Early Physical Therapist Interventions for Patients With COVID-19 in the Acute Care Hospital: A Case Report Series

Eggmann, Sabrina; Kindler, Angela; Perren, Andrea; Ott, Natalie; Johannes, Frauke; Vollenweider, Rahel; Balma, Théophile; Bennett, Claire; Silva, Ivo Neto; Jakob, Stephan M. (2020). Early Physical Therapist Interventions for Patients With COVID-19 in the Acute Care Hospital: A Case Report Series. Physical therapy, 101(1) Oxford University Press 10.1093/ptj/pzaa194

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Objective
The aim of this case series was to describe the experience of Swiss physical therapists in the treatment of patients with COVID-19 during their acute care hospital stay and to discuss challenges and potential strategies in the clinical management of these patients.

Methods
We report 11 cases of patients with COVID-19 from five Swiss hospitals that illustrate the various indications for physical therapy, clinical challenges, potential treatment methods and short-term response to treatment.

Results
Physical therapists actively treated patients with COVID-19 on wards and in the ICU. Interventions ranged from patient education, to prone positioning, to early mobilization and respiratory therapy. Patients were often unstable with quick exacerbation of symptoms and a slow and fluctuant recovery. Additionally, many patients who are critically ill developed severe weakness, post-extubation dysphagia, weaning failure or presented with anxiety or delirium. In this setting, physical therapy was challenging and required specialized and individualized therapeutic strategies. Most patients adopted the proposed treatment strategies and lung function and physical strength improved over time.

Conclusion
Physical therapists clearly have a role in the COVID-19 pandemic. Based on our experience in Switzerland, we recommend that physical therapists routinely screen and assess patients for respiratory symptoms and exercise tolerance on acute wards. Treatment of patients who are critically ill should start as soon as possible to limit further sequelae. More research is needed for awake prone positioning, early breathing exercises as well as post-COVID rehabilitation.

Impact
To date there are few data on the physical therapist management of patients with COVID-19. This article is among the first to describe the role of physical therapists in the complex pandemic environment and to describe the potential treatment strategies for countering the various challenges in the treatment of these patients.

Interest & Impact

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