CLINICAL PRACTICE RECOMMENDATIONS FOR COVID-19 SURVIVORS IN OUT-PATIENT PHYSIOTHERAPY SETTING

A. Annethattil¹, S. Koyili¹

Background: Coronavirus disease 2019 (COVID-19) has spread rapidly throughout the globe. It is associated with significant mortality, particularly in at-risk groups with poor prognostic features at hospital admission. The spectrum of disease is broad but among hospitalized patients with COVID-19, pneumonia, sepsis, respiratory failure, and acute respiratory distress syndrome (ARDS) are frequently encountered complications. the severity of COVID-19 symptoms can range from very mild to severe. Older adults or those who have existing chronic medical conditions, such as heart disease, lung disease, diabetes, severe obesity, chronic kidney or liver disease, compromised immune systems are at higher risk of infection. Administration has taken various proactive measures to curb the spread of COVID-19. Stay home campaign is one the most effectively used method to restrict the transmission. With evolving COVID-19 literatures suggest patients who were mechanically ventilated (MV) have potential long-term secondary effects that can cause considerable impact on the individual leading to reduced functional performance, impaired Quality of Life (QOL) and poor health status on discharge.

Purpose: Knowledge about COVID-19 including its presentations and treatment is changing very rapidly and guidelines are quickly being created and updated. The importance of rehabilitation of COVID-19 has been emphasized according to the framework of International Classification of Functioning, Disability and Health. Although acute care physiotherapy is well established in COVID-19 management, continuity of physiotherapy care through out-patient settings to address the long-term secondary effects of COVID-19 survivors should also be given prime importance. Till date there are physiotherapy practice recommendations for the management of COVID-19 in acute hospital settings from various geographic locations, with negligible resources available on out-patient physiotherapy management of COVID-19 survivors. The primary objective is to develop a clinical practice recommendation for the physiotherapy management of post discharge COVID-19 patients through tele-rehabilitation or face-to-face treatment depending upon the post-discharge functional status of the survivors.

Methods: Experienced neurophysiotherapists, cardiopulmonary physiotherapists and musculoskeletal physiotherapists with the support of ICU physiotherapists and frontline physiotherapists constituted the core group for developing the practice recommendation. Around 38 articles were reviewed to provide guidance on screening/categorization, special considerations, system-wise management of COVID-19 survivors.

Results: The clinical practice recommendation was structured after performing systematic literature review by the core group with the aim to provide critical information to physiotherapists for the evidence-based management of COVID-19 survivors in the out-patient physiotherapy setting.

Conclusion(s): This clinical practice recommendation provides guidance on all aspects of the management, re-assessment/safe discharge and provision of tailored home exercises program.

Implications: The patient algorithm given in this recommendation will help the physiotherapist to form a framework for the physiotherapy management of COVID-19 survivorsin out-patient setting. The core group recommends the use of appropriate PPE and allotment of dedicated treatment area as per the recommendation of national infection control committee.

Funding, acknowledgements: This project is not funded by any agency

Keywords: COVID-19, Out-patient physiotherapy, Practice recommendation

Topic: COVID-19

Did this work require ethics approval? No

Institution: HMC

Committee: MRC HMC

Reason: practice recommendations