Article: Functional outcome after inpatient rehabilitation in postintensive care unit COVID-19 patients: findings and clinical implications from a real-practice retrospective study - European Journal of Physical and Rehabilitation Medicine 2021 June;57(3):443-50 - Minerva Medica - Journals

The outbreak of COVID-19 epidemics has challenged the provision of health care worldwide, highlighting the main flaws of some national health systems with respect to their capacity to cope with the needs of frail subjects. People experiencing disability due to COVID-19 express specific rehabilitation needs that deserve a systematic evidence-based approach. The aim of this article is to provide the rehabilitation community with updates on the latest scientific literature on rehabilitation needs due to COVID-19. The first rapid "living" review will present the results of a systematic search performed up to March 31st, 2020. A systematic search in PubMed, Pedro, and Google Scholar was performed using the search terms: "COVID-19," "Coronavirus," "severe acute respiratory syndrome coronavirus 2," "rehabilitation," "physical therapy modalities," "exercise," "occupational therapy," and "late complications." Papers published up to March 31st, 2020, in English, were included. Out of the 2758 articles retrieved, nine were included in the present review. Four of them are "calls for action", three provide recommendations about rehabilitation interventions in the acute phase, two address the needs of people quarantined at home or with restricted mobility due to the lockdown, and one provides a Core Outcome Set to be used in clinical trials to test the efficacy of health strategies in managing COVID-19 patients. All selected papers were based on previous literature and not on the current COVID-19 pandemic. Main messages included: 1) early rehabilitation should be granted to inpatients with COVID-19; 2) people with restricted mobility due to quarantine or lockdown should receive exercise programs to reduce the risk of frailty, sarcopenia, cognitive decline and depression; 3) telerehabilitation may represent the first option for people at home. Further updates are warranted in order to characterize the emerging disability in COVID-19 survivors and the adverse effects on the health of chronically disabled people.

Miniaturized wearable Inertial Measurement Units (IMU) offer new opportunities for the functional assessment of motor functions for medicine, sport, and ergonomics. Sparse reliability validation studies have been conducted without a common specific approach and protocol. A set of guidelines to design validation protocol for these systems is proposed hereafter. They are based on the comparison between video analysis and the gold standard optoelectronic motion capture system for Gait Analysis (GA). A setup of the protocol has been applied to a wearable device implementing an inertial measurement unit and a dedicated harmonic oscillator kinematic model of the center of mass. In total, 10 healthy volunteers took part in the study, and four trials of walking at a self-selected speed and step length have been simultaneously recorded by the two systems, analyzed, and compared blindly (40 datasets). The model detects the steps and the foot which supports body weight. The stride time and the cadence have a mean absolute percentage error of 5.7% and 4.9%, respectively. The mean absolute percentage error in the measurement of step’s length and step’s speed is 5.6% and 13.5%, respectively. Results confirm that the proposed methodology is complete and effective. It is demonstrated that the developed wearable system allows for a reliable assessment of human gait spatio-temporal parameters. Therefore, the goal of this paper is threefold. The first goal is to present and define structured Protocol Design Guidelines, where the related setup is implemented for the validation of wearable IMU systems particularly dedicated to GA and gait monitoring. The second goal is to apply these Protocol Design Guidelines to a case study in order to verify their feasibility, user-friendliness, and efficacy. The third goal is the validation of our biomechanical kinematic model with the gold standard reference.

Article: Rehabilitation and COVID-19: a rapid living systematic review by Cochrane Rehabilitation Field updated as of December 31st, 2020 and synthesis of the scientific literature of 2020 - European Journal of Physical and Rehabilitation Medicine 2021 April;57(2):181-8 - Minerva Medica - Journals

Innovations able to maintain patient safety while reducing the amount of transfusion add value to orthopedic procedures. Opportunities for improvement arise especially in elective procedures, as long as room for planning is available. Although many strategies have been proposed, there is no consensus about the most successful combination. The purpose of this investigation is to identify information to support blood management strategies in fast-track total joint arthroplasty (TJA) pathway, to (i) support clinical decision making according to current evidence and best practices, and (ii) identify critical issues which need further research. We identified conventional blood management strategies in elective orthopedic procedures. We performed an electronic search about blood management strategies in fast-track TJA. We designed tables to match every step of the former with the latter. We submitted the findings to clinicians who operate using fast-track surgery protocols in TJA at our research hospital. Preoperative anemia detection and treatment, blood anticoagulants/aggregants consumption, transfusion trigger, anesthetic technique, local infiltration analgesia, drainage clamping and removals, and postoperative multimodal thromboprophylaxis are the factors which can add best value to a fast-track pathway, since they provide significant room for planning and prediction. The difference between conventional and fast-track pathways does not lie in the contents of blood management, which are related to surgeons/surgeries, materials used and patients, but in the way these contents are integrated into each other, since elective orthopedic procedures offer significant room for planning. Further studies are needed to identify optimal regimens.