Chronic Lung Disease and COVID-19: Understanding Severity, Recovery and Rehabilitation Needs (LAUREL Study)

SARS-CoV-2（SARS 2）感染导致COVID-19，是一场全球大流行病。慢性肺病（CLD）， 特别是慢性阻塞性肺病（COPD），已成为感染的危险因素， COVID-19的严重程度。目前，人们对COVID-19的长期后果以及如何影响 CLD、其他合并症和健康的社会决定因素（SDOH）等因素影响了 幸存者的康复虽然COVID-19幸存者的类似并发症和健康状况不佳的风险因素 恢复可能是预期的，因为其他原因的肺炎和危重病，长期结果的COVID- 19个尚未定性或量化。预计住院和重症患者 有更大的功能缺陷，但即使是轻度和中度COVID-19患者也可能有显著的 考虑到感染的全身性参与，对功能的影响;康复需求可能更有可能 在许多患者中未得到充分认识和满足。总体而言，功能结局可能比 由于患病时间延长和接受康复治疗的障碍，预计所有COVID-19患者都会出现这种情况 服务，包括限制面对面的互动，有限的能力，并限制许多访问。因为 CLD与虚弱和功能受损增加相关，CLD患者可能特别 不仅易受感染，而且易受COVID-19后遗症的影响。鉴于目前的物理距离 环境，我们迫切需要一种新的模式，用于从COVID-19中康复的患者， 也可以应用于肺炎的其他病因。在本提案中，我们将确定患者 不同严重程度的COVID-19的康复需求，评估CLD的需求是否不同， 合并症负担、SDOH或其他患者风险因素。此外，我们亦会评估 为COVID-19幸存者提供新颖的、虚拟交付的、基于家庭的个性化远程康复计划， 包含COVID Reactivation and Engagement（CORE）干预，包括运动和呼吸困难 管理和基于患者需求的额外个性化模块。我们会招募那些 COVID-19门诊患者或直接出院回家参加此计划。我们有一个多学科的团队， 康复医学、心理学、肺病、重症监护、护理、补充和 综合健康，定量和定性的观察性研究和临床试验，并将完成 三个独立的目标：1）确定与COVID-19严重程度和并发症相关的患者因素 利用VA EHR数据; 2）确定COVID后自我报告的功能结果和恢复轨迹- 19在一项前瞻性研究中使用混合方法;和3）审查的可行性和可接受性的虚拟- 为COVID-19幸存者提供的基于家庭的康复干预，其组成部分基于 个别病人的需要。结果将描述COVID-19的恢复情况，并确定康复和 可以在VA内提供的跨服务领域的护理需求。我们的试点研究将为更大规模的试验提供信息， 测试这种新开发的程序的功效，以改善功能，减少继发症状， 改善COVID-19康复者的生活质量。

SARS-CoV-2 (SARS2) infection, which leads to COVID-19, is a global pandemic. Chronic lung disease (CLD), particularly chronic obstructive pulmonary disease (COPD), has emerged as a risk factor for infection and severity of COVID-19. Currently, very little is known of the long-term consequences of COVID-19 and how factors such as CLD, other comorbidities and social determinants of health (SDOH) influence the trajectory of recovery in survivors. While similar complications for COVID-19 survivors and risk factors for poor health recovery may be expected as in other causes of pneumonia and critical illness, long term outcomes of COVID- 19 have not been characterized or quantified. Patients who are hospitalized and critically ill are anticipated to have greater functional deficits, but even those with mild and moderate COVID-19 may have significant impacts on function given systemic involvement of infection; rehabilitation needs may be more likely to be under-recognized and unmet in many of these patients. Overall, functional outcomes may be worse than expected in all COVID-19 patients because of prolonged length of illness and barriers to receiving rehabilitation services, including restricted face-to-face interactions, limited capacity, and limited access for many. Because CLD is associated with increased frailty and impaired function, patients with CLD may be particularly vulnerable not only to infection but also sequalae of COVID-19. Given the current physical distancing environment, we urgently need a new paradigm for rehabilitation of patients recovering from COVID-19 that can inform and apply to other causes of pneumonia as well. In this proposal we will determine patient rehabilitation needs across the spectrum of severity of COVID-19, assessing if needs differ by CLD, comorbidity burden, SDOH or other patient risk factors. We will also assess the feasibility and acceptability of a novel, virtually-delivered, home-based personalized telerehabilitation program for survivors of COVID-19 that contains a COVID Reactivation and Engagement (CORE) intervention with exercise and dyspnea management and additional personalized modules based on patient needs. We will recruit patients treated for COVID-19 as outpatients or discharged directly home for this program. We have a multidisciplinary team with expertise in rehabilitation medicine, psychology, pulmonary, critical care, nursing, complementary and integrative health, quantitative and qualitative observational research and clinical trials, and will accomplish three separate aims: 1) Determine patient factors associated with severity and complications of COVID-19 utilizing VA EHR data; 2) Determine self-reported functional outcomes and trajectory of recovery after COVID- 19 in a prospective study using mixed methods; and 3) Examine the feasibility and acceptability of a virtually- delivered, home-based rehabilitation intervention for survivors of COVID-19, with components based on an individual patient’s needs. Results will characterize the recovery from COVID-19 and identify rehabilitation and care needs across domains of services that can be offered within VA. Our pilot study will inform larger trials to test the efficacy of this newly-developed program to improve functioning, reduce secondary symptoms, and improve quality of life among individuals recovering from COVID-19.