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

Abstract

This document provides an update to the recommendations for physiotherapy management for adults with coronavirus disease 2019 (COVID-19) in the acute hospital setting. It includes: physiotherapy workforce planning and preparation; a screening tool for determining requirement for physiotherapy; and recommendations for the use of physiotherapy treatments and personal protective equipment. New advice and recommendations are provided on: workload management; staff health, including vaccination; providing clinical education; personal protective equipment; interventions, including awake proning, mobilisation and rehabilitation in patients with hypoxaemia. Additionally, recommendations for recovery after COVID-19 have been added, including roles that physiotherapy can offer in the management of post-COVID syndrome. The updated guidelines are intended for use by physiotherapists and other relevant stakeholders caring for adult patients with confirmed or suspected COVID-19 in the acute care setting and beyond.

A Sensor Network Utilizing Consumer Wearables for Telerehabilitation of Post-Acute COVID-19 Patients

“…Our study was only focused on patients with mild to moderate dyspnea (dyspnea score of 1 or 2 on the mMRC); therefore, the results of this pilot study cannot be applied to patients with more severe dyspnea (mMRC score 3-4). Patients with more severe symptoms or patients with worse functional impairment after COVID-19 critical illness need an individualized and adapted inpatient or outpatient pulmonary rehabilitation program targeted to the needs of these patients [3]. Furthermore, systematic screening of patients at 6 to 8 weeks after COVID-19, as was also done in our study, is useful to identify patients with persistent symptoms [3].…”

“…The detailed recommendations for exercise training were also written in the educational brochure. Patients were instructed to contact the pulmonologist or the physiotherapist if they experienced worsening dyspnoea, chest or muscle pain, cardiac problems, muscle weakness or difficulty speaking during exercise training, as is recommended in Physiotherapy management of COVID-19 in the acute hospital setting and beyond [3]. The physiotherapist then conducted and supervised telerehabilitation lessons through video calls once per week.…”

“…For a more detailed evaluation, we provide anonymous details of the Wristband protocols as an online supplementary material 3 . A description of the protocol is part of the supplementary file.…”

“…Patients did not participate in another outpatient rehabilitation program simultaneously. Patients with severe or very severe dyspnea (mMRC score [3][4] were not included in this study; an outpatient rehabilitation program was recommended. Patients were informed regarding the study protocol, and they signed an informed consent form approved by the institutional ethics committee (reference number 202104 P19).…”

“…Apart from the considerable difficulties in managing patients in the disease's acute phase [1], numerous COVID-19 patients who have experienced more serious symptoms require an adequate rehabilitation program in the postacute phase. After having COVID-19, patients often complain of fatigue, breathing difficulties, and muscle weakness [2], [3]. Moreover, they frequently believe they will be unable to return to their pre-COVID-19 physical activity levels.…”