Highlights from

ISTH 2020

The International Society of Thrombosis and Haemostasis

Virtual 12-14 July 2020

Physical rehabilitation improves health outcomes after pulmonary embolism

Outpatient rehabilitation over 6 weeks improved functional constraints in patients who suffered from exertion dyspnoea after sustaining a pulmonary embolism [1].

Pulmonary embolism (PE) may have long-term effects on patient’s health status. Long-term consequences include decreased functional capacity with chronic exercise limitations that are observed in many patients. Dr Stephan Nopp (Medical University Vienna, Austria) and colleagues aimed to evaluate the possible benefits of outpatient physical rehabilitation for PE patients with persisting symptoms.

The analysis included 22 patients with physical rehabilitation between 2012 and 2019 with a median age of 47.5 years, among them 32.8% women, and 57.1% had been diagnosed with deep vein thrombosis when the PE happened. All of them suffered from dyspnoea upon exertion with a New York Heart Association (NYHA) ≥ class II, and 45.5% had arterial hypertension.

The study subjects completed a physical rehabilitation programme with 3-4 hours of exercise, patient education, and physiotherapy with multi-professional supervision thrice weekly over 6 weeks. A change in 6-minute-walk-test (6MWT) was defined as primary outcome, while other parameters like performance on the cycle ergometer, inspiratory muscle strength, and extremity strength served as secondary outcomes. As also long-term advantages were of interest, follow-up took place until 39 months (median value) after completion of physical rehabilitation. The beginning of physical rehabilitation was set around 19 weeks after the acute PE. The mean value for 6MWT at baseline was 556.1 m.

Directly after completion of the physical rehabilitation programme, clinically meaningful ameliorations in 6MWT were observed with a mean change of 49.4 m (P<0.001). Furthermore, test for constant work rate, maximal inspiratory pressure, and strength in upper and lower extremities showed significant progress (all P-values <0.001). A rate of 78% of the patients reported amelioration of their health condition at long-term follow-up. Altogether, the investigators see a potential benefit of physical rehabilitation for patients with chronic functional limitations and advocate further research.

Keywords: Pulmonary Embolism, Rehabilitation, Dyspnoea

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