Predictors of Recovery and the App-Facilitated Tele-Rehabilitation (AFTER) Program for COVID Survivors

项目总结/摘要 老年人和患有合并症或残疾的成人的发病率和死亡率风险最高， COVID-19，尽管许多没有潜在风险因素的健康中年人也经历了严重的 疾病，可能是由深刻和夸张的炎症反应驱动的。那些发展严重的 COVID-19合并急性呼吸窘迫综合征通常需要长时间机械通气， 由于传染性和缺乏，与医院工作人员（包括康复提供者）的接触有限。 适当的个人防护装备。即使是病情较轻的COVID-19患者， 重症监护室（ICU）护理经常经历长时间疲劳、肌痛和活动限制性呼吸困难。 虽然COVID-19的长期后果尚不清楚，但不动、有限的- 医院干预和炎症加剧可能对身体功能的持久性产生不利影响 远远超过了其他危重疾病。最重要的假设是， 多morphians和健康的中年人谁经历的“加速老化”的影响，深刻的 与COVID-19相关的炎症将经历显著的持续的身体和神经心理 损伤可以克服COVID-19造成的许多障碍的新颖、可扩展的干预措施是 迫切需要扭转身体和神经心理障碍，并防止长期功能障碍， 后果目标1将确定最近改善成人住院后恢复的预测因素 因新型冠状病毒病住院。目的2将研究多组分远距离治疗的可行性和初步疗效， 在COVID-19恢复期间的康复计划。这项研究将招募300名最近住院的成年人， COVID-19，并在出院后使用远程医疗跟踪这些人16周; Aim 2将招募一个子集 来自目标1的40名需要ICU护理至少24小时的患者，将与类似患者进行比较， 目标1中的控制。所提议的工作的重要性是基于对确定 为COVID-19幸存者提供多系统康复和长期健康，并提供安全有效的 康复护理的医疗复杂的病人，甚至，特别是当他们面临住院后 个人护理的障碍。这项工作将直接转化为其他医学复杂的人群， 从创新的远程康复中受益，该技术尚未应用于医学上复杂的患者。这 这项研究将立即有助于我们了解COVID-19幸存者的康复过程， COVID-19复苏期间长期减值的预测因素。此外，它还将提高 远程康复作为一种更普遍有用的干预措施，适用于无法获得医疗服务的复杂患者 （距离、可用性、流动性）。发展安全有效的远程教育， 康复计划作为医学复杂人群的亲自康复的替代方案， 转变医疗复杂患者的院后护理，包括但不限于COVID-19患者。

PROJECT SUMMARY/ABSTRACT Older adults and adults with comorbidities or disability are at highest risk for morbidity and mortality from COVID-19, although many healthy middle-aged adults without underlying risk factors also experience severe disease, likely driven by a profound and exaggerated inflammatory response. Those who develop severe COVID-19 with acute respiratory distress syndrome often require prolonged mechanical ventilation and have limited contact with hospital personnel, including rehabilitation providers, due to infectivity and shortages of adequate personal protective equipment. Even patients with less severe COVID-19 who do not require intensive care unit (ICU) care often experience prolonged fatigue, myalgias, and activity-limiting dyspnea. While the long-term consequences of COVID-19 are not yet known, the combination of immobility, limited in- hospital interventions, and heightened inflammation may have detrimental effects on physical function lasting well beyond that seen with other critical illness. The overarching hypothesis is that both older adults with multimorbidity and healthy middle-aged adults who experience the `accelerated aging' effects of profound inflammation associated with COVID-19 will experience significant ongoing physical and neuropsychological impairment. Novel, scalable interventions that can overcome many of the barriers imposed by COVID-19 are urgently needed to reverse physical and neuropsychological impairments and prevent the long-term functional consequences. Aim 1 will determine predictors of improved post-hospitalization recovery of adults recently hospitalized with COVID-19. Aim 2 will investigate the feasibility and initial efficacy of a multicomponent tele- rehabilitation program during COVID-19 recovery. This study will enroll 300 adults recently hospitalized due to COVID-19 and follow these individuals for 16 weeks post-discharge using telehealth; Aim 2 will enroll a subset of 40 individuals from Aim 1 who required ICU care for at least 24 hours, who will be compared to similar controls in Aim 1. Significance of the proposed work is based on the great need to identify predictors of multisystem recovery and long-term health in survivors of COVID-19, and to deliver safe and effective rehabilitative care to medically complex patients even, and especially, when they face post-hospitalization barriers to in-person care. This work will directly translate to other medically complex populations who will benefit from innovative tele-rehabilitation, which has not yet been applied to medically complex patients. This study will contribute immediately to our knowledge of the course of recovery for survivors of COVID-19 and predictors for prolonged impairment during COVID-19 recovery. Furthermore, it will advance the feasibility of tele-rehabilitation as a more generally useful intervention in medically complex patients lacking access (distance, availability, mobility) to standard rehabilitative services. Developing safe and effective tele- rehabilitation programs as alternatives to in-person rehabilitation for medically complex populations could transform post-hospital care for medically complex patients including, but not limited to, those with COVID-19.