Translating COVID-19 Evidence to Maximize Physical Therapists’ Impact and Public Health Response

Abstract

Coronavirus disease 2019 (COVID-19) has sounded alarm bells throughout global health systems. Late May, 2020, over 100,000 COVID-19 related deaths were reported in the United State, the highest number of any country. This article describes COVID-19 as the next historical turning point in the physical therapy profession’s growth and development. The profession has had over a 100-year tradition of responding to epidemics including poliomyelitis; two world wars and geographical regions experiencing conflicts and natural disasters; and the epidemic of noncommunicable diseases (NCDs). The evidence-based role of non-invasive interventions (non-pharmacologic/non-surgical) that hallmark physical therapist practice has emerged as being highly relevant today in addressing COVID-19 in two primary ways. First, despite some unique features, COVID-19 presents as acute respiratory distress syndrome (ARDS) in its severe acute stage. ARDS is well familiar to physical therapists in intensive care units. Body positioning and mobilization, prescribed based on comprehensive assessments/examinations, counter the negative sequelae of recumbency and bedrest; augment gas exchange and reduce airway closure, deconditioning and critical illness complications; and maximize long-term functional outcomes. Physical therapists have an indisputable role across the COVID-19 care continuum. Second, over 90% of individuals who contract and die from COVID-19 have co-morbidities, most notably cardiovascular disease, hypertension, chronic lung disease, type 2 diabetes mellitus, and obesity. Physical therapists need to redouble their efforts to address NCDs by assessing patients for risk factors and manifestations and institute evidence-based health education (smoking cessation, whole-food plant-based nutrition, weight control, physical activity/exercise), and/or support patients’ efforts when these are managed by other professionals. Effective health education is a core competency for addressing risk of COVID-19 as well as NCDs. COVID-19 is a wake-up call to the profession, an opportunity to assert its role throughout the COVID-19 care continuum and augment public health initiatives by reducing the impact of the current pandemic.

Pelvic Floor Considerations in COVID-19

“…Physical therapists have a long history of responding to pandemics and epidemics to help mitigate the long-term consequences of illnesses. 45 About 85% of COVID-19 cases will have mild symptoms and not require hospitalization, 10% will require hospitalization, and 5% of those will require long ICU stays. 9 One of the primary things that we must consider as physical therapists is that the effects of this infection will be far-reaching and pervasive in the short term.…”

Paradigm shifts are hard to come by: looking ahead of COVID-19 with the social and environmental determinants of health and the UN SDGs

“…Contrary to what has been suggested, we believe that this cannot mean that 'physical therapists need to redouble their efforts to address NCDs by assessing patients for risk factors and manifestations and institute evidence-based health education (smoking cessation, whole-food plant-based nutrition, weight control, physical activity/exercise)' in the context of the ongoing COVID-19 pandemic [9]. It can also not mean that we simply push for more self-management, or for no-touch modalities for either the prevention, or treatment and rehabilitation of COVID-19.…”

“…While all of this is highly necessary, should continue, and continue to be supported, there is also a limit to the extent that we can consider these efforts innovative, let alone representative of paradigm shifts borne out of the COVID-19 pandemic. The acute treatment and long-term rehabilitation of pulmonary, neurological, musculoskeletal and cardiovascular pathologies has been the mainstay of physiotherapy for well over a century now, particularly in times of crisis [9][10][11][12][13].…”

Activités physiques et sportives, prise en charge de la pandémie au COVID-19, Ségur de la santé et Ségur de la santé publique : pour un trinôme gagnant

“…Les APS sont reconnues pour améliorer le bien-être et prévenir la maladie mentale [3] . Les APS diminuent les impacts négatifs liés à l’âge, à l’obésité et à l’inactivité physique au cours de la pandémie au COVID-19 [4] . Le développement d’un programme de prévention par les APS qui serait un réel vecteur de bien être en luttant contre les effets délétères de la sédentarité ou de l’inactivité physique et de l’isolement social, effets accentués par la mise en place de confinements successifs pour enrayer la pandémie du COVID-19.…”