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

慢性肺病和 COVID-19：了解严重程度、恢复和康复需求（LAUREL 研究）

• 批准号: 10531867
• 负责人: Kristina Anne Crothers
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10531867
• 关键词: Acute; Admission activity; Anxiety; COVID-19; COVID-19 complications; COVID-19 impact; COVID-19 patient; COVID-19 risk; COVID-19 severity; COVID-19 survivors; COVID-19 treatment; Cardiac; Cardiovascular system; Caregivers; Caring; Cessation of life; Chronic; Chronic Obstructive Pulmonary Disease; Chronic lung disease; Classification; Clinical; Clinical Trials; Cognition; Cognitive; Complementary Health; Coronavirus; Critical Care; Critical Illness; Data; Dialysis procedure; Discipline of Nursing; Dyspnea; Dyspnea Management; Electronic Health Record; Environment; Event; Exercise; Future; Health; Healthcare Systems; Home; Hospitalization; Hospitals; Impairment; Individual; Infection; Influenza; Inpatients; Integrative Medicine; Intensive Care Units; International; Intervention; Interview; Location; Lung; Mental Depression; Mental Health; Methods; Modeling; Needs Assessment; Nurses; Observational Study; Outcome; Outpatients; Oxygen; Pain; Patient Recruitments; Patient Self-Report; Patient risk; Patient-Focused Outcomes; Patients; Personal Satisfaction; Physical Function; Physical Medicine; Pilot Projects; Pneumonia; Predisposition; Prospective Studies; Psychology; Quality of life; Recovery; Rehabilitation therapy; Reporting; Risk; Risk Factors; SARS-CoV-2 infection; Services; Severities; Social Distance; Stroke; Surveys; Survivors; Symptoms; Syndrome; Time; Veterans; Veterans Health Administration; acceptability and feasibility; community acquired pneumonia; comorbidity; coronavirus disease; design; disability; efficacy testing; feasibility testing; follow-up; frailty; functional improvement; functional outcomes; health administration; health related quality of life; hospital readmission; illness length; improved; individual patient; infection risk; long term consequences of COVID-19; mortality; multidisciplinary; novel; pandemic disease; pilot test; programs; prospective; rehabilitation paradigm; rehabilitation service; satisfaction; social health determinants; telerehabilitation; uptake; virtual delivery

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.

导致Covid-19的SARS-COV-2（SARS2）感染是全球大流行。慢性肺病（CLD）， 特别是慢性阻塞性肺疾病（COPD），已成为感染和 COVID-19的严重程度。目前，关于Covid-19的长期后果以及如何 诸如CLD，其他合并症和卫生社会决定者（SDOH）等因素都会影响 幸存者的康复。虽然相似的199幸存者的并发症和健康状况不佳的风险因素 可以预期恢复，就像肺炎和危重疾病的其他原因一样，共同的长期结局 19尚未表征或量化。预计住院和重病的患者将会 具有更大的功能性不足，但即使是中度和中等的19岁的人，也可能具有显着的 对系统感染的全身受累的功能的影响；康复需求可能更有可能 许多患者的认可和未被识别。总体而言，功能结果可能比 预计所有COVID-19患者的疾病长度和接受康复的障碍，预计 服务，包括受限制的面对面互动，容量有限和许多人的访问权限。 CLD与脆弱和功能受损有关，患有CLD的患者尤其是 不仅容易受到感染，而且还容易发生covid-19。考虑到当前的物理距离 环境，我们迫切需要一个新的范式来恢复从Covid-19的患者康复 也可以告知并应用于其他肺炎原因。在此提案中，我们将确定病人 跨互联-19的严重程度范围内的康复需求，评估需求是否有所不同，CLD是否有所不同 合并症Burnen，SDOH或其他患者风险因素。我们还将评估一个 小说，几乎交付的，基于家庭的个性化电信计划，用于COVID-19的生存 含有锻炼和呼吸困难的共同激活和参与（核心）干预（核心）干预 根据患者需求，管理和其他个性化模块。我们将招募接受治疗的患者 COVID-19作为门诊病人或直接出院该计划。我们有一个多学科团队 康复医学，心理学，肺部，重症监护，护士，完成和完整方面的专业知识 整合健康，定量和定性观察研究和临床试验，将完成 三个单独的目的：1）确定与严重程度和Covid-19的严重性和并发症相关的患者因素 利用VA EHR数据； 2）确定共同报告的自我报告的功能结果和恢复的轨迹 19在一项使用混合方法的前瞻性研究中； 3）研究虚拟的可行性和可接受性 - 提供的，基于家庭的康复干预措施，用于Covid-19的生存，其组件基于 个体患者的需求。结果将表征从Covid-19的恢复，并确定康复和 可以在VA内提供的服务领域的护理需求。我们的试点研究将为较大的试验提供信息 测试该新开发程序的效率以提高功能，减少辅助符号和 改善从199号恢复的个人的生活质量。