The RECLAIM study platform will be used to explore whether the use of Hyperbaric Oxygen therapy (HBOT) improves the symptoms of post covid cognitive dysfunction. Hyperbaric oxygen therapy is a well-established medical treatment. HBOT promotes healing by delivering a high concentration of oxygen into the body. This high level of oxygen has a number of known benefits, such as growth of new blood vessels, as well as regulating immune and inflammation responses. It helps protect the brain and other nervous tissue from inflammation. HBOT may also have antiviral effects. Collectively, it has the potential to target the underlying mechanisms believed to play a critical role in the development of Long COVID. Many individuals with Long COVID complain of fatigue, brain fog, muscle aches and other symptoms. There is evidence to suggest that these symptoms may be a problem with the blood vessels, resulting in abnormal delivery of oxygen to tissues. Thus, our group is investigating whether HBOT improves post-COVID cognitive dysfunction.
This is a Sub-Protocol to the Core Clinical Study Protocol titled: REcovering from COVID19 Lingering symptoms Adaptive Integrative Medicine (RECLAIM),
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
120
The SECHRIST INDUSTRIES mono-place Hyperbaric Chambers OR Sigma Series mono-place Hyperbaric Chambers
Simple reaction time [SRT] task from the TestMyBrain (TMB) Digital Neuropsychology Toolkit
On-line survey tool
Time frame: Baseline/Start of intervention to two months
Verbal paired associates [VPA] task from the TestMyBrain (TMB) Digital Neuropsychology Toolkit
On-line survey tool
Time frame: Baseline/Start of intervention to two months
Symptoms scale
Three point Likert scale assessing how bothersome symptoms are on a weekly basis for two months then monthly until end of study, as reported by the participant: to provide a granular, detailed picture of the symptom trajectory.
Time frame: Baseline/start of intervention weekly to 2 months, then once monthly to 6 months.
Symptom Checklist
Symptom Checklist (adapted from the De Paul Symptom Questionnaire (DSQ2), the World Health Organization Global COVID-19 Clinical Platform's Post COVID-19 CRF and the Symptom Burden Questionnaire for Long COVID): to track symptom trajectory.
Time frame: Baseline/start of intervention to 1, 2 months 3 and 6 months
Six Minute Walking Test (6MWT) with oximetry
Subjects walk as far as they can in six minutes while receiving maximum encouragement. It is simple to execute, inexpensive, standardized and gives a tangible measure of functional exercise capacity. It has been validated in many different populations. The 6MWT will be conducted according to American Thoracic Society standards.
Time frame: Baseline/start of intervention and 2 months.
SF-36
The self-administered SF-36 evaluates eight health concepts: physical functioning, role functioning-physical, bodily pain, general health, vitality, social functioning, role functioning-emotional, and mental health. Previous studies have used this instrument in many different populations and it takes approximately 15 minutes to complete.
Time frame: Baseline/start of intervention to 1, 2 months 3 and 6 months
TestMyBrain cognitive testing
TestMyBrain was developed as a tool to collect large, population-based samples for understanding the relationship between cognition, emotion, social functioning, and health. This test battery includes: TMB Verbal Paired Associates (Concrete), TMB Digit Span - Backward, TMB Digit Span - Forward, TMB Choice Reaction Time, TMB Simple Reaction Time, TMB Gradual Onset Continuous Performance Task. The test battery will take about 20 minutes to complete and will assess: verbal, episodic and working memory, attention, processing speed, basic psychomotor response speed, and cognitive control.
Time frame: Baseline/start of intervention to 1, 2 months 3 and 6 months
Post COVID19 functional status scale
The post-COVID-19 functional status (PCFS) scale focuses on relevant aspects of daily life during follow-up after the infection. The scale is intended to help users become aware of current functional limitations in COVID-19 patients, whether or not as a result of the specific infection, and to objectively determine this degree of disability. The scale is ordinal, has 6 steps ranging from 0 (no symptoms) to 5 (death), and covers the entire range of functional outcomes by focusing on limitations in usual duties/activities either at home or at work/study, as well as changes in lifestyle. The PCFS demonstrates good construct validity.
Time frame: Baseline/start of intervention to 1, 2 months 3 and 6 months
Reintegration to Normal Living Index (RNLI)
This short self-administered assessment tool will determine the degree to which participants reintegrate into normal social activities such as recreation, mobility in the community and interaction in family and other relationships. This tool has been validated in community living adults with mobility limitations.
Time frame: Baseline/start of intervention to 1, 2 months 3 and 6 months
The Fatigue Scale
The Fatigue Scale was adapted from the De Paul Symptom Questionnaire (DSQ2)'s 38 questions assessing medical history of Myalgic Encephalitis/Chronic Fatigue Syndrome (ME/CFS), comorbidities, medications, impact on quality of life and daily activities, etc.
Time frame: Baseline/start of intervention to 1, 2 months 3 and 6 months
Brief Fatigue inventory
The self-administered Brief Fatigue Inventory is composed of 9 items evaluated on a 10-point scale, assessing severity of fatigue and impact of fatigue on daily life. It takes approximately 2-3 minutes to complete.
Time frame: Baseline/start of intervention to 1, 2 months 3 and 6 months
Post-Exertional Malaise
The self-administered DPEMQ is comprised of three sections assessing post-exertional malaise (PEM): (i) onset and triggers of PEM (9 questions), (ii) consequences and symptoms (14 questions), (iii) duration, recovery and pacing (7 questions).
Time frame: Baseline/start of intervention to 1, 2 months 3 and 6 months
Mental Health - General Anxiety Assessment Form (GAD-7)
The GAD-7 is a valid and efficient tool for screening for generalized anxiety disorder and assessing its severity in clinical practice and research. It is an easy-to-use, self-administered patient questionnaire that can be completed in minutes.
Time frame: Baseline/start of intervention to 1, 2 months 3 and 6 months
Mental Health - Patient Health Questionnaire (PHQ-9)
The PHQ-9 is a validated, multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression. It incorporates Diagnostic and Statistical Manual 1V (DSM-IV) depression diagnostic criteria with other leading major depressive symptoms into a brief self-report tool. The PHQ-9 is brief and useful in clinical practice.
Time frame: Baseline/start of intervention to 1, 2 months 3 and 6 months
Dyspnea
Assessed using the Borg Dyspnea scale. This short assessment tool assesses perceived shortness of breath on exertion using a 10 point scale as assessed by the patient.
Time frame: Baseline/start of intervention to 1, 2 months 3 and 6 months
Blood samples
Blood samples will be used in correlative studies using advanced multi-omic and machine learning techniques to better understand our results so as to identify phenotypes that will benefit from specific therapies
Time frame: Baseline/start of intervention and 2 months
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