Objective: To compare low-level laser therapy and myofascial release in reducinginflammation and functional recovery in critically ill COVID-19 patients with 3-monthhome-based telerehabilitation assessment.Participants: One hundred two COVID-19 patients aged 45-60 years randomized into threegroups: low-level laser therapy (n=34), myofascial release (n=34), and control (n=34).Intervention: Intensive care unit-based low-level laser therapy, myofascial release, orstandard physiotherapy with medical treatment. Following discharge, all participantsreceived 12 weeks of multidimensional home-based telerehabilitation incorporating patienteducation, breathing exercises, inspiratory muscle training, limb strengthening, aerobictraining, and trunk control.Outcomes: Primary outcomes were ferritin and D-dimer levels. Secondary outcomes includedC-reactive protein, interleukin-6, white blood cell counts, maximum inspiratory pressure,six-minute walk test, bilateral knee strength, dyspnea perception, fatigue severity, andoxygen saturation. All measured at baseline, discharge, and 3 months. Intensive care unitlength of stay and physiotherapy sessions measured at discharge.
One hundred-two COVID 19 patients (56 men and 46 women) aged 45-60 years were recruited
from the Al Kasr Al Ainy teaching hospitals ICUs. All patients were informed of the
study, risks, and expected benefits before signing the informed consent form. The
low-level laser therapy group (LLLT) consisted of 34 patients, who received low-level
laser therapy, traditional physiotherapy, medical treatment and the myofascial release
group (MR) consisted of 34 patients, who received myofascial release techniques,
traditional physiotherapy, and medical treatment; and the control group (C) consisted of
34 patients, who received traditional physiotherapy and medical treatment only. After
discharge all patients received home multidimension telerehabilitation program.
The eligibility criteria were as follows: (I) Patients aged from 45 to 60 years old, (II)
Diagnosed by CT or PCR as positive COVID 19, (III) Moderate cases of COVID-19 (According
to CO-RA DS Scale).22 (IV) on low flow rate oxygen supply Exclusion criteria were (I)
patients on Invasive Mechanical Ventilation, (II) Hemodynamically Unstable with inotropic
support; (III) Septic Shock; (IV) ICU admission less than 24 h.
(V) physician termination of physiotherapy; and (VI) fever with causes other than chest
infection, (VII) severe electrolyte imbalance, acute venous thromboembolism without
therapeutic anticoagulation for over 48 h, (VIII) Unstable Atrial fibrillation, or severe
tachycardia compared to baseline.
Radiation: Photobiomodulation
It was applied for upper respiratory tract over tonsils, trachea, and main bronchi
(bilaterally parasternal at the level of angle of Lewis), upper and lower lung, and at
cubital vein
Procedure: Myofascial release therapy
technique was applied from supine position, with both hands cupping both diaphragmatic
domes
Device: traditional chest physiotherapy
included traditional chest physiotherapy (postural drainage, percussion and shaking),
stretching exercise
Other: telerehabilitation
Following ICU discharge, all patients participated in a 12-week structured home
multidimensional telerehabilitation program delivered via videoconferencing (Zoom or
Microsoft Teams) under the remote supervision of a physiotherapist. Sessions were
conducted three times per week and incorporated patient education, breathing exercises,
inspiratory muscle training (30 -50% MIP), strengthening of upper and lower limb muscle
groups (50- 70 % 1RM), aerobic training (40- 60% HRR), and trunk control activities.
Safety monitoring was emphasized throughout, with patients instructed to use a pulse
oximeter before, during, and after each session. Adherence was assessed by session
attendance, exercise diaries, and weekly therapist follow-up
Inclusion Criteria:
- The eligibility criteria were as follows:
- Patients aged from 45 to 60 years old.
- Diagnosed by CT or PCR as positive COVID 19.
- Moderate cases of COVID-19(According to CO-RADS Scale).
- On low flow rate oxygen supply
Exclusion Criteria:
- Patients on Invasive Mechanical Ventilation
- Hemodynamically Unstable with inotropic support
- Septic Shock
- ICU admission less than 24 h
- physician termination of physiotherapy;
- Fever with causes other than chest infection.
- Severe electrolyte imbalance
- Acute Venous Thromboembolism (VTE) without therapeutic anticoagulation for over 48
hours,
- Unstable Atrial fibrillation , or Severe Tachycardia compared to baseline.
Faculty of Physical Therapy , Beni-Suef University
Banī Suwayf, Egypt
Mahmoud Ibrahim Mahmoud, Lecturer, Principal Investigator
Faculty of Physical Therapy - Beni-Suef University