthel dyspnoea significantly improved. The percentage of patients with EID at 6MWT was 62.5% at admission and 66.7% at discharge (P = 0.6624), while at 1MSTS it was 50.0% at admission and 41.6% at discharge (P = 0.6735).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">At the end of the program, distance walked in 6MWT increased in 75.0% of patients, remained stable in 4.2%, and decreased in 20.8% of patients; 17 patients (70.8%) improved 6MWT above the MCID (30 m).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The number of sit-to-stands increased in 62.5%, remained stable in 16.6%, and decreased in 20.8% of patients; 12 patients (50.0%) improved 1MSTS above the MCID (3 rises).<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Barthel dyspnoea improved in 83.3%, remaining unchanged in 16.7% of patients; in 50% of patients, the dyspnoea decrease was 6.5 points above the MCID.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">This preliminary report, although limited by the small sample size and absence of a control group, confirms the feasibility and safety of a dedicated TR program for survivors of COVID-19 pneumonia. After one month of TR, patients improved exercise tolerance and dyspnoea. However, approximately 20% of patients were non-responders. No adverse events were found. As with chronic cardio-pulmonary diseases, telerehabilitation may help to avoid a gap in service delivery following hospital discharge of COVID-19 patients and should be integrated into their follow-up. Further randomized control trials are needed.</p><span id="sec1005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect1010">Funding</span><p id="par1045" class="elsevierStylePara elsevierViewall">This work was supported by the “Ricerca Corrente” Funding scheme of the <span class="elsevierStyleGrantSponsor" id="gs1">Ministry of Health</span>, Italy.</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "xpalclavsec1484349" "titulo" => "Keywords" ] 1 => array:2 [ "identificador" => "sec1005" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1484349" "palabras" => array:7 [ 0 => "COVID" 1 => "COVID-19" 2 => "Exercise" 3 => "Pulmonary rehabilitation" 4 => "Physiotherapist" 5 => "Telerehabilitation" 6 => "Telemedicine" ] ] ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2199 "Ancho" => 2500 "Tamanyo" => 351764 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Individual changes in outcome measures between admission (pre-TR) and discharge from (post-TR) the program. Red bar represents the mean data.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Legend: 6MWT = 6 min Walking Distance; 1MSTS = 1 min Sit-to-Stand.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">CIRS1 = Cumulative Illness Rating Scale 1, BMI = Body-Mass Index, SPPB = Short Physical Performance Battery, SpO<span class="elsevierStyleInf">2</span> = pulse oxymetry, FiO<span class="elsevierStyleInf">2</span> = Inspired Oxygen Fraction, FEV<span class="elsevierStyleInf">1</span> = Forced Expiratory Volume at first second, FVC = Forced Vital Capacity, MIP = Maximal Inspiratory Pressure, MEP = Maximal Expiratory Pressure, CPAP = Continuous Positive Airways Pressure, 6MWT = 6-Min Walk Test, 1MSTS = 1 min Sit-to-Stand.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Measure \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (45.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age, years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">66.0 ± 8.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BMI, kg/m<span class="elsevierStyleSup">2</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.1 ± 5.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SpO<span class="elsevierStyleInf">2</span>, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">95.4 ± 2.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FiO<span class="elsevierStyleInf">2</span>, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23.5 ± 4.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oxygen therapy at rest, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (20.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CIRS1, score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.0 ± 0.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SPPB, score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.1 ± 4.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FEV<span class="elsevierStyleInf">1</span>, % pred. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.6 ± 19.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FVC, % pred. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77.9 ± 18.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">FEV<span class="elsevierStyleInf">1</span>/FVC, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">89.9 ± 13.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MIP, cmH<span class="elsevierStyleInf">2</span>O \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">76.1 ± 28.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MIP, % pred. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82.2 ± 22.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MEP, cmH<span class="elsevierStyleInf">2</span>O \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">86.7 ± 31.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MEP, % pred. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49.2 ± 13.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Clinical History, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Invasive Mechanical Ventilation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (50.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>CPAP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (70.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tracheostomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (29.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oxygen Therapy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (100.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6MWT, meters \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">298.4 ± 111.7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6MWT, % predicted \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55.1 ± 21.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1MSTS, number of sit-to-stand rises \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.0 ± 8.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1MSTS, % predicted \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.6 ± 26.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Barthel dyspnoea, score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.7 ± 9.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2845918.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Demographic, anthropometric, physiological and clinical characteristics of patients at the start of the TR program. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 9 | 4 | 13 |
| 2024 October | 64 | 39 | 103 |
| 2024 September | 86 | 34 | 120 |
| 2024 August | 95 | 34 | 129 |
| 2024 July | 100 | 37 | 137 |
| 2024 June | 93 | 37 | 130 |
| 2024 May | 85 | 42 | 127 |
| 2024 April | 90 | 41 | 131 |
| 2024 March | 88 | 25 | 113 |
| 2024 February | 80 | 35 | 115 |
| 2024 January | 122 | 32 | 154 |
| 2023 December | 56 | 31 | 87 |
| 2023 November | 168 | 70 | 238 |
| 2023 October | 131 | 51 | 182 |
| 2023 September | 87 | 39 | 126 |
| 2023 August | 89 | 28 | 117 |
| 2023 July | 106 | 36 | 142 |
| 2023 June | 90 | 24 | 114 |
| 2023 May | 79 | 54 | 133 |
| 2023 April | 73 | 36 | 109 |
| 2023 March | 87 | 39 | 126 |
| 2023 February | 66 | 29 | 95 |
| 2023 January | 74 | 24 | 98 |
| 2022 December | 89 | 45 | 134 |
| 2022 November | 110 | 50 | 160 |
| 2022 October | 130 | 65 | 195 |
| 2022 September | 93 | 97 | 190 |
| 2022 August | 95 | 78 | 173 |
| 2022 July | 125 | 80 | 205 |
| 2022 June | 94 | 55 | 149 |
| 2022 May | 135 | 59 | 194 |
| 2022 April | 215 | 102 | 317 |
| 2022 March | 371 | 117 | 488 |
| 2022 February | 129 | 66 | 195 |
| 2022 January | 112 | 61 | 173 |
| 2021 December | 90 | 56 | 146 |
| 2021 November | 51 | 45 | 96 |
| 2021 October | 104 | 76 | 180 |
| 2021 September | 98 | 61 | 159 |
| 2021 August | 108 | 63 | 171 |
| 2021 July | 92 | 51 | 143 |
| 2021 June | 178 | 98 | 276 |
| 2021 May | 187 | 121 | 308 |
| 2021 April | 68 | 50 | 118 |
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