Personalized approach in complex rehabilitation of patients after COVID-19 pneumonia using hypoxia-hyperoxia therapy: a randomized study

INTRODUCTION. After the end of the pandemic, there is still a need for medical rehabilitation for patients with long-term covid and post-covid syndrome. Given the complex pathogenesis of coronavirus infection, complex rehabilitation methods with a personalized approach are of the greatest interest. AIM. To determine the effectiveness of medical rehabilitation using personalized normobaric interval hypoxic-hyperoxic therapy (NBIHHT) in patients after coronavirus pneumonia in a day hospital. MATERIALS AND METHODS. 120 patients with moderate-severity coronavirus pneumonia, randomized into two homogeneous groups, were examined in a day hospital. 60 patients of the comparison group underwent the procedures of the basic rehabilitation program: physical therapy, hydrokinesiotherapy, selective chromotherapy, halotherapy, sessions of psychoemotional relaxation. In addition to the basic program, 60 patients in the main group underwent personalized NBIHHT procedures. In patients of both groups, the intensity and severity of dyspnea (mMRC, BDI/TDI scales), hypoxia tolerance (Stange and Genchi tests), cardiovascular system condition (Martine test), exercise tolerance (six-minute walk test), the function of external respiration (spirography), microcirculation (laser Doppler flowmetry), anxiety and depression severity (HADS scale), and quality of life (SF-36 before, after rehabilitation and in the follow-up after 3 and 6 months) were assessed before and after rehabilitation. RESULTS AND DISCUSSION. After rehabilitation, a statistically significant positive trend was observed with a significance level of p 0.05 in patients of both groups for most indicators. However, in patients of the main group, the positive result was statistically more significant, which was manifested by a decrease in the intensity and severity of shortness of breath (p 0.001), an increase in the indicators of the function of external respiration: an increase in vital capacity by 12.8 % (p 0.001), forced vital lung capacity by 5.9 % (р = 0.015), forced expiratory volume in the first second by 5.7 % (р = 0.032), peak volumetric exhalation rate by 7.4 % (р = 0.009), an increase in hypoxia tolerance: increased breathing retention time on inspiration (Stange test) by 51.15 % (p = 0.000), on exhalation (Genchi test) by 24.14 % (р = 0.006). There was also an improvement in the functional state of the cardiovascular system: a decrease in heart rate before exercise by 13.29 % (р = 0.000), after exercise by 24.54 % (р = 0.000), an increase in exercise tolerance according to the six-minute walk test by 19.87 % (р = 0.000), and also increased activation of microcirculation (p 0.001), decreased anxiety and depression levels (p 0.001), and an improvement in quality of life after rehabilitation (p 0.001) and during a 3-month observation period (p 0.001), as well as stabilisation in the follow-up after 6 months (p 0.001). CONCLUSION. The inclusion of personalized NBIHHT procedures in the rehabilitation complex of patients with COVID-19 pneumonia can significantly improve immediate and long-term results in a day hospital environment.