Recommendations for Hospital-Based Physical Therapists Managing Patients With COVID-19

Abstract

Objective The COVID-19 pandemic is rapidly evolving and has led to increased numbers of hospitalizations worldwide. Hospitalized patients with COVID-19 experience a variety of symptoms, including fever, muscle pain, tiredness, cough, and difficulty breathing. Elderly people and those with underlying health conditions are considered to be more at risk of developing severe symptoms and have a higher risk of physical deconditioning during their hospital stay. Physical therapists have an important role in supporting hospitalized patients with COVID-19 but also need to be aware of challenges when treating these patients. In line with international initiatives, this article aims to provide guidance and detailed recommendations for hospital-based physical therapists managing patients hospitalized with COVID-19 through a national approach in the Netherlands. Methods A pragmatic approach was used. A working group conducted a purposive scan of the literature and drafted initial recommendations based on the knowledge of symptoms in patients with COVID-19, and current practice for physical therapist management for patients hospitalized with lung disease and patients admitted to the intensive care unit (ICU). An expert group of hospital-based physical therapists in the Netherlands provided feedback on the recommendations, which were finalized when consensus was reached among the members of the working group. Results The recommendations include safety recommendations, treatment recommendations, discharge recommendations, and staffing recommendations. Treatment recommendations address 2 phases of hospitalization: when patients are critically ill and admitted to the ICU, and when patients are severely ill and admitted to the COVID ward. Physical therapist management for patients hospitalized with COVID-19 comprises elements of respiratory support and active mobilization. Respiratory support includes breathing control, thoracic expansion exercises, airway clearance techniques, and respiratory muscle strength training. Recommendations toward active mobilization include bed mobility activities, active range-of-motion exercises, active (−assisted) limb exercises, activities-of-daily-living training, transfer training, cycle ergometer, pre-gait exercises, and ambulation.

Pneumonia in medical professionals during COVID-19 outbreak in cardiovascular hospital

“…On the other hand, physical therapy of cardiovascular patients carries an increased risk of infection for a person performing the treatment. Additionally, their work consists of visits to different departments which increases the number of contacts with patients and other employees further aggravating the possibility of infestation ( Felten-Barentsz et al, 2020 ).…”

Airway Clearance Techniques: The Right Choice for the Right Patient

“…Early reports indicate that patients with COVID-19 do not show airway mucus hypersecretion, however, patients with specific comorbidities (e.g., COPD, cystic fibrosis, neuromuscular disease) might actually need respiratory support due to airway secretion retention or ineffective cough. In case of clinical signs for presence of airway secretion (by hearing, feeling, or chest x-ray), different techniques and devices can be applied to mobilization or evacuation ( 76 ). In hypersecretive patients, the use of continuous or temporary positive expiratory pressure device with or without oscillation (PEP, TPEP, OPEP), should be considered, alone or in combination with lung expansion strategies, to enhance lung volume recruitment, to better control the expiration flow and to facilitate peripheral and proximal mucus mobilization.…”

Compromiso, secuelas y rehabilitación del Sistema Nervioso Central debido a infección por Coronavirus, Sars-CoV-2 (Covid-19)

“…La disminución de la resistencia al ejercicio, asociada con la disfunción cardiopulmonar y la atrofia muscular causada por la inmovilización a largo plazo, puede causar debilidad que es una de las disfunciones motoras en pacientes graves, sumado a la fragilidad, las comorbilidades cardiacas, cerebrales, hepáticas y renales características de los pacientes de mediana y avanzada edad 54 . Se han diseñado protocolos que buscan definir el manejo óptimo en estos pacientes, los cuales toman en cuenta el uso de implementos de protección personal y de herramientas adaptativas como la telecomunicación o las indicaciones escritas relacionadas con el tratamiento 52 . Como se dijo previamente, la evaluación funcional debe incluir la determinación del rango de movimiento de la articulación muscular, así como pruebas de fuerza y equilibrio para lo cual se sugiere el uso de la Escala de Equilibrio de Berg.…”

“…La movilización activa en supino (rotación cervical, elevación de hombros, flexión de bíceps, flexo-extensión de dedos y de tobillo) o sedente (flexo-extensión cervical, rotación torácica y extensión de rodilla) debe comenzar con 5 repeticiones en 1 serie, con progresión a 10 a 15 repeticiones en 3 series. Se recomienda el fortalecimiento muscular progresivo con carga de peso: un programa sugerido se basa en 8 a 12 repeticiones (con carga máxima), en 1 a 3 series con 2 minutos de descanso entre series, 3 sesiones a la semana durante 6 semanas; la utilización de bandas elásticas de resistencia suelen ser de gran utilidad 52 .…”

“…Se debe continuar la fisioterapia después de la transferencia a piso de hospitalización. La estimulación eléctrica neuromuscular se puede usar para promover el fortalecimiento y la capacidad del ejercicio, la cual se puede evaluar mediante la prueba de marcha de 6 minutos con monitoreo continuo de saturación de oxígeno y solo antes del alta [52][53][54] .…”