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: 10187862
• 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 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10187862
• 关键词: Acute; Admission activity; Anxiety; COVID-19; COVID-19 patient; COVID-19 severity; COVID-19 treatment; Cardiac; Cardiovascular system; Caregivers; Caring; Cessation of life; Chronic; Chronic Obstructive Airway Disease; Chronic lung disease; Classification; Clinical; Clinical Trials; Cognition; Cognitive; Complementary Health; Coronavirus; Critical Illness; Data; Dialysis procedure; Disease; 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; 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; Stroke; Surveys; Survivors; Symptoms; Syndrome; Testing; Time; Veterans; Veterans Health Administration; acceptability and feasibility; base; community acquired pneumonia; comorbidity; coronavirus disease; critical care nursing; design; disability; efficacy testing; feasibility testing; follow-up; frailty; functional outcomes; health administration; health related quality of life; hospital readmission; illness length; improved; improved functioning; individual patient; infection risk; mortality; multidisciplinary; novel; pandemic disease; programs; prospective; rehabilitation paradigm; rehabilitation service; rehabilitative care; 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.

SARS-CoV-2(SARS-CoV-2)感染导致新冠肺炎是一种全球性流行病。慢性肺病(CLD) 尤其是慢性阻塞性肺疾病(COPD)，已成为感染和 新冠肺炎的严重程度。目前，人们对新冠肺炎的长期后果以及如何应对知之甚少 慢性阻塞性肺病、其他合并症和健康的社会决定因素(SDOH)等因素影响着 幸存者的康复。而新冠肺炎幸存者的类似并发症和健康状况不佳的危险因素 就像肺炎和危重疾病的其他原因一样，COVID的长期结果可能是可以预期的- 19个尚未确定特征或量化。住院和危重病人预计将 有更大的功能缺陷，但即使是那些轻中度新冠肺炎的人也可能有显著的 考虑到全身感染对功能的影响；康复需求可能更有可能是 在这些患者中，许多人没有得到足够的认可和满足。总体而言，功能结果可能比 由于长期患病和接受康复的障碍，预计所有新冠肺炎患者都会出现 服务，包括有限的面对面互动、有限的容量和对许多人的有限访问。因为 CLD与虚弱增加和功能受损有关，CLD患者可能尤其 不仅易受感染，还易患新冠肺炎后遗症。考虑到目前的物理距离 我们迫切需要一种新的新冠肺炎康复者康复范式 也可告知并适用于其他肺炎原因。在本提案中，我们将确定患者 新冠肺炎不同严重程度的康复需求，评估需求是否因慢性阻塞性肺病而异， 共病负担、SDOH或其他患者危险因素。我们亦会评估这项计划的可行性和可接受性。 为新冠肺炎幸存者提供的新颖、虚拟交付、基于家庭的个性化远程康复计划 包含针对运动和呼吸困难的COVID重新激活和参与(核心)干预 基于患者需求的管理和其他个性化模块。我们将招募接受治疗的患者 新冠肺炎作为门诊患者或直接出院回家进行这一计划。我们有一个多学科的团队， 康复医学、心理学、肺部、重症监护、护理、补充和 综合健康、定量和定性观察研究和临床试验，并将完成 三个不同的目标：1)确定与新冠肺炎严重程度和并发症相关的患者因素 使用VA EHR数据；2)确定COVID后自我报告的功能结果和恢复轨迹- 19在一项使用混合方法的前瞻性研究中；以及3)检查虚拟- 为新冠肺炎幸存者提供基于家庭的康复干预，其组成部分基于 个别病人的需要。结果将表征新冠肺炎的康复情况，并确定康复和 可在退伍军人管理局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参考 测试这个新开发的程序的有效性，以改善功能，减少次要症状，以及 提高新冠肺炎康复者的生活质量。