Self-proning and Repositioning in COVID-19 Outpatients at Risk of Complicated Illness
COVID-19, COVID-19 Pneumonia, Proning
About this trial
This is an interventional treatment trial for COVID-19
Eligibility Criteria
Inclusion Criteria:
- Age ≥18 years
- Positive SARS-CoV-2 PCR test
Presence of two or more of the following criteria:
- Age>55 years
- Fever by history or at presentation
- Cough
- Dyspnea/shortness of breath
- Fatigue necessitating daytime bed rest
One or more of the following medical conditions:
- Hypertension
- Diabetes
- Cardiovascular disease
- Chronic lung disease
- Chronic kidney disease
- Obesity (BMI≥30kg/m2)
- Tachycardia > 110 bpm
- Oxygen saturation <94%
One or more of the following laboratory abnormalities:
- Lymphocytes <1500/microL
- ESR > 100 mm/h
- CRP > 10 mg/L
- D-Dimer > 1000 ng/mL
- LDH > 240 U/L
- Bilateral infiltrates or ground glass opacities on chest x-ray or CT scan
- Socially and medically fit for discharge
- Access to a smartphone
Exclusion Criteria:
- Pregnancy >20/40 weeks
- Body mass index (BMI) >40 kg/m2.
- Skeletal deformities that interfere with proning
- Developmental delay or cognitive impairment that would preclude patient cooperation
- Other contraindications to proning including any of the following: recent abdominal surgery, active vomiting, acute intoxication.
- Unlikely to adhere to the proning protocol according to the treating physician's judgment
- Fully vaccinated for COVID-19
Sites / Locations
- St. Joseph's Health Centre
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
Self-proning
Standard care
Participants assigned to the intervention arm will receive a SMS link to a PDF containing instructions on proning/repositioning and information about its physiological benefits. They'll also receive a PDF with standard recommendations for treating COVID-19 at home. Participants will be encouraged to lie flat on their belly, on their side, or sit upright and rotate between these positions when lying down during the day and night. Participants will be sent a daily SMS "proning reminder" and asked to complete a secure REDCap survey regarding their proning activity. They'll be advised to prone and reposition for seven days minimum whenever they are lying down. Participants who have failed to reach their functional baseline after this time period will be advised to continue doing so. Follow up assessment by telephone will be conducted in 7 day increments from baseline up to 28 days.
Participants assigned to the comparator arm will receive a SMS link to a PDF with standard recommendations for treating COVID-19 at home. This includes antipyretics and analgesics for fever, myalgias, and headaches; hydration; and rest with advancement of activity as soon as tolerated. Follow up assessment by telephone will be conducted in 7 day increments from baseline up to 28 days.