F. Driehuis1, R. Brouwer1, R.A. de Bie2, P.J. van der Wees3
1Royal Dutch Society for Physical Therapy (KNGF), Amersfoort, Netherlands, 2Maastricht University, Maastricht, Netherlands, 3Radboud University Medical Center, Nijmegen, Netherlands
Background: Clinical practice guidelines are developed through a rigorous process, using the principles of Evidence-Based Practice combining scientific evidence, expert opinion and patient preferences. Since 2014, the Royal Dutch Society for Physical Therapy (KNGF) develops physiotherapy guidelines using a guideline methodology complying with international standards. Once evidence is lacking or scarce, the importance of clinical expertise, such as expert opinion and clinical experience, increases. Quickly after the novel Coronavirus (COVID-19) outbreak in March 2020 it became clear that the virus had a significant impact on the physical, mental and cognitive functioning of patients infected with COVID-19. However, evidence on COVID-19 and early clinical experiences with treatment of infected patients, nationally and internationally, were scarce. Although many questions were still unanswered and the exact need for physiotherapy and rehabilitation in these patients was unclear, physiotherapists needed guidance in the delivery of care for this formally unknown group of patients.
Purpose: To develop recommendations to support physiotherapists in clinical reasoning, decision making and physiotherapy treatment in patients who had been infected with COVID-19.
Methods: Because evidence on COVID-19 was scarce, we used a more pragmatic approach for the development of physiotherapy recommendations. We formed a working group with researchers in physiotherapy sciences, physiotherapists with specific expertise in cardiorespiratory rehabilitation, intensive care, and geriatric and psychosomatic physiotherapy, together with patient representatives and KNGF-guideline experts. In a 2-month timeframe recommendations were developed using weekly video conferences during which the working group shared knowledge and discussed clinical experiences from hospital, rehabilitation center and general practice perspectives. Consensus was reached based on physiotherapists’ initial experiences with COVID-19, combined with available indirect evidence, mainly derived from cardiorespiratory rehabilitation (such as COPD) and rehabilitation of patients with post intensive care syndrome.
Results: Recommendations addressed screening on indication for physiotherapy, the use of outcome measurements, interventions for treatment, and evaluation. Patients with limitations in physical functioning, such as activities of daily living, physical activity or exercise capacity, are eligible for physiotherapy. Physiotherapy focuses on improving muscle strength and balance, exercise endurance, breathing and relaxation. Initial treatment includes gradually increasing patients’ functioning in daily life, and monitoring of physical function and activity levels. Further treatment goals are determined based on the individual patient’s needs and level of physical functioning, aimed at improving performance of daily activities, and increasing physical activity levels and exercise capacity.
Our recommendations were published as KNGF Position Statement with a first version in April 2020, and an updated version in June 2020. In order to share knowledge internationally, the Position statement was also published in English.
Our recommendations were published as KNGF Position Statement with a first version in April 2020, and an updated version in June 2020. In order to share knowledge internationally, the Position statement was also published in English.
Conclusion(s): Physiotherapists’ clinical expertise and experiences are of great importance for the development of clinical practice guidelines in general, and specifically for developing recommendations for physiotherapy treatment in new patient groups such as COVID-19 where scientific evidence is lacking. A pragmatic approach and a swift development process are important to address the needs of patients and physiotherapists.
Implications: The recommendations will be updated in short cycles, based on evolving evidence, clinical expertise and experience regarding physiotherapy management of patients with COVID-19.
Funding, acknowledgements: No funding
Keywords: COVID-19, guideline development, clinical expertise
Topic: COVID-19
Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: We developed recommendations for physiotherapy treatment in patients with COVID-19 and used a new methodology approach. No ethical approval was required.
All authors, affiliations and abstracts have been published as submitted.
