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Reviews of "Virtual reality exercise to help COVID patients with refractory breathlessness"

Giuseppe Riva (Catholic University of Sacred Heart) |📗📗📗📗◻️ • Fabrizio Stasolla (Università Telematica Giustino Fortunato) | 📒📒📒◻️◻️

Published onJan 25, 2022
Reviews of "Virtual reality exercise to help COVID patients with refractory breathlessness"
key-enterThis Pub is a Review of
Virtual reality exercise to help COVID patients with refractory breathlessness

SummaryBackgroundImmersive virtual reality (iVR)-based digital therapeutics (DTx) are gaining clinical attention in the field of pain management. Based on known analogy between chronic pain and dyspnea, we investigated the effects of visual respiratory feedback in iVR, on refractory breathlessness in patients recovering from severe COVID-19 pneumonia.MethodsWe performed a controlled, randomized, single-blind, cross-over clinical study to evaluate an iVR-based intervention to alleviate refractory breathlessness in patients recovering from COVID-19 pneumonia. The single-site study was conducted at the university hospital of Geneva, Switzerland. Patients reported refractory breathlessness (≥5 on a 10-point dyspnea scale) and had a MoCA score of ≥24. Cross-over groups were randomly assigned, concealed from the referring clinician. Participants received synchronous (intervention) or asynchronous (control) feedback of their breathing, embodied via a gender-matched avatar in iVR. Prior to the first exposure and following both experimental conditions, patients completed questionnaires. Breathing patterns were captured continuously. The COVVR clinical study is registered with (NCT04844567) and is now closed.FindingsStudy enrollment was open between November 2020 and April 2021. A total of 26 patients (27% women; age: mean=57, SD±12) were enrolled; 14 patients were randomly assigned to the “synchronous/asynchronous” sequence, 12 to the “asynchronous/synchronous” sequence. Data was available for all except two (7.7%) of 26 patients. The mean rating of breathing comfort was 0.1 at baseline, 0.8±1.8 for asynchronous, and 1.3±1.4 synchronous feedback (estimated difference of 0.5 (95%CI 0.05 to 1.04; p<0.05) between iVR conditions). Of all patients, 91.2% were satisfied with the intervention (1.8±1.6, t=5.201, p<0.0001, 95%CI 1.173 to inf) and 66.7% perceived it as beneficial for their breathing (0.7±1.9, t=1.806, p<0.05, 95%CI 0.036 to inf). No adverse events were reported.InterpretationBased on these findings, we propose that our iVR-based DTx is a feasible and safe neuro-rehabilitation tool that improves breathing comfort in patients recovering from severe COVID-19 infection. More research is needed to generalize this tool in other groups of patients suffering from refractory breathlessness.FundingMarie Skłodowska-Curie Individual Fellowship (H2020-MSCA-IF-2019 894111/ RESPVR), Bertarelli Foundation

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Summary of Reviews: This preprint evaluates whether a virtual reality-based rehabilitation program could improve breathing comfort in patients recovering from COVID-19 and found this iVR-based DTx treatment protocol was effective. Reviewers rated the study as potentially informative but confounded.

Reviewer 1 (Giuseppe Riva) | 📗📗📗📗◻️

Reviewer 2 (Fabrizio Stasolla) | 📒📒📒 ◻️◻️

RR:C19 Strength of Evidence Scale Key

📕 ◻️◻️◻️◻️ = Misleading

📙📙 ◻️◻️◻️ = Not Informative

📒📒📒 ◻️◻️ = Potentially Informative

📗📗📗📗◻️ = Reliable

📘📘📘📘📘 = Strong

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