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

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          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.

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          Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

          Zunyou Wu, Jennifer M. McGoogan (2020)
          Article 0 comments Cited 8508 times – based on 0 reviews     Review now
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            Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

            Mark Peters (2021)
            Abstract Background Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. Methods In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison. Results A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55). Conclusions In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN number, 50189673.)
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              Acute respiratory distress syndrome: the Berlin Definition.

              V Ranieri, Gordon D Rubenfeld, B Taylor Thompson … (2013)
              The acute respiratory distress syndrome (ARDS) was defined in 1994 by the American-European Consensus Conference (AECC); since then, issues regarding the reliability and validity of this definition have emerged. Using a consensus process, a panel of experts convened in 2011 (an initiative of the European Society of Intensive Care Medicine endorsed by the American Thoracic Society and the Society of Critical Care Medicine) developed the Berlin Definition, focusing on feasibility, reliability, validity, and objective evaluation of its performance. A draft definition proposed 3 mutually exclusive categories of ARDS based on degree of hypoxemia: mild (200 mm Hg < PaO2/FIO2 ≤ 300 mm Hg), moderate (100 mm Hg < PaO2/FIO2 ≤ 200 mm Hg), and severe (PaO2/FIO2 ≤ 100 mm Hg) and 4 ancillary variables for severe ARDS: radiographic severity, respiratory system compliance (≤40 mL/cm H2O), positive end-expiratory pressure (≥10 cm H2O), and corrected expired volume per minute (≥10 L/min). The draft Berlin Definition was empirically evaluated using patient-level meta-analysis of 4188 patients with ARDS from 4 multicenter clinical data sets and 269 patients with ARDS from 3 single-center data sets containing physiologic information. The 4 ancillary variables did not contribute to the predictive validity of severe ARDS for mortality and were removed from the definition. Using the Berlin Definition, stages of mild, moderate, and severe ARDS were associated with increased mortality (27%; 95% CI, 24%-30%; 32%; 95% CI, 29%-34%; and 45%; 95% CI, 42%-48%, respectively; P < .001) and increased median duration of mechanical ventilation in survivors (5 days; interquartile [IQR], 2-11; 7 days; IQR, 4-14; and 9 days; IQR, 5-17, respectively; P < .001). Compared with the AECC definition, the final Berlin Definition had better predictive validity for mortality, with an area under the receiver operating curve of 0.577 (95% CI, 0.561-0.593) vs 0.536 (95% CI, 0.520-0.553; P < .001). This updated and revised Berlin Definition for ARDS addresses a number of the limitations of the AECC definition. The approach of combining consensus discussions with empirical evaluation may serve as a model to create more accurate, evidence-based, critical illness syndrome definitions and to better inform clinical care, research, and health services planning.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Physiother
                Journal ID (iso-abbrev): J Physiother
                Title: Journal of Physiotherapy
                Publisher: Australian Physiotherapy Association. Published by Elsevier B.V.
                ISSN (Print): 1836-9553
                ISSN (Electronic): 1836-9561
                Publication date PMC-release: 23 December 2021
                Publication date (Electronic): 23 December 2021
                Affiliations
                [a ]Department of Physiotherapy, Royal Brisbane and Women's Hospital, Brisbane, Australia
                [b ]Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
                [c ]Department of Physiotherapy, The Royal Melbourne Hospital, Melbourne, Australia
                [d ]Discipline of Physiotherapy, University of Canberra, Canberra, Australia
                [e ]Physiotherapy Department, Canberra Hospital, Canberra, Australia
                [f ]Physiotherapy Department, Launceston General Hospital, Launceston, Australia
                [g ]School of Medicine, University of Tasmania, Launceston, Australia
                [h ]Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia
                [i ]Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
                [j ]Department of Critical Care, University Hospitals Leuven, Leuven, Belgium
                [k ]Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
                [l ]Alfred Health, Melbourne, Australia
                [m ]Department of Critical Care, School of Medicine, University of Melbourne, Melbourne, Australia
                [n ]The George Institute for Global Health, Sydney, Australia
                [o ]Central Clinical School, Monash University, Melbourne, Australia
                [p ]Departments of Physiotherapy and Respiratory Medicine, Alfred Health, Melbourne, Australia
                [q ]School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
                [r ]School of Rehabilitation Science, McMaster University, Hamilton, Canada
                [s ]St Joseph's Healthcare, Hamilton, Canada
                [t ]The Research Institute of St Joe's, Hamilton, Canada
                [u ]Physiotherapy Department, Fiona Stanley Hospital, Perth, Australia
                [v ]NHS Leadership Academy, Leadership and Lifelong Learning, People Directorate, NHS England and Improvement, London, UK
                [w ]Department of Physiotherapy, St Vincent's Hospital, Sydney, Australia
                [x ]Faculty of Medicine, Nursing and Midwifery, Health Sciences & Physiotherapy, The University of Notre Dame Australia, Perth, Australia
                Author notes
                [∗ ] Correspondence: Peter Thomas, Department of Physiotherapy, Royal Brisbane and Women's Hospital, Australia.
                Article
                Publisher Item ID: S1836-9553(21)00139-9
                DOI: 10.1016/j.jphys.2021.12.012
                PMC ID: 8695547
                PubMed ID: 34953756
                SO-VID: 52af700a-46fd-4ff4-93e3-a48fda685cbb
                Copyright © © 2021 Australian Physiotherapy Association. Published by Elsevier B.V.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                Subject: Invited Topical Review

                Keywords: physical therapy,coronavirus,covid-19
                Data availability:
                Keywords: physical therapy, coronavirus, covid-19

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