Reabilitação pulmonar domiciliar pós-alta hospitalar em pacientes pós-COVID-19 imediato
Data
2024-10-18
Autores
Carneiro, Ana Carolina Carvalho 
Orientadores
Gazzotti, Mariana Rodrigues
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
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Resumo
Introdução: Em dezembro de 2019, houve o surgimento de um novo coronavírus, o SARS-CoV-2, que causa uma doença infectocontagiosa e sistêmica chamada COVID-19. Nesta doença os pacientes desenvolvem disfunções respiratórias, física, psicológica e sistêmica generalizada. Uma em cada seis pessoas infectadas por esta doença desenvolvem sintomas, que podem permanecer após três meses. Objetivo: Avaliar a capacidade física dos pacientes no Pós-Covid-19 imediato, submetidos a um programa de reabilitação pulmonar domiciliar. Métodos: Trata-se de um ensaio clínico controlado quase experimental, realizado entre maio de 2021 a abril de 2022. Foram avaliados pacientes acompanhados no ambulatório de COVID-19, após a alta hospitalar, sendo dividos em dois grupos, intervenção (n=37) e controle (n=16). Pacientes foram avaliados quanto a fadiga, qualidade de vida, dispneia, índice de comorbidades, cognição geral, capacidade de exercício e força muscular periférica dos membros superiores e inferiores. Os pacientes receberam orientação do protocolo de reabilitação pulmonar domiciliar de 24 sessões (3x/semana), sendo entregue uma cartilha educativa de exercícios e diário para registro das atividades e foram acompanhados por ligações telefônicas semanais. Resultados: Ambos os grupos avaliados, intervenção e controle, eram semelhantes quanto a idade, maioria do sexo masculino, tinham nível de dispneia leve. Na avaliação do teste de caminhada de seis minutos (TC6) pré e pós-reabilitação, o grupo intervenção apresentou um Δ 77,3 ± 51,8 m (p = 0,009) e o grupo controle Δ 32 ± 65,2 m (p = 0,009). Nas demais avaliações do grupo intervenção houveram: aumento de força muscular dos membros inferiores e superiores no pós-reabilitação (<0,001) e da carga máxima no teste incremental de membros superiores de 0,9 (0,4) para 1,3 (0,4) (p <0,001). Houve melhora no nível de fadiga muscular no pós-reabilitação com aumento da pontuação para 127,0 pontos (p < 0,001), assim como melhora na qualidade de vida entre seu domínio físico, com pontuação de 3,36 (0,74) para 3,72 (0,72) (p < 0,001). Conclusões: O programa de Reabilitação Pulmonar Domiciliar após alta hospitalar em pacientes no Pós-Covid-19 imediato apresentou bons resultados, trazendo benefícios aos pacientes, com importante melhora da capacidade de exercício, qualidade de vida e nível de fadiga muscular. Apresenta baixo custo, viabilidade e segurança.
Introduction: In December 2019, a new coronavirus, SARSCoV2, emerged, causing an infectious and systemic disease called COVID19. In this disease, patients develop respiratory, physical, psychological and generalized systemic dysfunctions. One in six people infected with this disease develop symptoms, which can persist after three months. Objective: To evaluate the physical capacity of patients in the immediate postCOVID19 period, undergoing a home pulmonary rehabilitation program. Methods: This is a quasiexperimental controlled clinical trial, carried out between May 2021 and April 2022. Patients followed up at the COVID19 outpatient clinic were evaluated after hospital discharge and divided into two groups, intervention (n=37) and control (n=16). Patients were evaluated for fatigue, quality of life, dyspnea, comorbidity index, general cognition, exercise capacity and peripheral muscle strength of the upper and lower limbs. Patients received guidance on the 24session home pulmonary rehabilitation protocol (3x/week), were given an educational exercise booklet and a diary to record activities, and were followed up by weekly telephone calls. Results: Both groups evaluated, intervention and control, were similar in age, mostly male, and had mild dyspnea. In the sixminute walk test (6MWT) evaluation before and after rehabilitation, the intervention group presented a Δ 77.3 ± 51.8 m (p = 0.009) and the control group Δ 32 ± 65.2 m (p = 0.009). In the other evaluations of the intervention group there was: an increase in muscle strength of the lower and upper limbs after rehabilitation (<0.001) and in the maximum load in the incremental test of upper limbs from 0.9 (0.4) to 1.3 (0.4) (p <0.001). There was an improvement in the level of muscle fatigue after rehabilitation, with an increase in the score to 127.0 points (p < 0.001), as well as an improvement in the quality of life in its physical domain, with a score of 3.36 (0.74) to 3.72 (0.72) (p < 0.001). Conclusions: The Home Pulmonary Rehabilitation program after hospital discharge in patients in the immediate PostCovid19 period showed good results, bringing benefits to patients, with significant improvement in exercise capacity, quality of life and level of muscle fatigue. It presents low cost, feasibility and safety.
Introduction: In December 2019, a new coronavirus, SARSCoV2, emerged, causing an infectious and systemic disease called COVID19. In this disease, patients develop respiratory, physical, psychological and generalized systemic dysfunctions. One in six people infected with this disease develop symptoms, which can persist after three months. Objective: To evaluate the physical capacity of patients in the immediate postCOVID19 period, undergoing a home pulmonary rehabilitation program. Methods: This is a quasiexperimental controlled clinical trial, carried out between May 2021 and April 2022. Patients followed up at the COVID19 outpatient clinic were evaluated after hospital discharge and divided into two groups, intervention (n=37) and control (n=16). Patients were evaluated for fatigue, quality of life, dyspnea, comorbidity index, general cognition, exercise capacity and peripheral muscle strength of the upper and lower limbs. Patients received guidance on the 24session home pulmonary rehabilitation protocol (3x/week), were given an educational exercise booklet and a diary to record activities, and were followed up by weekly telephone calls. Results: Both groups evaluated, intervention and control, were similar in age, mostly male, and had mild dyspnea. In the sixminute walk test (6MWT) evaluation before and after rehabilitation, the intervention group presented a Δ 77.3 ± 51.8 m (p = 0.009) and the control group Δ 32 ± 65.2 m (p = 0.009). In the other evaluations of the intervention group there was: an increase in muscle strength of the lower and upper limbs after rehabilitation (<0.001) and in the maximum load in the incremental test of upper limbs from 0.9 (0.4) to 1.3 (0.4) (p <0.001). There was an improvement in the level of muscle fatigue after rehabilitation, with an increase in the score to 127.0 points (p < 0.001), as well as an improvement in the quality of life in its physical domain, with a score of 3.36 (0.74) to 3.72 (0.72) (p < 0.001). Conclusions: The Home Pulmonary Rehabilitation program after hospital discharge in patients in the immediate PostCovid19 period showed good results, bringing benefits to patients, with significant improvement in exercise capacity, quality of life and level of muscle fatigue. It presents low cost, feasibility and safety.
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CARNEIRO, Ana Carolina Carvalho. Reabilitação pulmonar domiciliar pós-alta hospitalar em pacientes pós-COVID-19 imediato. 2024. 88 f. Tese (Doutorado em Pneumologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2024.