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）

基本信息

批准号：
10321683
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
项目类别：
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/10321683
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 Illness Data Dialysis procedure 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 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 long term consequences of COVID-19 mortality multidisciplinary novel pandemic disease pilot test programs prospective rehabilitation paradigm rehabilitation service rehabilitative care satisfaction social health determinants telerehabilitation uptake virtual delivery

项目摘要

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 (SARS2) 感染会导致 COVID-19，是一种全球性的慢性肺病 (CLD)。尤其是慢性阻塞性肺疾病（COPD），已成为感染和疾病的危险因素。目前，人们对 COVID-19 的长期后果及其影响知之甚少。慢性肺病 (CLD)、其他合并症和健康社会决定因素 (SDOH) 等因素会影响疾病的发展轨迹幸存者的康复情况，而 COVID-19 幸存者的类似并发症和健康状况不佳的风险因素。与肺炎和危重疾病的其他原因一样，预计会康复，新冠肺炎的长期结果- 预计有 19 名住院且病情危重的患者尚未得到特征或量化。具有更大的功能缺陷，但即使那些患有轻度和中度 COVID-19 的人也可能有显着的功能缺陷鉴于感染的全身性影响，康复需求可能更可能受到影响；总体而言，许多患者的功能结果可能比这些患者更糟糕。由于病程较长且接受康复存在障碍，预计所有 COVID-19 患者都会出现这种情况服务，包括面对面互动受限、容量有限以及许多人的访问受限。 CLD 与虚弱程度增加和功能受损有关，CLD 患者可能尤其如此鉴于目前的物理距离，他们不仅容易受到感染，还容易受到 COVID-19 的后遗症。环境中，我们迫切需要一种新的模式来帮助从 COVID-19 中康复的患者康复也可以告知并适用于肺炎的其他原因。在本提案中，我们将确定患者。涵盖不同严重程度的 COVID-19 的康复需求，评估不同 CLD 的需求是否不同，我们还将评估合并症负担、SDOH 或其他患者风险因素。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针对运动和呼吸困难的新冠病毒重新激活和参与 (CORE) 干预措施我们将招募接受治疗的患者。参加此计划的 COVID-19 患者为门诊患者或直接出院回家。康复医学、心理学、肺科、重症监护、护理、补充和整体健康、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 COVID-19 严重程度和并发症相关的患者因素 2) 确定自我报告的功能结果和新冠肺炎后的恢复轨迹 19 在使用混合方法的前瞻性研究中；以及 3) 检查虚拟的可行性和可接受性为 COVID-19 幸存者提供基于家庭的康复干预，其组成部分基于结果将描述 COVID-19 的康复情况并确定康复和康复情况。我们的试点研究将为更大规模的试验提供信息。测试这个新开发的计划在改善功能、减少继发症状和改善 COVID-19 康复者的生活质量。