Rehabilitation Treatment for Discharged Patients with Severe/Critically Severe Disease
22.214.171.124.1 Objectives of Rehabilitation Treatment
The rehabilitation treatment objectives are to further improve symptoms, restore muscle strength and endurance, improve lung and motor function, reduce the risk of readmission, and restore daily activities, social participation, and psychological adaptation.
126.96.36.199.2 Criteria Exclusion and Motion Termination
At the beginning and during the rehabilitation of discharged patients with severe/critically severe disease, pay special attention to observing their vital signs and treatment response, and master the exclusion criteria and exercise termination criteria for rehabilitation.
1) Exclusion criteria:
a. Heart rate > 100 beats/min
b. Blood pressure < 90/60 mmHg or > 140/90 mmHg
c. Blood oxygen saturation < 95%
d. Other diseases that are not suitable for exercise
2) Exercise termination criteria:
a. Temperature fluctuates, > 37.2 °C
b. Respiratory symptoms and fatigue are aggravated and are not relieved after a rest
c. Stop exercise and consult a doctor if the following symptoms occur: Chest tightness, chest pain, dyspnea, severe cough, dizziness, headache, blurred vision, palpitations, sweating, unstable standing, and other symptoms
- 188.8.131.52.3 Rehabilitation Treatment Methods
- 1) Patient education:
a. Help patients understand lung consolidation after virus infection and preach on the physical and psychological changes that may occur after severe patients are discharged from the hospital. Instruct patients about the importance of regular follow-up visits, precautions, nutrition support, oxygen therapy, the significance of respiratory muscle training, energy-saving ways in daily life, etc., which can be carried out through manuals or videos to improve patients’ mastery of disease knowledge.
b. Help patients understand respiratory rehabilitation treatment and its importance to increase their compliance. Introduce to patients the role of respiratory rehabilitation in patients after being discharged from the hospital, specific contents of respiratory rehabilitation, effects of respiratory rehabilitation, precautions in respiratory rehabilitation, etc.
c. Inform patients that follow-up visits will ask about their participation in respiratory rehabilitation, progress, and benefits, as well as their participation in family and social activities.
2) Respiratory training:
a. Active circulatory breathing techniques include breath control, thoracic expansion, and forced exhalation.
b. Respiratory pattern training techniques include position management, breathing rhythm adjusting (inhalation: exhalation = 1:2), thoracic activity training, respiratory muscle groups activating, and abdominal breathing training, etc.
c. If there is inspiratory muscle dysfunction, patients are recommended to perform inspiratory muscle training by using a breathing trainer with a 30%-50% MIP* load seven times a week, 30 inhalations each time, and each inhaling interval should be no less than 6 seconds. @ For sputum excretion training, when cleaning the airway, use the “ha” coughing technique to reduce patients’ sputum excretion and energy consumption. Devices such as positive expiratory pressure (PEP)/OPEP can also be used to assist patients. Train for 5 minutes three times a day. Hie patient should exhale for more than 3 seconds each time.
3) Aerobic training:
a. This adopts the FITT (frequency, intensity, time, type) principle. For details, refer to the relevant chapter on rehabilitation treatment technology.
4) Strength training:
a. For those with decreased muscle strength, progressive resistance training is recommended for target muscle groups. The training load of each target muscle group is 8-12 repetition maximum (RM) (i.e., each group repeats 8-12 movements of the load), completing one to three groups each time, with each groups training interval at 2 minutes, and the frequency is 2-3 times/week. Train for 6 weeks with a weekly increase of 5%-10%.
5) Balance training:
a. Patients with balance dysfunction should be involved in balance training, such as free-hand balance training and balance training equipment under rehabilitation therapists’ guidance.
6) Occupational therapy mainly improves necessary activities of daily living within 2-4 weeks upon being discharged from hospitals. The main concerns are contractures caused by bed immobilization, pain caused by soft tissue damage, and limited joint movement. Comprehensive treatment including drugs, physical factors, braces and stretching are mainly given. For patients with joint disorders of essential daily activities caused by weak limbs,strength training and occupational therapy training are mainly carried out to improve their muscle strength and endurance. As for the disorder in ADL caused by dyspnea, it is necessary to assess patients’ respiratory function, aerobic activity ability, body strength, and other factors and then intervene with training on using energy-saving techniques or compensatory energy-saving assistance devices.
The maximum inspiratory oral pressure is the maximum inspiratory oral pressure that can be generated with the maximum inspiratory effort when the airway is blocked at the residual air level or the functional residual air level.
It mainly improves patients’ instrumental activities of daily life at more than 4 weeks upon being discharged from hospitals. It is necessary to evaluate patients’ instrumental daily activities at more than 1 month upon being discharged from hospitals, to know patients’ social participation and other higher-level daily activity abilities. It is also necessary to comprehensively consider patients’ psychological and physical function capabilities when they complete these activities, find out the obstacles to task participation, and take targeted treatment. It can be carried out by simulating the actual scene.
- 1. General Office of the National Health Commission, Office of the National Administration of Traditional Chinese Medicine. COVID-19 Diagnosis and Treatment Protocol (Trial Version 7) [EB/OL]. [2020-03-03].
- 2. General Office of the National Health Commission, Hospital Administration and Hospital Authority. Notice of The General Office ofthe National Health Commission on Follow-Up and Follow-Up of CoVID-19 Discharged Patients [EB/OLf [2020-02-17]
- 3. Chinese Rehabilitation Medical Association. Comprehensive Guidance on Rehabilitation and Diagnosis during COVID-19 Pandemic (Second Edition) [EB/OL]. [2020-02-18].
- 4. Novel Coronavirus Infection Prevention and Control Technical Guide (first edition) in Medical Institutions [EB/OL]. [2020-01-22].
- 5. General Office of the National Health Commission, Hospital Administration. Guidelines on the Scope of Common Medical Protection in Novel Coronavirus Infection Prevention (Trial) [EB/OL]. [2020-01-26].
- 6. General Office of the National Health Commission. Notice of the General Office of the National Health Commission on the Issuance of the Novel Coronavirus Prevention and Control Plan (Third Edition) [EB/OL]. [2020-01-28].
- 7. Novel Coronavirus 2019 (Second Edition) [J/OL], Chinese Journal of Tuberculosis and Respiration, 2020(04): 308-314.
- 8. Yu Pengming, He Chengqi, Gao Qiang, He Hongchen, Wei Quan. Guidelines and recommendations for full cycle physical therapy for COVID-19 patients [J]. Chinese Journal of Physical Medicine & Rehabilitation, 2020,42(2): 102-104.
- 9. Tire General Office of the National Health Commission issued a notice on the issuance of the Rehabilitation Plan for coVID-19 discharged patients (Trial), medical Letter  189 (4 March 2020) of the State Health Office.
- 10. Respiratory Critical Care Medicine Group, Respiratory Critical Care Medicine Branch, Chinese Medical Association, Critical Care Medicine Working Committee, Respiratory Physicians Branch, Chinese Medical Doctor Association. Airway management recommendations for adult patients with severe COVID-19 (trial) [J]. Chinese Journal of Medicine, 2020(10): 729-737.
- 11. National Health Commission. Notice on the Issuance of Novel Coronavirus Outbreak Emergency Psychological Crisis Intervention Guidelines [OL]. [2020-01-26].
- 12. Chinese Rehabilitation Medical Association. Expert consensus of rehabilitation diagnosis and treatment during coVID-19 outbreak of respiratory infectious Diseases [J]. Chinese Journal of Physical Medicine and Rehabilitation, 2020,42(2): 97-101.
- 13. Li Dekun, Zou Yucong, Jin Kai, Dai Jian. Chinese Medicine combined with modern rehabilitation forcoVID-19 patients [J/OL]. Clinical Journal of Chinese Medicine,: 2020,32(05):832-836.
- 14. Xu Cheng, Cheng Yanqi, Tang Ling, Li Shaobin, Wu Yinyin, Fang Song. Pulmonary rehabilitation strategies for patients with severe/critically severe COVID-19 mechanical ventilation [J/OL]. Shanghai Journal of Traditional Chinese Medicine, 2020,54(05): 1-4.
- 15. Hie Standing Committee of the National People’s Congress of China. Law of the People’s Republic of China on the Prevention and Treatment of Infectious Diseases.[EB/OL].[1989-02-12].