Early Physical Therapist Interventions for Patients With COVID-19 in the Acute Care Hospital: A Case Report Series

Abstract

Objective The aim of this case series was to describe the experience of Swiss physical therapists in the treatment of patients with COVID-19 during their acute care hospital stay and to discuss challenges and potential strategies in the clinical management of these patients. Methods We report 11 cases of patients with COVID-19 from five Swiss hospitals that illustrate the various indications for physical therapy, clinical challenges, potential treatment methods and short-term response to treatment. Results Physical therapists actively treated patients with COVID-19 on wards and in the ICU. Interventions ranged from patient education, to prone positioning, to early mobilization and respiratory therapy. Patients were often unstable with quick exacerbation of symptoms and a slow and fluctuant recovery. Additionally, many patients who are critically ill developed severe weakness, post-extubation dysphagia, weaning failure or presented with anxiety or delirium. In this setting, physical therapy was challenging and required specialized and individualized therapeutic strategies. Most patients adopted the proposed treatment strategies and lung function and physical strength improved over time. Conclusion Physical therapists clearly have a role in the COVID-19 pandemic. Based on our experience in Switzerland, we recommend that physical therapists routinely screen and assess patients for respiratory symptoms and exercise tolerance on acute wards. Treatment of patients who are critically ill should start as soon as possible to limit further sequelae. More research is needed for awake prone positioning, early breathing exercises as well as post-COVID rehabilitation. Impact To date there are few data on the physical therapist management of patients with COVID-19. This article is among the first to describe the role of physical therapists in the complex pandemic environment and to describe the potential treatment strategies for countering the various challenges in the treatment of these patients.

Physiotherapy management for COVID-19 in the acute hospital setting and beyond: an update to clinical practice recommendations

“…While awake proning may be a strategy used to improve arterial oxygenation, not all patients tolerate it for prolonged periods and trial of different positions like side lie, semi-recumbent, sitting, forward lean, prone and semi-prone may identify positions that maximise arterial or peripheral oxygenation and comfort for individuals. 131 , 132 , 133 …”

Feasibility of sit training for patients with severe COVID-19 pneumonia during deep sedation

“…There have been a few reports on the early rehabilitation of patients with COVID-19, [ 9 , 10 ] and none on the effectiveness and adverse events of early mobilization for mechanically ventilated patients (other than COVID-19) during deep sedation. The present study indicates that sitting without adverse events is possible in patients with severe COVID-19 pneumonia during deep sedation (RASS of -5) with muscle relaxation.…”

Application of an evidence-based, out-patient treatment strategy for COVID-19: Multidisciplinary medical practice principles to prevent severe disease

“…[3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , ...…”

“…percussion and expectoration) is best achieved by having the patient raise their right arm and percuss from the front approximately under the breast between the 4 th or 6 th intercostal spaces. [53][54][55]…”