Pub Date : 2021-01-01DOI: 10.1097/cpt.0000000000000172
V. A. Nastav, B. Peterson
BACKGROUND AND PURPOSE: The rehabilitation of post-intensive care syndrome and critical illness myopathy has been well documented.1,2 However, the recent wave of individuals recovering from COVID-19 demonstrate unique treatment considerations based on their presentation. While there is some research regarding acute care for post-COVID patients, there is a need for information later in the recovery process.3Most of those in the post-acute phase have cardiopulmonary complications, but there is increased evidence of neurological and orthopedic components.4 This case series aims to discuss the physical therapy treatment of two post-COVID patients based on NYU's categorizations 'debility with COVID-19,' or 'neurological with COVID-19' and highlight their differences.5 CASE DESCRIPTION: Two subjects admitted to an acute inpatient rehabilitation (AIR) facility after hospital stay of 42 (subject A) and 64 days (subject B), due to COVID- 19. The latter being longer due to development of a lacunar stroke. Both are male with an average age of 54.5 years. Each received symptom specific physical therapy 2-3hrs, 6-7 days/week. Subject A received cardiopulmonary therapy, nightly CPAP, standard balance and strengthening exercises. Limitations were O2 desaturation and orthostatic hypotension. Patient B received functional strengthening, balance and blocked motor control exercises to promote neural plasticity. AIR length of stay was 17 days for patient A and 28 days for patient B. OUTCOMES: Outcome measures included the Berg Balance Score (BBS), 6 min walk test, and 10m walk test. O2 saturation levels and heart rate were monitored with activity. For patient A, BBS improved by 19 points, 6 min walk improved by more than 100ft, limited primarily by O2 desaturation. No significant change in gait speed was made, but he transitioned from rolling walker to cane. For patient B, BBS improved by 36 points, 6 min walk improved by over 800ft, and gait speed by .32 m/s. Patient B received a right ankle-foot orthotic and required a rolling walker. Neither subject required O2 at discharge. Patient A was at an independent level, but had decreased cardiovascular endurance and activity tolerance. Patient B was largely independent but required intermittent supervision with some higher level activities, primarily due to motor control deficits. DISCUSSION: By the end of their inpatient rehabilitation stay, both patients made statistically significant improvements in all measured outcomes. This suggests while a primary focus will be on treatment of pulmonary impairments, there should also be adjustments made based on their individual presentation of COVID and neuromuscular deficits. In conclusion, the outcomes of this case series demonstrate the efficacy of treating post-COVID patients with variable presentations in the acute inpatient rehabilitation physical therapy setting.
{"title":"Acute inpatient rehabilitation of two post-covid presentations: A case series","authors":"V. A. Nastav, B. Peterson","doi":"10.1097/cpt.0000000000000172","DOIUrl":"https://doi.org/10.1097/cpt.0000000000000172","url":null,"abstract":"BACKGROUND AND PURPOSE: The rehabilitation of post-intensive care syndrome and critical illness myopathy has been well documented.1,2 However, the recent wave of individuals recovering from COVID-19 demonstrate unique treatment considerations based on their presentation. While there is some research regarding acute care for post-COVID patients, there is a need for information later in the recovery process.3Most of those in the post-acute phase have cardiopulmonary complications, but there is increased evidence of neurological and orthopedic components.4 This case series aims to discuss the physical therapy treatment of two post-COVID patients based on NYU's categorizations 'debility with COVID-19,' or 'neurological with COVID-19' and highlight their differences.5 CASE DESCRIPTION: Two subjects admitted to an acute inpatient rehabilitation (AIR) facility after hospital stay of 42 (subject A) and 64 days (subject B), due to COVID- 19. The latter being longer due to development of a lacunar stroke. Both are male with an average age of 54.5 years. Each received symptom specific physical therapy 2-3hrs, 6-7 days/week. Subject A received cardiopulmonary therapy, nightly CPAP, standard balance and strengthening exercises. Limitations were O2 desaturation and orthostatic hypotension. Patient B received functional strengthening, balance and blocked motor control exercises to promote neural plasticity. AIR length of stay was 17 days for patient A and 28 days for patient B. OUTCOMES: Outcome measures included the Berg Balance Score (BBS), 6 min walk test, and 10m walk test. O2 saturation levels and heart rate were monitored with activity. For patient A, BBS improved by 19 points, 6 min walk improved by more than 100ft, limited primarily by O2 desaturation. No significant change in gait speed was made, but he transitioned from rolling walker to cane. For patient B, BBS improved by 36 points, 6 min walk improved by over 800ft, and gait speed by .32 m/s. Patient B received a right ankle-foot orthotic and required a rolling walker. Neither subject required O2 at discharge. Patient A was at an independent level, but had decreased cardiovascular endurance and activity tolerance. Patient B was largely independent but required intermittent supervision with some higher level activities, primarily due to motor control deficits. DISCUSSION: By the end of their inpatient rehabilitation stay, both patients made statistically significant improvements in all measured outcomes. This suggests while a primary focus will be on treatment of pulmonary impairments, there should also be adjustments made based on their individual presentation of COVID and neuromuscular deficits. In conclusion, the outcomes of this case series demonstrate the efficacy of treating post-COVID patients with variable presentations in the acute inpatient rehabilitation physical therapy setting.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61664605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1097/CPT.0000000000000167
A. Gurovich, Lisa Rodriguez, M. Gómez, Paulina Caraveo, Luis Ochoa, Francisco Morales-Acuna
Alvaro N. Gurovich, PT, PhD, FACSM; Lisa Rodriguez, Manuel Gomez, BS; Paulina Caraveo, BS; Luis Ochoa, MS; Francisco Morales-Acuna, MD, PhD Clinical Applied Physiology (CAPh) Lab, The University of Texas at El Paso, El Paso, TX Doctor of Physical Therapy Program, College of Health Science, The University of Texas at El Paso, El Paso, TX Department of Mechanical Engineering, College of Engineer, The University of Texas at El Paso, El Paso, TX
Alvaro N. Gurovich, PT, PhD, FACSM;Lisa Rodriguez, Manuel Gomez, BS;宝琳娜·卡拉维奥，理学学士;路易斯·奥乔亚，硕士;Francisco Morales-Acuna，医学博士，临床应用生理学(CAPh)实验室博士，德克萨斯大学埃尔帕索分校埃尔帕索分校健康科学学院物理治疗项目博士，德克萨斯大学埃尔帕索分校工程学院机械工程系，德克萨斯州埃尔帕索分校
{"title":"Imaging Ultrasound Assessment of Exercise-Induced Endothelial Shear Stress of the Brachial and Carotid Arteries","authors":"A. Gurovich, Lisa Rodriguez, M. Gómez, Paulina Caraveo, Luis Ochoa, Francisco Morales-Acuna","doi":"10.1097/CPT.0000000000000167","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000167","url":null,"abstract":"Alvaro N. Gurovich, PT, PhD, FACSM; Lisa Rodriguez, Manuel Gomez, BS; Paulina Caraveo, BS; Luis Ochoa, MS; Francisco Morales-Acuna, MD, PhD Clinical Applied Physiology (CAPh) Lab, The University of Texas at El Paso, El Paso, TX Doctor of Physical Therapy Program, College of Health Science, The University of Texas at El Paso, El Paso, TX Department of Mechanical Engineering, College of Engineer, The University of Texas at El Paso, El Paso, TX","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61664550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-01DOI: 10.1097/cpt.0000000000000162
Liana C Wooten, Brian T Neville, Andrew A Guccione, Lisa M K Chin, Randall E Keyser
Purpose: This study examined the influence of aerobic exercise training (AET) on components of carbon dioxide expiration (VCO2), cardiorespiratory function, and fatigability.
Methods: Twenty healthy adults completed peak cardiopulmonary exercise (CPX) and submaximal tests before and after a vigorous, 4-week AET regimen. Each test was followed by a 10-min recovery and endurance test at 70% of peak wattage attained during CPX. Fatigability was assessed using testing durations and power output. Respiratory buffering (excess VCO2) and non-buffering (metabolic VCO2) were calculated. Data were analyzed for significance (p<0.05) using regressions and paired t-tests.
Results: Significant improvements in all measures of fatigability were observed after AET. A significant increase in excess VCO2 was observed, though not in metabolic VCO2. Excess VCO2 was strongly predictive of fatigability measures.
Conclusion: Significant decreases in fatigability are often observed in clinical populations such as obstructive or restrictive lung disease or pulmonary hypertension following AET, even when peak cardiorespiratory function does not appear to adapt. Decreases in fatigability appear to predict longevity with no yet identified mechanism. These results suggest that respiratory buffering and metabolic components of VCO2 may adapt independently to AET, introducing foundational plausibility for an influence of respiratory buffering adaptation to AET on fatigability status.
{"title":"Carbon Dioxide Expiration and Performance Fatigability Following Aerobic Exercise Training: A Longitudinal, Observational, Pilot Study.","authors":"Liana C Wooten, Brian T Neville, Andrew A Guccione, Lisa M K Chin, Randall E Keyser","doi":"10.1097/cpt.0000000000000162","DOIUrl":"10.1097/cpt.0000000000000162","url":null,"abstract":"<p><strong>Purpose: </strong>This study examined the influence of aerobic exercise training (AET) on components of carbon dioxide expiration (VCO<sub>2</sub>), cardiorespiratory function, and fatigability.</p><p><strong>Methods: </strong>Twenty healthy adults completed peak cardiopulmonary exercise (CPX) and submaximal tests before and after a vigorous, 4-week AET regimen. Each test was followed by a 10-min recovery and endurance test at 70% of peak wattage attained during CPX. Fatigability was assessed using testing durations and power output. Respiratory buffering (excess VCO<sub>2</sub>) and non-buffering (metabolic VCO<sub>2</sub>) were calculated. Data were analyzed for significance (p<0.05) using regressions and paired t-tests.</p><p><strong>Results: </strong>Significant improvements in all measures of fatigability were observed after AET. A significant increase in excess VCO<sub>2</sub> was observed, though not in metabolic VCO<sub>2</sub>. Excess VCO<sub>2</sub> was strongly predictive of fatigability measures.</p><p><strong>Conclusion: </strong>Significant decreases in fatigability are often observed in clinical populations such as obstructive or restrictive lung disease or pulmonary hypertension following AET, even when peak cardiorespiratory function does not appear to adapt. Decreases in fatigability appear to predict longevity with no yet identified mechanism. These results suggest that respiratory buffering and metabolic components of VCO<sub>2</sub> may adapt independently to AET, introducing foundational plausibility for an influence of respiratory buffering adaptation to AET on fatigability status.</p>","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"32 1","pages":"3-10"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10445408/pdf/nihms-1917262.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10458646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-26DOI: 10.1097/CPT.0000000000000168
Rachel Pata, Jillian Giblin, Emily Cassata, R. Cortez, Alicia Pascale, Megan Hall
Supplemental Digital Content is Available in the Text. Purpose: Research about methods implemented in pulmonary rehabilitation is needed. Inconsistencies in this multifaceted intervention may impact care. Methods: A survey was administered to outpatient pulmonary rehabilitation programs, addressing program characteristics, and perceived importance and frequency of rehabilitation components. Descriptive statistics and post-hoc correlations were analyzed. Results: Clinicians present during exercise included respiratory therapists (72.2%), exercise physiologists (50%), registered nurses (44.4%), physical therapists (11.1%), occupational therapists (5.6%), dieticians (5.6%), and physicians (5.6%). On a scale of 1 to 5 (never vs always), programs provided: exercises for all extremities (5), individualized exercise (4.89, SD = 0.46), resistance training (4.5, SD = 0.83), balance training (3.28, SD = 1.1), alternative exercise methods (1.94, SD = 1.55), home equipment education (3.44, SD = 1.12), social support avenues (3.83, SD = 1.26), and home safety assessments (1.56, SDs = 1.07). All programs offered warm-up, cool down, and breathing exercises; 44% offered inspiratory resistance training, 22% high-intensity aerobic, and 11% high-intensity interval training. Twenty-four varied resources were used for patient education. Smoking cessation and nutritional consults were inconsistently offered. Reported limiting factors included compliance (66.7%), transportation (55.6%), staffing (33.3%), and facility size (33.3%). Conclusions: Limited resources, varied personnel, and patient compliance may contribute to practice inconsistencies. Improved resources, transportation, and an inclusive team may improve care standardization.
{"title":"A Survey of Factors That May Cause Practice Inconsistencies and Impact Care in Pulmonary Rehabilitation","authors":"Rachel Pata, Jillian Giblin, Emily Cassata, R. Cortez, Alicia Pascale, Megan Hall","doi":"10.1097/CPT.0000000000000168","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000168","url":null,"abstract":"Supplemental Digital Content is Available in the Text. Purpose: Research about methods implemented in pulmonary rehabilitation is needed. Inconsistencies in this multifaceted intervention may impact care. Methods: A survey was administered to outpatient pulmonary rehabilitation programs, addressing program characteristics, and perceived importance and frequency of rehabilitation components. Descriptive statistics and post-hoc correlations were analyzed. Results: Clinicians present during exercise included respiratory therapists (72.2%), exercise physiologists (50%), registered nurses (44.4%), physical therapists (11.1%), occupational therapists (5.6%), dieticians (5.6%), and physicians (5.6%). On a scale of 1 to 5 (never vs always), programs provided: exercises for all extremities (5), individualized exercise (4.89, SD = 0.46), resistance training (4.5, SD = 0.83), balance training (3.28, SD = 1.1), alternative exercise methods (1.94, SD = 1.55), home equipment education (3.44, SD = 1.12), social support avenues (3.83, SD = 1.26), and home safety assessments (1.56, SDs = 1.07). All programs offered warm-up, cool down, and breathing exercises; 44% offered inspiratory resistance training, 22% high-intensity aerobic, and 11% high-intensity interval training. Twenty-four varied resources were used for patient education. Smoking cessation and nutritional consults were inconsistently offered. Reported limiting factors included compliance (66.7%), transportation (55.6%), staffing (33.3%), and facility size (33.3%). Conclusions: Limited resources, varied personnel, and patient compliance may contribute to practice inconsistencies. Improved resources, transportation, and an inclusive team may improve care standardization.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"33 1","pages":"15 - 23"},"PeriodicalIF":0.0,"publicationDate":"2020-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43872099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-26DOI: 10.1097/CPT.0000000000000165
Melanie Lloyd, E. Callander, Koen Simons, A. Karahalios, G. Maguire, E. Janus, H. Karunajeewa
Purpose: To assess the association of mobility deterioration during community-acquired pneumonia (CAP) illness on length of stay (LOS), readmissions, and institutional costs. Methods: This longitudinal observational study included 347 individuals hospitalized with CAP. All were offered routine early mobilization with a physiotherapist within 24 hours of admission and then daily during hospital stay. The exposure of interest was mobility status at time of clinical stability when compared with the premorbid level. Modelling adjusted for factors such as age, residential status, premorbid mobility level, comorbidities, and pneumonia severity. Results: One hundred forty-one (41%) individuals met the definition of mobility deterioration during the acute illness. The mean (95% confidence interval [CI]) time from achievement of clinical stability to hospital discharge for the groups with and without mobility deterioration was 5.7 (4.2–7.2) and 2.3 (1.4–3.2) days, respectively, with associated higher hospitalization costs (arithmetic mean ratio [95% CI] 1.61 [1.24–2.10]) in the mobility deterioration group. There was no evidence of an association between mobility deterioration and 90-day readmission (odds ratio [95% CI]: 1.34 [0.81–2.24]). Conclusions: Mobility deterioration during acute pneumonia illness has a significant impact on hospital LOS and resource use even in a hospital system that has an early mobility program. Further research is needed to investigate these associations and alternative interventions. Trial registration: ClinicalTrials.gov, Identifier: NCT02835040.
{"title":"Mobility Deterioration During Acute Pneumonia Illness Is Associated With Increased Hospital Length of Stay and Health Service Costs: An Observational Study","authors":"Melanie Lloyd, E. Callander, Koen Simons, A. Karahalios, G. Maguire, E. Janus, H. Karunajeewa","doi":"10.1097/CPT.0000000000000165","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000165","url":null,"abstract":"Purpose: To assess the association of mobility deterioration during community-acquired pneumonia (CAP) illness on length of stay (LOS), readmissions, and institutional costs. Methods: This longitudinal observational study included 347 individuals hospitalized with CAP. All were offered routine early mobilization with a physiotherapist within 24 hours of admission and then daily during hospital stay. The exposure of interest was mobility status at time of clinical stability when compared with the premorbid level. Modelling adjusted for factors such as age, residential status, premorbid mobility level, comorbidities, and pneumonia severity. Results: One hundred forty-one (41%) individuals met the definition of mobility deterioration during the acute illness. The mean (95% confidence interval [CI]) time from achievement of clinical stability to hospital discharge for the groups with and without mobility deterioration was 5.7 (4.2–7.2) and 2.3 (1.4–3.2) days, respectively, with associated higher hospitalization costs (arithmetic mean ratio [95% CI] 1.61 [1.24–2.10]) in the mobility deterioration group. There was no evidence of an association between mobility deterioration and 90-day readmission (odds ratio [95% CI]: 1.34 [0.81–2.24]). Conclusions: Mobility deterioration during acute pneumonia illness has a significant impact on hospital LOS and resource use even in a hospital system that has an early mobility program. Further research is needed to investigate these associations and alternative interventions. Trial registration: ClinicalTrials.gov, Identifier: NCT02835040.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"32 1","pages":"156 - 166"},"PeriodicalIF":0.0,"publicationDate":"2020-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46362541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-26DOI: 10.1097/CPT.0000000000000164
D. Stam, J. Pernu
Purpose: Although recent advances in the neurological care of spinal cord injury have made great strides, cardiovascular disease has emerged as a leading contributor to mortality within this population. Achieving a greater understanding of the pathophysiology of acute cardiovascular dysfunction may aid the physical therapist in establishing more effective clinical care and decision making. The purpose of this article is to review the pathophysiology of acute cardiovascular dysfunction after cervical and thoracic spinal cord injury (injuries above the T6 vertebrae) and translate this knowledge to the clinical management of a medically complex patient case. Methods: A 62-year-old man sustained a traumatic sensory and motor complete T2 spinal cord injury. During the course of acute hospitalization, the patient suffered multiple episodes of cardiac arrest, and a permanent pacemaker was implanted. Inpatient rehabilitation was further complicated by orthostatic hypotension and emergence of autonomic dysreflexia. Results: Orthostatic hypotension was addressed with a combination of positional tolerance progression and patient education. Autonomic dysreflexia episodes required prompt recognition and appropriate response. After a 6-month hospitalization, the patient was discharged to home. Conclusion: Cardiovascular concerns after spinal cord injury have become increasingly prevalent leading to significant implications to physical therapists. Understanding the pathophysiology of these conditions as well as normal and abnormal cardiovascular responses to activity is crucial for establishing safe patient outcomes.
{"title":"Clinical Implications for Cardiovascular Compromise in Patients With Spinal Cord Injury: A Case Study of Autonomic Dysreflexia, Cardiac Pacing Abnormality, and Orthostatic Hypotension in Contemporary Physical Therapy Management","authors":"D. Stam, J. Pernu","doi":"10.1097/CPT.0000000000000164","DOIUrl":"https://doi.org/10.1097/CPT.0000000000000164","url":null,"abstract":"Purpose: Although recent advances in the neurological care of spinal cord injury have made great strides, cardiovascular disease has emerged as a leading contributor to mortality within this population. Achieving a greater understanding of the pathophysiology of acute cardiovascular dysfunction may aid the physical therapist in establishing more effective clinical care and decision making. The purpose of this article is to review the pathophysiology of acute cardiovascular dysfunction after cervical and thoracic spinal cord injury (injuries above the T6 vertebrae) and translate this knowledge to the clinical management of a medically complex patient case. Methods: A 62-year-old man sustained a traumatic sensory and motor complete T2 spinal cord injury. During the course of acute hospitalization, the patient suffered multiple episodes of cardiac arrest, and a permanent pacemaker was implanted. Inpatient rehabilitation was further complicated by orthostatic hypotension and emergence of autonomic dysreflexia. Results: Orthostatic hypotension was addressed with a combination of positional tolerance progression and patient education. Autonomic dysreflexia episodes required prompt recognition and appropriate response. After a 6-month hospitalization, the patient was discharged to home. Conclusion: Cardiovascular concerns after spinal cord injury have become increasingly prevalent leading to significant implications to physical therapists. Understanding the pathophysiology of these conditions as well as normal and abnormal cardiovascular responses to activity is crucial for establishing safe patient outcomes.","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":"32 1","pages":"167 - 177"},"PeriodicalIF":0.0,"publicationDate":"2020-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41558078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-16DOI: 10.1097/cpt.0000000000000157
E. Dean
Once the SARS-CoV-2 virus hit the planet in the fall of 2019 and an understanding of its infectiousness and severity quickly became apparent, the starting gun in the race for a vaccine sounded. The trajectory for vaccine development follows a typical path: the identification of a specific pathogen, deconstruction of its structural characteristics, construction of a vaccine to counter it, and years of phased clinical trials to establish its safety, efficacy, and eventual effectiveness when administered to humans. Correspondingly, as the race for a vaccine escalated, research emerged examining susceptibility and risk factors for poor outcomes of COVID-19, the disease caused by SARS-CoV-2. Based on the concurrence of findings from multiple studies that were being published at a feverish rate, a pattern arose. Multimorbidity including obesity, hypertension, diabetes, cancer, heart disease, chronic lung disease, and renal failure; aging; and frailty emerged as key predictors of susceptibility and poor outcomes of COVID-19 includingmortality. Between 96% and 99% of individuals who die from SARS-CoV-2 infection have at least one underlying chronicmorbidity or risk factor. This proportion cannot be overlooked. Not only are physical therapists well qualified to prevent as well as manage these morbidities and risk factors, but the cardiopulmonary physical therapy community has a primary responsible to lead the way. Vaccines not only take years to formulate and test before becoming widely available and distributed, but typically have variable rates of effectiveness. This is particularly true of viruses that adapt and mutate quickly. The earliest predictions for the development of a safe and reasonably effective vaccine may be several years. But, what if we shifted our lens on conceptualizing and developing a safe and effective vaccine?What if we focused on the immune status, general health status, and lifestyle practices of those who are uninfected by SARS-CoV-2; those who are infected but experience few, if any, symptoms; and those who are infected and have severe symptoms and recover? What if we stratified these 3 cohorts and compared them with respect to their immune status, their general health status, and lifestyle practices? Based on the extant literature, such an analysis leads one to reasonably hypothesize whether the reach of SARS-CoV-2 would have resulted in being a mere blip on the global health radar screen rather than a full-blown pandemic, had unhealthy lifestyle practices, that largely underlie the prevalence of lifestyle-related noncommunicable diseases, been minimal. One cannot deny that the food industry (perhaps better termed the “edible products” industry) in high-income countries and increasingly in middle-income and lowincome countries, contributes substantially to the unhealthy western diet that typically consists of excessive amounts of fat, sugar, salt, and consumable processed products and dangerously inadequate amounts of vegetabl
{"title":"Novel Physical Therapist Lens on Developing a SARS-CoV-2 Vaccine: “Healthy Lifestyle Practices” Are Safe and Cost-Effective","authors":"E. Dean","doi":"10.1097/cpt.0000000000000157","DOIUrl":"https://doi.org/10.1097/cpt.0000000000000157","url":null,"abstract":"Once the SARS-CoV-2 virus hit the planet in the fall of 2019 and an understanding of its infectiousness and severity quickly became apparent, the starting gun in the race for a vaccine sounded. The trajectory for vaccine development follows a typical path: the identification of a specific pathogen, deconstruction of its structural characteristics, construction of a vaccine to counter it, and years of phased clinical trials to establish its safety, efficacy, and eventual effectiveness when administered to humans. Correspondingly, as the race for a vaccine escalated, research emerged examining susceptibility and risk factors for poor outcomes of COVID-19, the disease caused by SARS-CoV-2. Based on the concurrence of findings from multiple studies that were being published at a feverish rate, a pattern arose. Multimorbidity including obesity, hypertension, diabetes, cancer, heart disease, chronic lung disease, and renal failure; aging; and frailty emerged as key predictors of susceptibility and poor outcomes of COVID-19 includingmortality. Between 96% and 99% of individuals who die from SARS-CoV-2 infection have at least one underlying chronicmorbidity or risk factor. This proportion cannot be overlooked. Not only are physical therapists well qualified to prevent as well as manage these morbidities and risk factors, but the cardiopulmonary physical therapy community has a primary responsible to lead the way. Vaccines not only take years to formulate and test before becoming widely available and distributed, but typically have variable rates of effectiveness. This is particularly true of viruses that adapt and mutate quickly. The earliest predictions for the development of a safe and reasonably effective vaccine may be several years. But, what if we shifted our lens on conceptualizing and developing a safe and effective vaccine?What if we focused on the immune status, general health status, and lifestyle practices of those who are uninfected by SARS-CoV-2; those who are infected but experience few, if any, symptoms; and those who are infected and have severe symptoms and recover? What if we stratified these 3 cohorts and compared them with respect to their immune status, their general health status, and lifestyle practices? Based on the extant literature, such an analysis leads one to reasonably hypothesize whether the reach of SARS-CoV-2 would have resulted in being a mere blip on the global health radar screen rather than a full-blown pandemic, had unhealthy lifestyle practices, that largely underlie the prevalence of lifestyle-related noncommunicable diseases, been minimal. One cannot deny that the food industry (perhaps better termed the “edible products” industry) in high-income countries and increasingly in middle-income and lowincome countries, contributes substantially to the unhealthy western diet that typically consists of excessive amounts of fat, sugar, salt, and consumable processed products and dangerously inadequate amounts of vegetabl","PeriodicalId":72526,"journal":{"name":"Cardiopulmonary physical therapy journal","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47733885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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