Physiotherapy management for COVID-19 in the acute hospital setting and beyond: an update to clinical practice recommendations, 2021, Thomas et al

[Wyva]

Abstract

This document provides an update to the recommendations for physiotherapy management for adults with coronavirus disease 2019 (COVID-19) in the acute hospital setting. It includes: physiotherapy workforce planning and preparation; a screening tool for determining requirement for physiotherapy; and recommendations for the use of physiotherapy treatments and personal protective equipment.

New advice and recommendations are provided on: workload management; staff health, including vaccination; providing clinical education; personal protective equipment; interventions, including awake proning, mobilisation and rehabilitation in patients with hypoxaemia.

Additionally, recommendations for recovery after COVID-19 have been added, including roles that physiotherapy can offer in the management of post-COVID syndrome. The updated guidelines are intended for use by physiotherapists and other relevant stakeholders caring for adult patients with confirmed or suspected COVID-19 in the acute care setting and beyond.

Open access: https://www.sciencedirect.com/science/article/pii/S1836955321001399?

 

[Wyva]

I'm posting this after getting a Google Scholar alert because the entire paper was translated to Hungarian. This paper was mostly written by Australians involved in physiotherapy.

PEM is mentioned:

Mobilisation and exercise prescription should involve careful consideration of the patients' physiological state and reserve (eg, degree of respiratory and haemodynamic dysfunction). This includes consideration of:
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the presence and severity of hypoxaemia

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exertional hypoxaemia

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cardiac impairments

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autonomic dysfunction and orthostatic intolerance

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post-exertional symptom exacerbation

Regardless of the model used for exercise-based rehabilitation, programs that include or are designed specifically for people with COVID-19 should incorporate disease-specific education on post-COVID conditions, screening related to specific complications and monitoring for post-exertional symptom exacerbation. When prescribing physical interventions to people who have post-COVID conditions, they should be screened for new or worsened cardiac impairment, post-exertional symptom exacerbation, exertional oxygen desaturation, autonomic dysfunction and orthostatic intolerance.149

Providing guidance for exercise training to people post-COVID should always be done with caution, as it is possible for symptoms to be exacerbated. This may include worsening of fatigue, cognitive dysfunction or any other symptoms experienced following COVID-19.149 Where post-exertional symptom exacerbation is identified, adaptations may include the “Stop. Rest. Pace” approach, activity management or pacing.149 Patients should be encouraged to contact their healthcare team if they experience any ‘red flag’ symptoms with exercise, including new or worsening breathlessness, chest pain, tachycardia, palpitations, confusion, difficulty speaking or understanding speech, or weakness in their face, arm or leg.173

ME/CFS is not mentioned (I haven't read the whole paper though).

 

[Wyva]

Additional info: this is not just an Australian thing but an update to the original guideline endorsed by the organization World Physiotherapy. Originally, PEM wasn't mentioned, so this is a new addition. The guideline has been translated to many different languages: https://world.physio/covid-19-information-hub/covid-19-practice-based-resources



About World Physiotherapy: "World Physiotherapy is a non-profit organisation and is registered as a charity in the UK. It has been in official relations with the World Health Organization (WHO) since 1952,[3] collaborating on work programmes to improve world health. It works with a wide range of other international bodies and is a member of the World Health Professions Alliance.[4]" From Wikipedia