Реабилитация после новой коронавирусной инфекции (COVID-19): принципы и подходы
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Bubnova M.G., Persiyanova-Dubrova A.L., Lyamina N.P., Aronov D.M. Rehabilitation after new coronavirus infection (COVID-19): principles and approaches. Cardiosomatics. 2020; 11 (4): 6–14. DOI: 10.26442/22217185.2020.4.200570
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COVID-19, в первую очередь перенесшие болезнь в среднетяжелой и тяжелой форме, нуждаются в реабилитации.
В статье обоснована необходимость разработки реабилитационных программ для пациентов с COVID-19, обозначены их реабилитационные проблемы, ведущие к ограничениям самообслуживания, мобильности, бытовой жизни, коммуникации, межличностных взаимоотношений, профессиональной деятельности. Приведены цели и общие принципы организации медицинской реабилитации в условиях пандемии на всех 3 этапах. Выделены особенности реабилитационных подходов и представлены важные составляющие индивидуальной программы реабилитации пациентов с COVID-19.
Ключевые слова: коронавирусная инфекция, COVID-19, реабилитация, физическая реабилитация, дыхательные упражнения, лечебная гимнастика.
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The novel coronavirus infection (COVID-19), which quickly became a pandemic in 2020, has presented new challenges for healthcare system. COVID-19, being a contagious infectious disease predominantly affects respiratory system, causes cardiovascular, neurocognitive, renal, gastrointestinal, hepatic, metabolic and mental damages, which is in fact a multisystem disease. Patients with COVID-19, primarily with moderate and severe forms, need appropriate rehabilitation. This article establishes need of development of rehabilitation programs for COVID-19 patients, identifies their problems that leads to restrictions on everyday life, self-service, mobility, communication, interpersonal relationships, and professional activities. Goals and general principles of medical rehabilitation in context of a pandemic at all three stages are presented. Features of rehabilitation approaches are highlighted and important components of individual rehabilitation program for COVID-19 patients are highlighted.
Key words: coronavirus infection, COVID-19, rehabilitation, physical rehabilitation, breathing exercises, therapeutic exercises.
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1. Johns Hopkins Coronavirus Research Center. https://coronavirus.jhu.edu/map.html
2. Brugliera L, Spina A, Castellazzi P et al. Rehabilitation of COVID-19 patients. J Rehabil Med 2020; 52 (4): jrm00046. DOI: 10.2340/16501977-2678
3. Ruan Q, Yang K, Wang W et al. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020; 46: 846–8. DOI: 10.1007/s00134-020-05991-x
4. Guan W-J, Liang W-H, Zhao Y et al. Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis. Eur Respir J 2020. DOI: 10.1183/13993003.00547-2020
5. Richardson S, Hirsch JS, Narasimhan M et al. Presenting characteristics, Comorbidities, and outcomes among 5700 patients hospitalized With COVID-19 in the New York City area. JAMA 2020; 323 (20): 2052–9. DOI: 10.1001/jama.2020.6775
6. Arutyunov G.P., Tarlovskaya E.I., Arutyunov A.G. et al. International register “Dynamics analysis of comorbidities in SARS-CoV-2 survivors” (AKTIV SARS-CoV-2): analysis of 1,000 patients. Russian Journal of Cardiology. 2020; 25 (11): 4165. DOI: 10.15829/1560-4071-2020-4165 (in Russian).
7. Inciardi RM, Adamo M, Lupi L et al. Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy. Eur Heart J 2020; 41: 1821–9. DOI: 10.1093/eurheartj/ehaa388
8. Samsonov M.V., Mishaleva L.M., Chernyev A.L. et al. Pathological anatomy of the lungs by COVID-19: atlas. Ed. O.V. Zairatyants. Moscow–Ryazan: Ryazan regional printing house, 2020 (in Russian).
9. Khan F, Amatya B. Мedical rehabilitation in pandemics: towards a new perspective. J Rehabil Med 2020; 20: jrm00043. DOI: 10.2340/16501977-2676
10. Xiang YT, Zhao YJ, Liu ZH et al. The COVID-19 outbreak and psychiatric hospitals in China: managing challenges through mental health service reform. Int J Biol Sci 2020; 16 (10): 1741–4. DOI: 10.7150/ijbs.45072
11. Ivanova G.E., Balandina I.N., Batisheva T.T. et al. Medical Rehabilitation for new coronavirus infection (COVID-19). Temporary guidelines of the Ministry of health of the Russian Federation. Version 2 (31.07.2020); p. 150. https://xn--80aesfpebagmfblc0a.xn--p1ai/ai/doc/461/attach/28052020_ Preg_COVID-19_v1.pd. ISBN 150 (in Russian).
12. Sheehy LM. Considerations for Postacute Rehabilitation for Survivors of COVID-19. JMIR Public Health Surveill 2020; 6 (2): e19462. DOI: 10.2196/19462
13. Thomas P, Baldwin C, Bissett B et al. Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother 2020; 66 (2): 73–82. DOI: 10.1016/j.jphys.2020.03.011
14. Belkin A.A., Alasheev A.M., Varako N.A. et al. Rehabilitation in intensive care. Clinical guidelines. Bulletin of Rehabilitation Medicine. 2017; 2 (78): 139–43 (in Russian).
15. Tingbo L, Hongliu C, Yu C et al. Handbook of COVID-19 prevention and treatment. 2020.
http://education.almazovcentre. ru/wp-content/uploads/2020/03/Spravochnik_po_profilaktike_i_lecheniju_COVID_19.pdf
16. Zhao H-M, Xie Y-X, Wang C. Recommendations for respiratory rehabilitation in adults with COVID-19. Chinese Association of Rehabilitation Medicine, Respiratory Rehabilitation Committee of Chinese Association of Rehabilitation Medicine, Cardiopulmonary Rehabilitation Group of Chinese Society of Physical Medicine Rehabilitation. Chin Med J 2020 DOI: 10.1097/ CM9.0000000000000848
17. Sessler CN, Gosnell MS, Grap MJ et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002; 166 (10): 1338–44.
18. Bartlo P, Bauer N. Pulmonary rehabilitation post-acute care for Covid-19 (PACER). 2020. https://youtu.be/XjY_7O3Qpd8
19. Centers for Disease Control and Prevention. Discontinuation of Isolation for persons with COVID-19 not in healthcare settings (Interim Guidance). 2020. https://www.cdc.gov/coronavirus/ 2019-ncov/hcp/disposition-in-home-patients.html
20. Yang L-L, Yang T. Pulmonary rehabilitation for patients with coronavirus disease 2019 (COVID-19) Chronic Dis Transl Med 2020; 6: 79–86. DOI: 10.1016/j.cdtm.2020.05.002
21. Avdeev S.N., Tsareva N.A., Merzhoeva Z.M. et al. Practical guidelines for oxygen therapy and respiratory support for patients with COVID-19 in the pre-life support. Pul’monologiya. 2020; 30 (2): 151–63. DOI: 10.18093/0869-0189-2020-30-2-151-163 (in Russian).
22. Cheng Y-Y, Chen C-M, Huang W-C et al. Rehabilitation programs for patients with COronaVIrus Disease 2019: consensus statements of Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation. J Formos Med Assoc 2020.
DOI: 10.1016/j.jfma.2020.08.015
23. Meshcheryakova NN, Belevsky AS, Kuleshov AV. Pulmonary rehabilitation of patients with coronavirus infection COVID-19, clinical examples. Pul’monologiya. 2020; 30 (5): 715–22. DOI: 10.18093/0869-0189-2020-30-5-715-722 (in Russian).
24. Lazzeri M, Lanza A, Bellini R et al. Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR). Monaldi Arch Chest Dis 2020; 90 (1): 1285. DOI: 10.4081/monaldi.2020.1285
25. Garber CE, Blissmer B, Deschenes MR et al. American College of Sports Medicine Position Stand. Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise. Med Sci Sports Exerc 2011; 43 (7): 1334–59. DOI: 10.1249/MSS.0b013e318213fefb
26. Spruit MA, Singh SJ, Garvey C et al.; on behalf of the ATS/ERS Task Force on Pulmonary Rehabilitation. An Official American Thoracic Society/European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation. Am J Respir Crit Care Med 2013; 188 (8): e13–64. DOI: 10.1164/rccm.201309-1634ST
27. Barker-Davies RM, O’Sullivan O, Senaratne KPP et al. The Stanford Hall consensus statement for post-COVID-19 rehabilitation. Br J Sports Med 2020; 54 (16). DOI: 10.1136/bjsports-2020-102596
28. Bubnova M.G., Aronov D.M. Ensuring physical activity of citizens with disabilities. Guidelines. Ed. by S.A. Boytsov. Cardiosomatics. 2016; 7 (1): 5–50 (in Russian).
29. Piercy KL, Troiano RP, Ballard RM et al. The Physical Activity Guidelines for Americans. JAMA 2018; 12. DOI: 10.1001/jama.2018.14854
30. Aronov D.M., Bubnova M.G., Barbarash O.L. et al. Acute ST elevation myocardial infarction: rehabilitation and secondary prevention. National Russian Guidelines. Russian Journal of Cardiology. 2015; 20 (1): 6–52. DOI: 10.15829/1560‑4071-2015-1-6-52 (in Russian).
31. Bokeriya L.A., Aronov D.M., Bubnova M.G. et al. Russian clinical guidelines Coronary artery bypass grafting in patients with ischemic heart disease: rehabilitation and secondary prevention. Cardiosomatics. 2016; 7 (3–4): 5–71 (in Russian).
32. Makarova M.R., Lyamina N.P., Somov D.A. et al. Physical rehabilitation for СOVID-19 associated pneumonia. Teaching guide. Moscow, 2020; р. 84 (in Russian).
1 ФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава России, Москва, Россия;
2 ГАУЗ «Московский научно-практический центр медицинской реабилитации, восстановительной
и спортивной медицины» Департамента здравоохранения г. Москвы, Москва, Россия
*mbubnova@gnicpm.ru
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Marina G. Bubnova*1, Anna L. Persiyanova-Dubrova1, Nadezhda P. Lyamina2, David M. Aronov1
1 National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia;
2 Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
*mbubnova@gnicpm.ru