American Journal of Physical Medicine & Rehabilitation Articles Ahead of Print

DOI: 10.1097/PHM.0000000000001441

Staying active in isolation: Telerehabilitation for individuals

with the SARS-CoV-2 infection

Masahiko Mukaino, MD, PhD1, Tsuyoshi Tatemoto, PT, PhD2,

Downloaded from https://journals.lww.com/ajpmr by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3Nu6/x40YHMNhzg5V3NsuhvyEnALZYj2H09sU0jLG5TQ= on 04/30/2020

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Nobuhiro Kumazawa, PT, MSc2, Shigeo Tanabe, PT, PhD2,

Masaki Kato, PT3, Eiichi Saitoh, MD, PhD1, and Yohei Otaka, MD, PhD1

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1
Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi,

Japan
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Faculty of Rehabilitation, School of Health Sciences, Fujita Health University, Aichi, Japan

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Department of Rehabilitation, Fujita Health University Hospital
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Corresponding author
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Yohei Otaka, M.D., Ph.D.

Department of Rehabilitation Medicine I

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Fujita Health University School of Medicine

1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi 470-1192, Japan

Tel: +81-562-93-2167

Fax: +81-562-95-2906

Email: [email protected]

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 The recent outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is

now a pandemic.1 As a result, many individuals worldwide are in isolation for treatment and/or

monitoring to prevent the spread of the infection.1 However, isolation leads to activity restriction,

which can cause physical and psychological decline.2 It also increases the risk of depression and

anxiety in patients with an isolation3 These issues are especially concerning in the elderly,4 who

are at greater risk of serious illness due to the SARS-CoV-2 infection. Additionally, it can be

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difficult while in isolation to access rehabilitation services, which are the most effective

countermeasure against physical and psychological decline.

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Telerehabilitation, which aims to provide rehabilitation services to individuals in remote

locations,5 may serve as a solution to this problem. Here, therefore, we introduce a preliminary
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attempt to use a telerehabilitation system to deliver exercise opportunities to individuals isolated

due to SARS-CoV-2 infection. Four hospitalized individuals (aged 19–66, median age 53 years;

two male), who were infected with SARS-CoV-2 during the outbreak on the Diamond Princess

cruise ship, participated in the program. Written informed consent was obtained from the
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participants. The telerehabilitation equipment consisted of an android tablet computer connected

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to the internet via Wi-Fi and a pulse oximeter (Ring O2, Neuroceuticals Inc., Tokyo, Japan)

connected to the tablet via Bluetooth, both of which were located in the participant’s room, as well
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as a desktop computer in the therapist’s room.

Using videoconferencing (Zoom by Zoom Video Communications Inc., San Jose, USA) and

remote-control software (TeamViewer by TeamViewer GmbH, Goeppingen, Germany), a

physical therapist guided each individual in a 20-minute exercise program (Figure 1). The actionss

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by the participants were minimized with the use of the remote-control software to facilitate

participation in the program. The participants were simply asked to wear the pulse oximeter and

launch the remote control software at the scheduled time; the physical therapist then accessed the

tablet from the host computer and started the exercise program, which consisted of stretching,

muscle strengthening, and balance exercises directed by a video program with real-time

instructions provided by the physical therapist. A movie file of the video exercise program was

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pre-installed on the tablet, to allow for possible instability of the internet connection.

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After the session, the participants were asked to rate, using numeric rating scales (0–10), 1)

their overall satisfaction, 2) whether they felt it meaningful for their health to participate in this

program, and 3) whether they would recommend this exercise to others. The exercise session was
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successfully completed by all participants without any issues or complications. The participant-

reported overall satisfaction with the exercise program ranged from 8 to 10 (median of 10), while

the answers on the second and third questions ranged from 7 to 10 (median of 10) and 8 to 10

(median of 10), respectively.

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With the pandemic spread of SARS-CoV-2, the number of isolated individuals is expected to

increase. In addition to the efforts being made for the prevention and treatment of the infection,
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attempts to minimize declines in functional status—especially in vulnerable populations, such as

the elderly and disabled—are important to reduce the accompanying social burden. This type of

telerehabilitation system, which can be easily assembled using a combination of affordable

technologies, could be a powerful tool—regardless of whether it is used in hospitals or the

community—to address the social struggles related to this pandemic.

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Funding: This work was partially supported by the Aichi Prefectural Government’s

“Demonstration Project for Telerehabilitation and Rehabilitation Robots (2016–2018)”.

Conflicts of interest: The authors have no conflicts of interest to disclose.

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References

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https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200312-sitrep-

52-covid-19.pdf?sfvrsn=e2bfc9c0_4.

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4. Pisot R, Marusic U, Biolo G, et al. Greater loss in muscle mass and function but smaller

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5. Winters JM. Telerehabilitation research: emerging opportunities. Annu Rev Biomed Eng.
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2002;4:287-320.

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Figure legend

Exercise program delivered using the telerehabilitation system.

Left panel: A physical therapist provides the participant with exercise guidance using the

telerehabilitation system. The pulse rates and SpO2, measured using a monitoring device, are

displayed on the monitor in the therapist’s room (lower corner). Right panel: Participant

performing exercises in his room. Exercise instructions were provided on the screen of the tablet

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computer installed in the participant’s room (lower corner).

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Figure 1

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