Physiotherapy & COVID-19: Rehabilitating on the front line
Each year, September 8 has been celebrated as World Physiotherapy Day since 1996. This is significant as it marks the date that the World Physiotherapy was founded in 1951. World Physiotherapy is the voice of the global physiotherapy community and we unite each year to raise awareness of our role in the medical fraternity. This year was celebrated under the theme ‘Rehabilitation after COVID-19’.
Physiotherapists are a critical part of the management of COVID-19 patients worldwide. Here in Jamaica, we have been playing our role in managing our critically ill patients since March, when the first case was diagnosed. You may ask, how can a physiotherapist help to manage this condition? Well, there are two main phases that we fall into; first, there is the acute-subacute management, and second, rehabilitation after COVID-19.
ACUTE AND SUBACUTE MANAGEMENT
COVID-19 can cause impaired lung function that can lead to a patient being placed on ventilatory or oxygen support. The virus may also cause a variety of respiratory conditions, such as bronchiectasis, pneumonia and other lower respiratory tract infections that may manifest with any of the following symptoms:
• Low oxygen saturation;
• Shortness of breath;
• Increased work of breathing;
• Increased sputum production;
• Retained secretions in the lung; and
• Inability to clear secretions independently.
Early mobilisation is critical to our entire body as it helps to maintain proper blood flow and oxygen circulation to all organs, improve muscle strength, maintain and improve joint integrity and range of motion. As soon as is safely possible, the physiotherapist will teach bed mobility, get the patient out of bed and into a chair by the bedside, and work on the patient’s sitting balance. Eventually, the patient will be progressed to sitting and standing, and then walking independently. Exercise is also vital to manage the effects of deconditioning. Initially, the patient will be given gentle exercises, such as arm curls, shoulder lifts, heel slides and cycle ergometry (small bicycle) for the arms and legs.
Chest physiotherapy techniques such as manual percussions, mechanical vibrations, positional lung drainage, stacked breathing, and manual-assisted cough are employed to improve breathing, clear secretions, and improve lung recruitment. Working in conjunction with the Intensive Care Unit team, these chest physiotherapy techniques help the critically ill and moderately ill patients transition to the next stage of their recovery and breathe independently.
REHABILITATION AFTER COVID-19
The moderately to critically ill patient will need rehabilitation to recover from the effects of prolonged ventilation and oxygen support, prolonged immobilisation and bed rest. Related impairments, which may include respiratory, neurological, musculoskeletal or otherwise, must also be addressed. The earlier the intervention of a physiotherapist, the better the outcome and the possibility of improving the patient’s quality of life.
COVID-19 patients may manifest with post-viral fatigue syndrome and post-intensive care syndrome. As a result, a thorough assessment will be done in the outpatient physiotherapy department before starting the treatment programme. The physiotherapist will also establish practical rehabilitation goals in line with the patient’s personal goals and their rehabilitation needs. The aims of the treatment programme include:
• Increased endurance and muscle strength;
• Improved fitness and energy;
• Improved balance and coordination;
• Reduced breathlessness;
• Improved thinking;
• Reduction of stress and improved mood; and
• Increased confidence.
A combination of rest and exercise are extremely important to the patient’s recovery. Every patient is given a home exercise programme to maximise their rehabilitation potential, along with their regular sessions with the physiotherapist. As the patient improves, their treatment programme will be progressed to meet their needs.
If you or your loved one haven’t been referred for physiotherapy after having COVID-19 or upon discharge from the hospital, ask your doctor for one. Make an appointment at your local hospital physiotherapy department or with a private physiotherapist to help you get back on your feet!