tesi e progetti di ricerca 2021_SOMA

Efficacia del trattamento manipolativo fasciale nei pazienti con esiti di polmonite da sars-cov-2 in fase post acuta

Effectiveness of the fascial manipulative treatmente on patients with outcomes of pneumonia from sars-Cov-2 in the postacute phase 

Tesi di: Magarelli Mauro, Polito Federico, Soprano Teresa
Relatore: Dott. Vismara Luca DO MROI
Correlatore: Tarantino Andrea DO
2020-2021

Riassunto

INTRODUZIONE
Il presente studio nasce dall’osservazione diretta di pazienti con esiti di polmonite da Sars-Cov-2 in fase post-acuta, in cui si è potuto notare quanto la riduzione di elasticità della gabbia toracica rappresentasse un carattere ricorrente, spesso non adeguatamente considerato (1-2).
Ci si è posti pertanto l’obiettivo di strutturare uno studio randomizzato controllato monocentrico che permetta di verificare l’efficacia del trattamento manipolativo fasciale in tali pazienti, in aggiunta ai programmi riabilitativi attualmente già praticati e supportati da evidenze scientifiche (3-4-5).

MATERIALI E METODI

I pazienti con esiti di polmonite da Sars-Cov-2, ricoverati presso il reparto di Riabilitazione Respiratoria dell’Ospedale Delmati di Sant’Angelo Lodigiano, ASST di Lodi, verranno suddivisi in un gruppo di controllo e in un gruppo sperimentale. Il primo prenderà parte al programma riabilitativo respiratorio standard, consistente in esercizi respiratori (incentivatori di volumi inspiratori, applicazione di pressioni positive espiratorie), aerobici (cyclette e cicloergometro) ed attivi (training della deambulazione) già attualmente adottati (3-4). Il secondo riceverà in aggiunta un trattamento manipolativo fasciale a settimana per l’intera durata del ricovero (5). Verranno esclusi dallo studio esclusivamente i pazienti non complianti, oppositivi o con diagnosi di decadimento cognitivo tale da compromettere la partecipazione al programma riabilitativo.

RISULTATI

Entrambi i gruppi verranno valutati in ingresso e in dimissione con la rilevazione della capacità polmonare inspiratoria tramite incentivatore di volumi Coach (endpoint primario), prove di funzionalità respiratoria (MIP e MEP), rilevazione dello spessore e dell’escursione diaframmatica tramite studio ecografico, somministrazione di scale di valutazione quali Barthel e K-Bild, 6 minutes walking test e rilevazione dei giorni di degenza.

DISCUSSIONE

Una volta ottenute le autorizzazioni necessarie dal comitato etico, potrà comiciare la raccolta dati così come strutturata nel presente protocollo di studio.
Dai risultati ottenuti sarà così possibile verificare se il trattamento manipolativo fasciale nelle polmoniti da Sars-Cov-2 in fase post-acuta incrementi in termini quantitativi e/o qualitativi i risultati già auspicabili dal trattamento riabilitativo standard o non apporti ad essi alcuna modifica.

CONCLUSIONI

In base ai risultati ottenuti, potrà rendersi necessaria un’analisi costi-benefici per verificare l’introduzione del trattamento manipolativo fasciale nel protocollo riabilitativo ospedaliero, nonché ulteriori approfondimenti dell’efficacia di tale trattamento su patologie respiratorie differenti.

BIBLIOGRAFIA
1) Diaphragm Dysfunction in Critical Illness. Gerald S. Supinski, MD; Peter E. Morris, MD; Sanjay Dhar, MD; Leigh Ann Kallahan, MD. Chest 2018; 153 (4): 1040-1051
2) How SARS-CoV-2 (COVID-19) spreads within infected hosts- what we know so far. Sumana Sanyal review Emerg Top Life Sci – 2020 dec 11 ;4 (4):371-378)
3) Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living systematic review. Maria G. Ceravolo, Chiara Arienti, Alessandro de Sire, Elisa Andrenelli, et al. European Journal of Physical and Rehabilitation Medicine 2020 Oct; 56 (5): 642-51
4) Joint Statement on the Role of Respiratory Rehabilitation in the Covid-19 Crisis: the Italian Position Paper. Vitacca M, Carone M, Clini E M, Paneroni M, et al. On behalf of the Italian thoracic society (ITS-AIPO), the Association for the Rehabilitation of Respiratory Failure (ARIR) and the Italian Respiratory Society (SIP/IRS). DOI:10.1159/000508399
5) Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia Sheldon Yao, John Hassani, Martin Gagne, Gebe George, Wolfgang Gilliar. Date Published: 5/6/2014. Citation: Yao, S., Hassani, J., Gagne, M., George, G., Gilliar, W. Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia. J. Vis. Exp. (87), e50687, doi:10.3791/50687 (2014)

 Abstract

INTRODUCTION

The present study arises from the direct observation of patients with outcomes of Sars-Cov-2 pneumonia in the post-acute phase, in which it was possible to note how the reduction in elasticity of the rib cage represented a recurrent character, often not adequately considered (1-2). The present work therefore aims to structure a single-center randomized controlled study that allows to verify the efficacy of fascial manipulative treatment in such patients, in addition to the rehabilitation programs currently already practiced and supported by adequate scientific evidence (3-4-5).

MATERIALS AND METHODS

Patients with outcomes of Sars-Cov-2 pneumonia, admitted to the Respiratory Rehabilitation Department of the Delmati Hospital of Sant’Angelo Lodigiano, ASST of Lodi, will be divided into a control group and an experimental group. The first will take part in the standard respiratory rehabilitation program, consisting of breathing exercises (stimulating inspiratory volumes, application of positive expiratory pressures), aerobic (exercise bike and cycle ergometer) and active (walking training) exercises already adopted (3-4). The second will receive, in addition, one fascial manipulative treatment per week for the entire duration of hospitalization (5). Only patients who are not compliant, oppositional or with a diagnosis of cognitive impairment such as to compromise participation in the rehabilitation program will be excluded from the study.

RESULTS

Both groups will be evaluated at entrance and at discharge with the detection of the inspiratory lung capacity through the Coach volume incentivator (primary endpoint), respiratory function tests (MIP and MEP), detection of the thickness and diaphragmatic excursion through ultrasound study, administration of evaluation scales such as Barthel and K-Bild, 6 minutes walking test and detection of length of stay. Furthermore, where possible, a global spirometry will be performed for a better classification of the patient from a pneumological point of view.

DISCUSSION

Once the necessary authorizations have been obtained from the ethics committee, data collection can begin as structured in this study protocol.
From the results obtained it will thus be possible to verify whether fascial manipulative treatment in post-acute Sars-Cov-2 pneumonia increases in quantitative and / or qualitative terms the results already desirable from standard rehabilitation treatment or does not bring any changes to them.

CONCLUSION

Based on the results obtained, a cost-benefit analysis may be necessary to verify the introduction of fascial manipulative treatment in the hospital rehabilitation protocol, as well as further investigations of the effectiveness of this treatment on different respiratory diseases.

BIBLIOGRAPHY
1) Diaphragm Dysfunction in Critical Illness. Gerald S. Supinski, MD; Peter E. Morris, MD; Sanjay Dhar, MD; Leigh Ann Kallahan, MD. Chest 2018; 153 (4): 1040-1051
2) How SARS-CoV-2 (COVID-19) spreads within infected hosts- what we know so far. Sumana Sanyal review Emerg Top Life Sci – 2020 dec 11 ;4 (4):371-378)
3) Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living systematic review. Maria G. Ceravolo, Chiara Arienti, Alessandro de Sire, Elisa Andrenelli, et al. European Journal of Physical and Rehabilitation Medicine 2020 Oct; 56 (5): 642-51
4) Joint Statement on the Role of Respiratory Rehabilitation in the Covid-19 Crisis: the Italian Position Paper. Vitacca M, Carone M, Clini E M, Paneroni M, et al. On behalf of the Italian thoracic society (ITS-AIPO), the Association for the Rehabilitation of Respiratory Failure (ARIR) and the Italian Respiratory Society (SIP/IRS). DOI:10.1159/000508399
5) Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia Sheldon Yao, John Hassani, Martin Gagne, Gebe George, Wolfgang Gilliar. Date Published: 5/6/2014. Citation: Yao, S., Hassani, J., Gagne, M., George, G., Gilliar, W. Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia. J. Vis. Exp. (87), e50687, doi:10.3791/50687 (2014)