Infectious diseases

COVID-19 patients need physio support for respiratory recovery

Patients recovering from COVID-19 should be targeted for physiotherapy interventions for respiratory management, exercise and mobilisation, according to new Australian guidelines for physiotherapy.

The new guidelines  aim to prevent complications of the respiratory system and muscle deconditioning, speed up recovery from mechanical ventilation, and improve long-term physical function and recovery.

Published in Australian Journal of Physiotherapy, the guidelines say that physiotherapy will be required to limit the severity of ICU-acquired weakness in patients and provide longer term rehabilitation and interventions to survivors of COVID-19 to allow them to function upon returning home and regain their life roles.

“Physiotherapy input to the prevention and treatment of ICU acquired weakness is vitally important, but COVID-19 brings unique challenges and some adaptations to the way that care is delivered,” says Flinders University Caring Futures Institute researcher Dr Claire Baldwin, a co-author of the clinical practice guide.

According to Dr Baldwin, the guidelines are just as much about who not to treat, where treatment benefits may be minimal, but health care worker risks are high, just as it is about where there is an indication for physiotherapy.

They advise that for many patients with COVID-19 disease, the respiratory infection associated is mostly associated with a dry and non-productive cough and lower respiratory tract involvement usually involves pneumonitis rather than exudative consolidation. In these cases, respiratory physiotherapy interventions are not indicated, they advise.

“However, some people may develop phlegm that they are unable to clear from their lungs, or, have added challenges because they have difficulty with coughing up phlegm even under normal circumstances. This is where respiratory physiotherapy treatments may be needed,” says Dr Baldwin.

“Patients with pre-existing health conditions who contract COVID-19 and those who require treatment in an ICU will especially need our help,” she says.

The guidelines also provide recommendations regarding personal protective equipment for physiotherapists managing COVID-19 disease.

“Because cough generates aerosols, it is important that respiratory physiotherapy techniques are recognised as an aerosol generating exposure and physiotherapists can be protected with the correct PPE,” says Dr Baldwin.

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