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Table of Contents
EDITORIAL
Year : 2020  |  Volume : 2  |  Issue : 1  |  Page : 1-3

COVID-19 pandemic: An emerging physical therapy paradigm


1 Department of Paediatric Physiotherapy, KAHER, Institute of Physiotherapy, Belagavi, Karnataka, India
2 Department of Oncology Physiotherapy, KAHER, Institute of Physiotherapy, Belagavi, Karnataka, India
3 Department of Orthopaedic Physiotherapy, KAHER, Institute of Physiotherapy, Belagavi, Karnataka, India

Date of Submission30-Apr-2020
Date of Decision15-May-2020
Date of Acceptance29-May-2020
Date of Web Publication03-Jul-2020

Correspondence Address:
Dr. Deepa C Metgud
Department of Paediatric Physiotherapy, KAHER, Institute of Physiotherapy, Belagavi - 590 010, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijptr.ijptr_16_20

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How to cite this article:
Metgud DC, Pattanshetty R, Welling A. COVID-19 pandemic: An emerging physical therapy paradigm. Indian J Phys Ther Res 2020;2:1-3

How to cite this URL:
Metgud DC, Pattanshetty R, Welling A. COVID-19 pandemic: An emerging physical therapy paradigm. Indian J Phys Ther Res [serial online] 2020 [cited 2020 Oct 1];2:1-3. Available from: http://www.ijptr.org/text.asp?2020/2/1/1/288859



When the going gets tough, the tough gets going is a popular saying in English and is aptly true for everyone living today during this global pandemic of coronavirus disease 2019 (COVID-19).

COVID-19, an ongoing pandemic of respiratory disease, is the latest menace to global health ever since its outbreak in December 2019 in Wuhan, China. It has generated a major distress due to the high percentage of death it has caused globally and nonavailability of valid treatment till date. This explains that the new virus COVID-19 is extremely contagious crossing specific barriers and causing illness in human ranging from common cold (mimicking flu or influenza) to severe disease patterns such as Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome leading to serious public health risk.[1],[2] The continuum of severity of the disease varies from subclinical illness, upper respiratory tract disease, serious breathing failure, viral pneumonia, and/or death. Existing studies suggest that 80% of cases are asymptomatic; 15% serious (oxygen-requiring illness); and 5% cases are crucial who require ventilator support system.[2]

Currently, we are in a circumstance in which we have limited experience and preparation toward fighting a battle against COVID-19 and this is the biggest challenge to all in general and to the medical scientific community in particular worldwide. Health workers are at the front line for the management of the COVID-19 outbreak and regular updated guidelines are released by the WHO.[3] Worldwide physical therapy services are given in conjunction with medical treatment, necessitating collective response to COVID-19 patients being treated and assisted. Hence, guidelines for physical therapists are needed to define their role both at preventive and therapeutic levels. Physical therapists employed in health-care facility especially in the intensive care units (ICU) are expected to play a role in the rehabilitation of confirmed or suspected cases of COVID-19.[4] In particular, cardiorespiratory physical therapists who work in ICUs and acute care settings are focused to rehabilitate patients with acute and chronic respiratory conditions aiming to improve physical recovery following an acute illness.[5]

Globally, physical therapy associations have made dire attempts to set guidelines and recommendations to treat COVID-19 patients in conjunction with the intensivists and nursing staff. The Government of New South Wales and the Australian Physical Therapy Association have collaborated in delivering substantial training to physical therapists seeking to rehabilitate COVID-19 patients.[6] A document by the World Confederation of Physical Therapy (WCPT) has provided guidelines for physical therapists working in hospital that would assist physical therapists in the management of confirmed or suspected cases of COVID-19.[4] It has been anticipated that physical therapy could be beneficial in respiratory problems and physical rehabilitation in patients with COVID-19 having profuse secretions that are difficult to clear independently by the patient. Techniques such as airway clearance and positioning may assist the ventilated patient in maintaining bronchial hygiene.[5] Prone positioning could help acute respiratory distress syndrome (ARDS) patients improve ventilation. Since the prevalence of ARDS in COVID patients is 17%, it can be considered as a treatment option to decrease mortality in patients with impaired oxygenation in the initial hours of disease.[7] It also helps in recruiting the dorsal lung regions and thereby increasing end expiratory lung volume, increasing the chest wall elastance, decreasing alveolar shunt, and also improving tidal volume.[8] It has been reported that COVID-19 patients on prolonged ventilator support, sedatives, neurogenic inhibitors, analgesics, and antibiotics are susceptible to develop ICU-acquired illness that may worsen the morbidity and mortality.[5],[9] In order to avoid this, it is important to anticipate early rehabilitation of patients with respiratory disease to avoid ICU-induced weakness and enhance early recovery.[10] Physical therapist plays an extensive role in providing exercise therapy, mobilization, and rehabilitation interventions to COVID-19 survivors in order to enable functional recovery.[4] This advocates that physical therapy is significant in early recovery of COVID patients.

Although the guidelines for physical therapy are recommended, there are still many queries unanswered and risky like the usage of the aerosol generating procedures, use of bubble positive expiratory pressure, use of mechanical insufflations, exsufflation, and humidification. However, they may be used under instruction, disposable circuits with consultation, and agreement. Manual hyperinflation or Ambuing is recommended to be avoided as it involves disconnection and opening of ventilator circuit.[4],[11],[12]

Besides the recommended guidelines in ICU by physical therapy associations, the head of physical therapist team may frame screening and treatment guidelines. These guidelines may be framed and documented as per their hospital policy in a manner that may include detection of mild, moderate, and severe cases of COVID-19 and physiotherapy measures for confirmed and suspected cases in separate isolation areas.[4],[11],[12]

In the present COVID-19 pandemic in India, although there are >1 lakh affected cases, 61,149 active cases, 42,297 cases recovered, and 3303 deaths as per Aarogya Setu database of the Ministry of Health and Family Welfare, Government of India, dated May 20, 2020, there is a lack of training and participation of physical therapists or rehabilitation practitioners as vital components of the health-care system.[13] Physical therapists have been set aside a little with the cancellation and restriction of ambulatory and hospital facilities to some degree. However, as per the recent WCPT guidelines, physical therapist definitely plays a vital role in meeting patient's needs. In India, a report published in Tribune News Service on outcome of physiotherapy in COVID-19 patients showed beneficial effects of age-old postural therapy technique (also known as postural drainage) for the early recovery of COVID patients with hypoxemia, which may result in preventing development of frank respiratory failure.[14] Hence, physical therapists in India should be given the opportunity and training to apply the various rehabilitation strategies that would help recover confirmed or suspected patients with COVID-19.

Since very less has been documented regarding the physical therapy treatment options in COVID-19 patients, the Editorial team deliberates to focus more on involving physical therapist as a team member and possible treatment techniques that can be used for early recovery of COVID-19 patients with least morbidity and optimal functional outcome.



 
  References Top

1.
Del Rio C, Malani PN. 2019 novel coronavirus-important information for clinicians. JAMA 2020;323:1039-40.  Back to cited text no. 1
    
2.
World Health Organisation. Coronavirus Disease 2019 (COVID-19) Situation Report 46. World Health Organisation; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/situation-reports. [Last accessed on 2020 Apr 16].  Back to cited text no. 2
    
3.
Rights, Roles and Responsibilities of Health Workers, Including Key Considerations for Occupational Safety and Health: Interim Guidance; 2020. p. 1-2. Available from: https://www.who.int/publications-detail/coronavirus-disease-(covid-19)-outbreak-rights-roles-and-responsibilities-of-health-workers-including-key-considerations-for-occupational-safety-and-health. [Last accessed on 2020 Apr 16].  Back to cited text no. 3
    
4.
Thomas P, Baldwin C, Bissett B, Boden I, Gosse R, Granger CL, et al. Physiotherapy management for COVID-19 in acute hospital settings. Version 1.0. J Physiother 2020;66:73-82. Available from: https://www.wcpt.org/sites/wcpt.org/files/files/wcptnews/images/Physiotherapy_Guideline_COVID-19. [Last accessed on 2020Apr 17].  Back to cited text no. 4
    
5.
Kress JP, Hall JB. ICU-acquired weakness and recovery from critical illness. N Engl J Med 2014;370:1626-35.  Back to cited text no. 5
    
6.
NSW Government Health. Physiotherapist Deployed to Assist on COVID-19 Frontline; 2020. Available from: https://www.health.nsw.gov.au/news/Pages/20200329_02.aspx. [Last accessed on 2020 Apr 18].  Back to cited text no. 6
    
7.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet 2020;395:507-13.  Back to cited text no. 7
    
8.
Ghelichkhani P, Esmaeili M. Prone position in management of COVID-19 patients; a commentary. Arch Acad Emerg Med 2020;8:e48.  Back to cited text no. 8
    
9.
Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, et al. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011;364:1293-304.  Back to cited text no. 9
    
10.
Pattanshetty RB, Gaude GS. Critical illness myopathy and polyneuropathy - A challenge for physiotherapists in the intensive care units. Indian J Crit Care Med. 2011;15:78-81. doi:10.4103/0972-5229.83009.  Back to cited text no. 10
    
11.
Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, et al. Physiotherapy management for COVID-19 in the acute hospital setting: Clinical practice recommendations. J Physiother 2020;66:73-82.  Back to cited text no. 11
    
12.
Cieloszczyk A, Lewko A, Sliwka A, Wtoch T, Pyszora A. Recommendations for physiotherapy of adult patients with COVID-19. The Polish Chamber of Physiotherapist; 2020. Available from: https://www.wcpt.org/sites/wcpt.org/files/files/wcptnews/images/Recommendations/physiotherapy/adult/patients/with/COVID-19_POLISH.pdf. [Last accessed on 2020 Apr 18].  Back to cited text no. 12
    
13.
AarogyaSetu IVRS. Ministry of Health Government of India; 2020. Available from: https://www.mohfw.gov.in/pdf/AAROGYASETUIVRS1921.pdf. [Last accessed on 2020 May 18].  Back to cited text no. 13
    
14.
Mishra N. PGI Chandigad uses Postural Therapy for Early Patient Recovery. Tribune News Service; April 26, 2020. Available from: https://www.tribuneindia.com/news/chandigarh/pgi-uses-postural-therapy-for-early-patient-recovery-. [Last accessed on 2020 Apr 28].  Back to cited text no. 14
    




 

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