Coronavirus 19 disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This is a case of a previously healthy 61-year-old man who presented to the emergency department with progressive dyspnea and a confirmed COVID-19 test, who was critically ill with severe acute respiratory distress syndrome. The principles of pulmonary rehabilitation were implemented starting from the sixth hospital day (time of referral from the intensive care unit) until he was transferred to a non-COVID ward and discharged. The patient participated in six treatment sessions while admitted, with each session lasting nearly 30 minutes. His Barthel index score improved from 0 (total dependence) to 85/100 (modified independence), with improvements in pulmonary secretions, shortness of breath, rate of perceived exertion, muscle strength, and endurance. He was able to return to work after three months. The application of the principles of pulmonary rehabilitation for critically ill patients with severe COVID-19 helped improve the cardiopulmonary, cognitive, and functional aspects of the patient throughout the course of hospital admission and beyond discharge.
COVID-19 ; Intensive Care Units ; Rehabilitation

BACKGROUND<p style="text-align: justify;" data-mce-style="text-align: justify;">The Philippine General Hospital (PGH) is a tertiary government hospital that serves as the national referral center for Filipinos from across the country. In partnership with Latter-Day Saint Charities (LDSC), PGH has been serving patients in need of mobility devices, such as wheelchairs, through in-person services from screening to assessment, measurement, assembly, fitting, and mobility training. Given the patients’ barriers to in-person follow-up consultations, regular healthcare provision has been challenging. The use of telerehabilitation, a form of telemedicine, has emerged as a practical and innovative solution, but it needs further evaluation.p>OBJECTIVES<p style="text-align: justify;" data-mce-style="text-align: justify;">The study aimed to determine the wheelchair recipients’ perceived barriers to in-person and virtual follow-up consultations.p>METHODS<p style="text-align: justify;" data-mce-style="text-align: justify;">This cross-sectional study involved a purposive sample of 413 patients who received a wheelchair from the LDSC through PGH. An original survey was prepared to determine patients’ perceived barriers to actual in-person and potential virtual follow-up consultations. Consent was obtained prior to data collection. After the pretest and pilot testing were conducted, the final version of the survey was administered either electronically or through individual phone interviews. Descriptive statistics was used to analyze and present the data.p>RESULTS<p style="text-align: justify;" data-mce-style="text-align: justify;">A total of 113 wheelchair recipients participated, with an average of 42.9 years of age. The majority resided outside Metro Manila (53.1%), and 86.7% were within the income bracket of less than PhP 9,520 per month. The majority received a standard type of wheelchair (85.8%). The top 3 reasons hindering compliance to in-person consultation follow-ups were accessibility issues (82.3%), costs of travel (79.6%), and distance to hospital/wheelchair assessor (71.7%). With respect to potential virtual follow-ups, 72% expressed willingness to experience telemedicine/telerehabilitation in the future, despite having neither prior awareness (50.4%) nor experience (74.3%) of it. The majority had access to mobile phones (98.2%), and 67% had stable internet access.p>CONCLUSION<p style="text-align: justify;" data-mce-style="text-align: justify;">The main barriers to in-person follow-ups were related to accessibility, costs, and travel. Telehealth or telerehabilitation in particular, despite patients’ interest and willingness to try it, still has yet to be optimized in our country. Internet connectivity can still be improved, as well as our stakeholders’ level of telehealth awareness. Future efforts to improve and sustain the uptake of telehealth solutions are recommended, as well as studies comparing the cost-effectiveness of in-person versus virtual consultations especially among persons with lived experiences of disability.p>
Human ; Telehealth ; Telemedicine ; Telerehabilitation ; Physical And Rehabilitation Medicine ; Wheelchairs ; Philippines

In April 2020, the Department of Rehabilitation Medicine (DRM) of the University of the Philippines - Philippine General Hospital (UP-PGH) transitioned to a telerehabilitation program called ITAWAG, an acronym for Introducing Telerehab As a Way to Access General rehabilitation medicine services. This was in response to the designation of UP-PGH as a COVID-19 referral center and the abrupt closure of all its in-patient and out-patient rehabilitation services. Eleven previous in-patients and out-patients with musculoskeletal and neurologic impairments continued their rehabilitation programs remotely, either through a phone call or video call. Their clinical outcomes and the implementation of the ITAWAG program were monitored to determine the effectiveness of an offsite continuing care program. Using the Clinical Global Impressions-Severity (CGI-S) scale, eight patients had a reduction in the severity of their illness, while the remaining three clients had no change. Feedback surveys showed that most clients and caregivers (68%) and health providers (77%) were satisfied with the program's implementation and its outcome. A frequent complaint was the poor phone reception and internet connection. As threats of a COVID-19 outbreak continue, telerehabilitation gives patients a safe, affordable, and convenient alternative for follow-up and continuity of care in medical rehabilitation. Integrating the ITAWAG program into the initial facility-based rehabilitation management can enhance its value in optimizing functional gains and resolving its shortcomings.
Telerehabilitation ; COVID-19 ; Continuity of Patient Care