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Posted by ULY CLINIC

24 Machi 2021 18:59:00


The guidance  is based on proper case management aspects intended for clinicians involved in the care of patients with suspected or confirmed COVID-19. It is not meant to replace clinical judgment or specialist consultation but rather to strengthen frontline clinical management and the public health response.




Physiotherapist is the essential discipline involved in multidisciplinary group of active hospital services and intensive care units. Early rehabilitation during acute period of respiratory pain can limit the discomfort of stability in this way and promote rapid respiratory recovery. In usual practice of physiotherapists, they are patient centred while fulfilling the role on managing cardiopulmonary patients.

Physiotherapists are expected more often to have a role in promoting respiratory recovery in acute hospital wards and the ICU. In particular, cardio respiratory physiotherapy is focused on the management of acute and chronic respiratory conditions and aims to improve physical recovery following an acute illness.

The benefits of Physiotherapy in the respiratory treatment and physical rehabilitation of patients with COVID- 19 definitely may be identified when patients present with airway secretions that they are unable to independently clear. Coronavirus (COVID 19) varies from other respiratory viruses in that it appears that human-to-human transmission occurs approximately 2 to 10 days prior to the individual becoming symptomatic.

The virus is transmitted from person to person through respiratory secretions. Large droplets from coughing, sneezing, or a runny nose land on surfaces within two meters of the infected person. The virus is transferred to another person through hand contact on a contaminated surface then touching the mouth, nose, or eyes. Thus, it has been unusual when dealing with COVID 19 pandemic as a collaborative team in the management; we propose to adhere with the international guidelines as stipulated from the World Conference of Physical Therapists (WCPT).

Therefore, this part outlines the basic guidelines for physiotherapy management and recommendations to guide clinical physiotherapy practice for COVID – 19 conditions.


The purpose of this document is prepared to provide information to physiotherapists and acute care healthcare facilities about the potential role of physiotherapy in the management of hospital admitted patients with confirmed and/or suspected COVID-19.

b. Guidelines

i) Respiratory physiotherapy interventions in hospital wards or ICU may be indicated for patients who have confirmed or suspected COVID-19 and concurrently or subsequentlydevelop exudative consolidation, mucous hyper secretion and/or difficulty clearing secretions.

ii) There will not be any respiratory physiotherapy intervention on patients with dry or non- productive cough, lower respiratory tract involvement hence the outcomes result to pneumonitis rather than exudative consolidation.

iii) Physiotherapy interventions should only be provided when there are clinical indicators, so that staff exposure to COVID-19 is minimised.

iv) Unnecessary review of patients with COVID-19 within their isolation room/areas will also have a negative impact on PPE supplies.

v) Physiotherapists should meet regularly with senior medical staff to determine indications for physiotherapy review in patients with confirmed or suspected COVID-19 and screen according to set/agreed guidelines.

vi) Patients with mild symptoms, pneumonia, co-existing respiratory or neuromuscular co morbidity indicated to physiotherapy for air clearance.

vii) Patients with mild symptoms, pneumonia with evidence of exudative consolidation and breathing difficulties in air clearance and secretion clearance

viii) There must be a separate team for managing COVID-19 patients to facilitate rotations and minimise over staying.

ix) Recommended staff ratio is 1 physiotherapist for 5 patients for 8hrs/40HRS per week

x) Staff who is pregnant or all staff at risk should not be exposed to COVID-19 patients.

xi) It is only a trained physiotherapist with knowledge and skills of using PPE and handling COVID 19 who will be located in isolation ward.

xii) Nebulisation in isolation ward to non-intubated patients is not allowed hence found to be the source of aeroionisation and transmission of infection to health workers in immediate vicinity.

xiii) Humidification and non-invasive ventilation should be conducted upon agreement with the physician.

xiv) Physiotherapy intervention is only recommended when there is significant functional limitation.

xv) Aerosol Generating Procedures (AGPs) will be allowed to patient with COVID 19 in needs and will be conducted in a negative pressure room with a door closed and minimum number of staff all wearing PPEs. Coming and going should be minimized during the procedure.

xvi) Avoid sharing facilities

xvii) Minimize auscultation procedures

c. Equipments Required

All equipment related for physiotherapy cardio respiratory care, mobilization, exercises and rehabilitation such as;

 1 tilting table
 3 Oxford chairs
 5 office chairs
 3 rollator /wheeled walking
 1 cycle ergometer
 1 steps/blocks
 1 treadmill
 4 tables
 Physiotherapists personal protective gears (PPE) eg face shade, gloves, long sleeves gowns, hair cover for AGP etc

d. Simple airway clearance techniques

• Consider the active cycle of breathing techniques when recommending an airway clearance technique for adults with non-cystic fibrosis-related bronchiectasis.

• Consider oscillating positive expiratory pressure where recommending an airway clearance technique for adults with non-cystic fibrosis-related bronchiectasis.

• The test of incremental respiratory endurance should not be considered as a first- line airway clearance technique.

• The inclusion of postural drainage should be considered for all airway clearance techniques.

• The inclusion of the forced expiration technique should be considered for all airway clearance techniques.

e. Postural Drainage

To enhance airway clearance postural drainage should be taught and encouraged to COVID-19 patients.

f. Respiration Functional Training

Active cycle breathing technique (ACBT). A circulation consists three parts;

• Breathing control
• Thoracic expansion movements
• Forced expiratory technology

g. Physical Function Training

Aerobic exercises

• Formulate aerobic exercise prescriptions for patients with combined underlying diseases and legacy dysfunction including:
• Stepping
• Jogging
• Brisk walking
• Swimming
• Skipping
• Other sports

It is advisable to exercise moderately without the feeling of fatigue the next day after exercises, starting from the low intensity and gradually progressing to 20-30 min each time, 3-5 times a week. For patients who are prone to fatigue, intermittent exercises can be used. Starting 1hour after a meal.

Strength Training

Use sand bags, thera band, dumbbellsor bottled water for progressive resistance training, 3-5 days per 15-20 moves per group, 1-2 groups per day week

h. Airway Clearance Techniques

• Teach all patients with bronchiectasis and a chronic productive cough, and/or evidence of mucus plugging on CT, an airway clearance technique for use as necessary.

• Review the effectiveness and acceptability of the chosen airway clearance technique within approximately 3 months of the initial visit.

• Patients should be made aware of other available airway clearance technique options.

• Positioning in prone. Prone position has been shown to improve oxygenation in spontaneously breathing, non-intubated non-Covid-19 patients with hypoxemic acute respiratory failure. Some studies have demonstrated that application of self-proning with HFNC may help avoid intubation. Recruitment of the posterior lung segments due to reversal of atelectasis.

• Another approach is to rotate positions, including lying on either side and sitting bolt upright which may be easier for many patients to tolerate.

• Some health care facilities encourage mobilization via walking of selected Covid-19 patients.
As one suggested approach, we suggest following the UK Intensive Care Society’s proning recommendations as outlined below. Awake pronation appears to be a safe, inexpensive, and versatile strategy, which can be used at all, levels across a variety of different healthcare settings.


25 Machi 2021 07:27:02



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