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E ec i eness o physical he apy p ac ice on COVID-19 pa ien s: A
sys ema ic e iew
Keziah Mae Vanezza R. Ca aluña*, Joanna T. Cab igas, Ma. T icia Jazmin V. Co ez,
Pauline Alexi G. Guinday, Kyle Anjela T isha P. He nandez, Angelica Kym R. Miole, Eunice Palicpic,
Ha y Canaba
Physical The apy Depa men , School o Heal h Science P o essions, S . Dominic College o Asia,
Bacoo , Ca i e, Philippines
*Co esponding au ho
Abs ac
This s udy aimed o show he impo ance and e ec s o physical he apy p ac ice on
pa ien s who a e diagnosed wi h COVID-19 disease, pa icula ly how physical he apis s
pe o m hei ea men sessions in he mos e ec i e way possible and how impo an hese
sessions a e o pa ien s wi h COVID-19 who need ehabili a ion. In his s udy, esea che s
ha e used quan i a i e sys ema ic e iew in analyzing he li e a u e p esen ed and ha e
acqui ed 313 e e ences om he da a check yield. The esea che s hen sc eened and
analyzed he i les and abs ac s and he ull ex s esul ing in a inal selec ion o 13
e e ences ha we e acqui ed using PRISMA and JBI e alua ion me hods. Based on he
a icles e iewed, physical he apy is e ec i e in pa ien s who a e diagnosed wi h COVID-
19. Physical he apis s play a signi ican pa du ing COVID-19 in p o iding espi a o y
suppo and ac i e mobili y o pa ien s in hospi als, wi h ea ly ehabili a ion o wi h
unde lying di icul ies ha can be ea ed. The e o e, physical he apis s had o go h ough
a g ea deal o adjus men s o comply wi h he new no mal due o he pandemic.
Keywo ds: Physical he apy p ac ice; E ec i eness; Impo ance; COVID-19 pa ien s;
Sys ema ic e iew.
To ci e his a icle:
Ca aluña, K. M. V. R., Cab igas, J. T., Co ez, M. T. J. V., Guinday, P. A. G., He nandez, K. A. T.
P., Miole, A. K. R., Palicpic, E., & Canaba, H. (2022). E ec i eness o physical he apy p ac ice on
COVID-19 pa ien s: A sys ema ic e iew. SDCA Jou nal o Physical The apy, 3, 32-45.
In oduc ion
Co ona i us Disease o mo e known as he SARS-CoV-2 i us is he in ec ious disease known as
COVID-19. I was o iginally de ec ed in Wuhan, a p o ince in China back in Decembe 2019. Back in
2020, he disease was ele a ed in o a pandemic by he i s qua e o he yea as i is impo an o be
con olled in i s ea lies s ages due o i s high dange o ansmission and p opaga ion. Wi h he a e ma h
o ansmission and p opaga ion o he disease, i has become a eason o he down all and o e whelm o
he global heal h sys em. The Wo ld Heal h O ganiza ion (WHO) has in o med he public ha i uses can
ansmi om he lips o nose o an a ec ed pe son in minu e quan i ies on he occu ence o he pe son
who is in ec ed wi h sneezes, coughs, speaks, sings, o e en jus by b ea hing. I can esul in pa ien s
de eloping espi a o y dis ess o ailu e causing some pa ien s o be se iously ill and equi e se e e medical
a en ion such as ge ing admi ed in o in ensi e ca e uni s o hospi als. Acco ding o Yuki e al. (2020),
COVID-19 disease is di ided in o i e ca ego ies: asymp oma ic, mild, mode a e, se e e, and c i ical. When
a pa ien has an asymp oma ic condi ion, he e a e no clinical symp oms o indica o s, and ches imaging is
no mal. Acu e uppe espi a o y in ec ions in mild cases can cause symp oms including e e , i edness,
myalgia, coughing up blood, so e h oa , unny nose, and sneezing. Addi ionally, diges i e issues like
nausea, omi ing, pain in he abdomen, and dia hea could de elop. Mode a e ins ances include pe sis en
e e , pe sis en cough, o pneumonia wi hou o e hypoxemia and ches compu e ized omog aphy (CT)
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indings o lesions. In se e e cases, pa ien s had hypoxemia wi h pneumonia and a SpO2 lowe han 92%.
The inal diagnosis o c i ically ill pa ien s wi h acu e espi a o y dis ess synd ome (ARDS) includes
encephalopa hy, myoca dial inju y, ca diac ailu e, coagula ion abno mali y, and acu e enal inju y. Mos
o he pa ien s who con ac ed he i us we e elde ly o had unde lying medical condi ions including
ca dio ascula disease, diabe es, ch onic lung disease, o cance , which make hem mo e p one o
con ac ing se ious in ec ions. Howe e , anyone who con ac s COVID-19 can become e y ill and die a
any age.
Acco ding o he Philippine Physical The apy Associa ion, physio he apis s se e indi iduals and
g oups o de elop, main ain and eco e maximum mo emen and unc ional ac i i y h oughou hei li es.
Physio he apis s o en ac as independen p ac i ione s and ac as he i s con ac p ac i ione o a pa ien
o clien who needs di ec con ac . As an allied heal h p o ession, physio he apis s and physical he apis s
a e well known o es o ing unc ional mobili y o a pe son. As s a ed by Li e al. (2020), in addi ion, ull-
ace masks and p ope hand hygiene we e also conside ed o be used du ing espi a o y physical he apy
in e en ions. The pu pose o physical he apy is aimed a minimizing spu um e en ion and espi a o y and
limb muscula powe , ai way pa ency, and ope a i e mobili y. Fel en-Ba en sz e al. (2020), indica ed ha
he physical he apis s’ managemen o COVID-19 hospi alized pa ien s includes igo ous mobiliza ion
and espi a o y suppo . B ea hing con ol, ho acic expansion exe cises, ai way clea ance me hods, and
espi a o y muscle s eng h aining all all unde he ca ego y o espi a o y suppo . Walking, ac i e limb
exe cises done wi h assis ance, ac i e ange o mo ion exe cises, and bed mobili y exe cises a e all
examples o ac i e mobiliza ion p ocedu es. Dean e al. (2020) also s a ed ha a comple e e alua ion is
necessa y o minimize long- e m unc ional epe cussions, enhance gas exchange, dec ease ai way
obs uc ion, p e en decondi ioning and signi ican sickness issues, and coun e ac he nega i e e ec s o
lying down and aking a nap. Body posi ioning and mobiliza ion is ecommended based on inspec ion. In
e e y aspec o COVID-19 ea men , physical he apis s ha e an unques ionable ole, since COVID-19
was a newly disco e ed illness, a he han concen a ing on speci ic symp oms and conce ns in speci ic
pa ien s. Wi h he p og ession o he pandemic, physical he apis s who a e known o ha e di ec con ac
wi h pa ien s ha e had ouble in handling pa ien s due o he possible isk o in ec ion. The e ha e been
changes o modi ica ions made o physio he apis s o p o ide he bes ca e ha hey can p o ide o hei
pa ien s despi e he su ge o he pandemic.
The objec i e o his s udy was o illus a e he signi icance and in luence o physical he apy
p ac ice on COVID-19 pa ien s. The e a e se e al ques ions ha he esea che s sough o answe
h oughou he cou se o he s udy. In his s udy, he esea che s would like o de e mine how
physio he apis s pe o m hei ea men sessions in he mos possible and sa es way and how impo an
hese sessions a e o pa ien s wi h COVID-19 who need ehabili a ion. Speci ically, esea che s we e able
o collec da a and conduc sys ema ic e iews demons a ing he impo ance and e ec i eness o
physio he apy p ac ices in pa ien s wi h COVID-19.
S a emen o he P oblem
This s udy aimed o de e mine he e icacy o physical he apy p ac ice on COVID-19 pa ien s. I
a emp ed o espond o he ollowing:
1. Wha is he impo ance o physical he apy p ac ice in pa ien s du ing COVID-19?
2. Wha is he e ec i eness o physical he apy ea men in pa ien s wi h COVID-19?
Resea ch Pa adigm
PRISMA (P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analyses) was used as
he s udy’s amewo k, as i is usually used o e iews ha analyze how di e en ea men s wo k, bu i
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can also be a good s a ing poin o w i ing sys ema ic e iews ha ha e o he goals besides ea men
e ec s. Sys ema ic e iews and me a-analyses in he ield o heal hca e a e becoming mo e impo an .
Clinicians ead hem o keep e en s in hei ield up- o-da e, and de elope s o clinical p ac ice
ecommenda ions o en use hem as a s a ing poin o w i ing new guidelines. Some unding g oups migh
ask o a sys ema ic e iew o show ha he e is a eason o do mo e esea ch, and some heal hca e jou nals
a e mo ing in his di ec ion. The alue o a sys ema ic e iew is de e mined, like he wo h o any o he
ype o s udy, by wha was done, wha was ound, and how clea ly he indings we e epo ed. Sys ema ic
e iews can a y, which makes i ha d o eade s o judge he s eng hs and weaknesses o hese s udied
opics. The PRISMA 2009 s a emen was e ised in 2017 by an in e na ional panel o b ing i up o da e
and ensu e ha i emains ele an . This was done by including new me hods and language used in
sys ema ic e iews o e he las en yea s.
Figu e 1. Concep ual F amewo k o he S udy
Based on he da a in igu e 1 which is he concep ual amewo k o he s udy, he esea che s ha e
used PRISMA o ex ac hei da a o ind jou nals o include in hei s udy. The esea che s ha e ound
313 a icles om base sea ching. They hen indi idually sc eened he a icles and educed he a icles o
311 a e duplica es had been emo ed. A e using he exclusion c i e ia, he esea che s ended up wi h
249 a icles. The esea che s hen indi idually sc eened he a icles hen ended up wi h 62 a icles a e
being sc eened wi h he abs ac . The esea che s hen ended up wi h 31 a icles a e he exclusion c i e ia
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hen sc eened he emaining a icles o ull ex assessmen . The esea che s hen ended up wi h 24 a icles
a e being e alua ed using di e en JBI assessmen ools which hen ended up emo ing 11 a icles a e
hei exclusion c i e ia which ended up wi h he esea che s ha ing 13 esul s included in he scoping
e iew.
Me hodology
Resea ch Design
To de e mine he e ec i eness o physical he apy on COVID-19 pa ien s and how physical
he apy came o be ele an du ing he pandemic, his esea ch s udy used a quan i a i e sys ema ic e iew
design. A sys ema ic e iew is a summa y o he medical li e a u e ha sea ches o , c i ically assesses, and
syn hesizes da a on a pa icula opic using de ined, epea able p ocesses. I accomplishes his by combining
he esul s o mul iple o iginal s udies ha a e ela ed o one ano he and by employing echniques ha
educe andom e o s and biases (Gopalak ishnan & Ganeshkuma , 2013). In a sys ema ic e iew, he
syn hesis phase o en in ol es a me a-analysis, whe e esul s om many di e en e iews a e b ough
oge he o o m a summa ized hypo hesis. This includes calcula ing he o e all e ec and assessing how
much his e ec a ies ac oss di e en s udies (Da is e al., 2019).
Sea ch p o ocols we e de eloped so ha he s udy e iew could con inue. To loca e jou nals and
s udies ha should be analyzed as pa o he e iew, da abase sea ches we e done. The da abases used o
he li e a u e sea ch we e Ox o d Academic, 2022 APTA Academy o Ca dio ascula and Pulmona y
Physical The apy, Else ie , MDPI, and PubMed Cen al because hey a e impo an o add essing he
esea ch ques ion and p o ide da a om ele an scien i ic, e hical, and echnical s udies. Conduc ing a
li e a u e sea ch is an essen ial i s s ep in doing eal esea ch. I helps wi h planning he s udy and o ming
a clea esea ch ques ion (G ewal e al., 2016). Since he e is a huge amoun o published da a, he abili y
o choose ele an a icles is a key skill. Sea ch e ms we e iden i ied using synonyms and keywo ds o ind
in o ma ion ac oss a ious da abases.
Table 1. Da abase Sea ch o Sys ema ic Re iew
Eligible
Da abases
Modi ied Keywo ds
Hi s
Yield A e
Ti les
Yield A e
Abs ac
Yield A e
Full A icles
PubMed Cen al
“Physical The apy” OR
“Physical The apy P ac ice” OR
“Physical The apy
Managemen ” OR “Physical
The apy Rehabili a ion” OR
“Physio he apy”
134,302
48
12
3
PubMed Cen al
“COVID-19 Pa ien s” OR
“COVID-19”
335,214
45
10
1
PubMed Cen al
“Physical The apy” OR
“Physical The apy P ac ice” OR
“Physical The apy
Managemen ” OR “Physical
The apy Rehabili a ion” OR
“Physio he apy” AND
“COVID-19 Pa ien s” OR
“COVID-19”
335,214
65
10
1
PubMed
“COVID-19 Pa ien s” OR
“COVID-19” OR
“Rehabili a ion” OR “Physical
The apy”
8,037
28
9
1
PubMed
“Physical The apy” OR
“Physical The apy P ac ice” OR
1,655
30
3
1
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“Physical The apy
Managemen ” OR “Physical
The apy Rehabili a ion” OR
“Physio he apy”
PubMed
(“Physical The apy” OR
“Physical The apy P ac ice” OR
“Physical The apy
Managemen ” OR “Physical
The apy Rehabili a ion” OR
“Physio he apy ”) AND
(“COVID-19 Pa ien s” OR
“COVID-19”)
4,543
44
9
1
Ox o d
Academic – PTJ
“Physical The apy” OR
“Physical The apy P ac ice” OR
“Physical The apy
Managemen ” OR “Physical
The apy Rehabili a ion” OR
“Physio he apy ”) AND
(“COVID-19 Pa ien s” OR
“COVID-19”
63
15
4
3
MDPI
(“Physical The apy” OR
“Physical The apy P ac ice” OR
“Physical The apy
Managemen ” OR “Physical
The apy Rehabili a ion” OR
“Physio he apy ”) AND
(“COVID-19 Pa ien s” OR
“COVID-19”)
1
1
1
1
Figu e 2. Da a sea ch om da abases
Resea ch Ques ion
PICO (Popula ion/Pa ien /P oblem, In e en ion, Compa ison, and Ou come) was u ilized by
esea che s o o mula e a esea ch ques ion. Wi h he PICO p esen ed in Table 2, he esea che s we e able
o o mula e a esea ch ques ion: “Is physical he apy impo an in ea ing pa ien s wi h COVID-19?”
Table 2. PICO F amewo k in Resea ch
P
COVID-19 Pa ien s
I
Physical The apy
C
No Applicable
O
E ec i eness o Physical The apy
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Eligibili y C i e ia
The esea che s ha e es ablished he ollowing inclusion and exclusion c i e ia o conduc mo e
e icien and accu a e s udy. To ensu e he alidi y o his li e a u e e alua ion, i is essen ial o pay a en ion
o he da a collec ion p ocess and he accu acy o he chosen esea ch. Fo he li e a u e e iew o be up- o-
da e and include he mos ecen indings, i is also essen ial o pay close a en ion o he a icles being
chosen and hei da es o publica ion.
Inclusion C i e ia
• COVID-19 pa ien s who we e in ec ed wi h any di e en a ian s o conce n
• COVID-19 pa ien s who unde wen any physical he apy ea men
• COVID-19 pa ien s wi h mild, mode a e, and se e e cases
• COVID-19 pa ien s wi h o wi hou como bidi ies
Exclusion C i e ia
• COVID-19 pa ien s who did no seek any physical he apy ea men
Resea ch Popula ion
The popula ion o his esea ch was aken om he compiled a icles ha he esea che s analyzed.
The popula ion ha was used we e COVID-19 pa ien s wi h and wi hou o he unde lying condi ions, ages
18-80 yea s old, aces om a ious coun ies wi h mild, mode a e, se e e, and c i ical cases.
Resea ch Ins umen
The ool u ilized in his s udy was based on collabo a i e a icles/jou nals compiled om a ious
esea ch and publica ion p ojec s o assess he signi icance and alue o physical he apy o COVID-19
pa ien s. The quali y o he s udies ha we e going o be examined was assessed using he Joanna B iggs
Ins i u e (JBI) C i ical App aisal Tools. I includes checklis s o quali a i e esea ch, sys ema ic e iews,
esea ch syn hesis, economic e alua ion, c oss-sec ional analysis, and ex and opinion. The inal s eps o
da a collec ion, con en e alua ion, and s o y accoun hus included a o al o 13 s udies.
This objec i e is o assess he e ec i eness o he esea ch me hodology employed and he deg ee
o success i has in ela ion o he iewpoin ha was examined in e ms o i s p esence, ac ions, and
in e p e a ion. The syn hesis and analysis we e acili a ed by he e alua ion’s indings as hey ela e o he
e ec i eness o each s udy (Joanna B iggs Ins i u e, 2017). Mo eo e , each s ep o he sea ch was
ho oughly i emized and documen ed ca e ully, in which duplica es we e emo ed, abs ac s we e analyzed,
and ull ex s o each s udy we e p obed in e e y single hough so ha i will i o he sys ema ic e iew
o he p esen s udy. Sco ing is commonly used in quali y assessmen checklis s. To make he JBI quali y
assessmen esul s easy o unde s and, sco ing was used. Pe cen ages we e gi en o allow o a clea
compa ison o he quali y o he a ious esea ch.
E en hough some s udies we e excluded because hei e idence quali y was conside ed low due
o unclea s udy designs o weak JBI c i e ia, hese we e no included in he inal lis o sou ces o e iew.
The included sys ema ic e iews had mode a e o high quali y (82-100%; mean 92%). All JBI quasi-
expe imen al s udies and quali a i e esea ch ecei ed a sco e o 100%, excep one s udy ha sco ed 59%
and was he e o e excluded om he sou ces. Howe e , he e ec i eness o s udy s a egies imp o ed he
le el o in-dep h comp ehension o he subjec .
On he o he hand, PRISMA was used in his esea ch. Al hough s udies we e mainly done and
w i en in di e en coun ies, i is no a ue ool o assessing he quali y o a sys ema ic e iew. Mos o
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he esea che s ocused on how COVID-19 pa ien s esponded o physical he apy. PRISMA is an app oach
o analyzing da a ga he ed h ough e iews and o he ypes o s udies ha a e e idence-based. I helps
au ho s in imp o ing me a-analysis and li e a u e e iew epo ing. The esea che s used he PRISMA o
ga he hei da a o choose a icles o be included in hei analysis. Th ough base sea ching, he esea che s
ha e loca ed 313 a icles. A e ca e ully e iewing each a icle, hey whi led he o al down o 311 a e
elimina ing duplica es. The esea che s e en ually p oduced 249 publica ions a e applying he exclusion
c i e ia. A e sc eening each publica ion manually using he abs ac , he esea che s had 62 a icles
emaining. A e applying he exclusion c i e ia and sc eening he emaining publica ions o ull ex
e alua ion, he esea che s we e le wi h 31 a icles. 24 publica ions we e ul ima ely p oduced by he
esea che s a e being examined u ilizing a ious JBI assessmen me hodologies, which subsequen ly
emo ed 11 pape s a e applying i s exclusion c i e ia, esul ing in 13 esul s o he esea che s being
included in he esea ch s udy.
Da a Ga he ing and P ocedu e
The esea che s independen ly e iewed he included publica ions om a ious da abases,
including PubMed Cen al, Else ie , MDPI, Ox o d Academic, and 2022 APTA Academy o
Ca dio ascula and Pulmona y Physical The apy. Based on he speci ied c i e ia, he publica ions used o
his s udy we e app op ia e.
A desc ip i e analy ical app oach was employed o ex ac quali a i e o p ocess-o ien ed
knowledge om each sample. Addi ionally, i was necessa y o compile he esul s and summa ize hem.
The quali y o he included esea ch is hen e alua ed explici ly and sys ema ically using he C i ical
App aisal Tools de eloped by he Joanna B iggs Ins i u e (JBI). Cla i y, accu acy, and e hical
conside a ions a e c ucial when i comes o da a disclosu e.
A o al o 313 e e ences we e ound as a esul o he da a check. 311 po en ial sou ces emained
a e duplica es we e elimina ed. The numbe o e e ences was educed o 31 a e he i les and abs ac s
we e i s sc u inized o ele ancy. Addi ionally, he whole ex was sc eened o p oduce 24 e e ences,
which we e hen analyzed, and inal 13 e e ences we e chosen. In he inal s ep, hese sou ces we e
examined and e alua ed using se e al JBI assessmen echniques. 13 sou ces in all we e used o suppo
his hesis du ing he analysis. The mos common easons o ejec ing pape s we e ha hey we e exac
duplica e copies o a icles al eady published in o he da abases, ha he opic was no ela ed o he s udy,
ha he w i ing lacked cla i y a he han being oo speci ic, o ha i had no hing o do wi h he p oblem
being s udied.
Resul s and Discussion
Impo ance o Physical The apy P ac ice in Pa ien s du ing COVID-19
Pa ien s who a e diagnosed wi h COVID-19 may expe ience long- e m epe cussions, including
a educ ion in hei unc ional capabili y and, as a esul , hei abili y o do hei job. Paz e al. (2021) did a
s udy in in es iga ing how COVID-19 pandemic a ec ed occupa ional heal h, wi h a ocus on he
impo ance o physical he apy in ehabili a ion. A comp ehensi e analysis o he a icle e ealed ou
hemes ha we e consis en wi h he esul s o his s udy: impac o COVID-19 on wo kplace heal h; use
o physio he apy in mild and mode a e cases ha do no equi e hospi aliza ion; use o physio he apy in
inpa ien s in ec ed wi h COVID-19; use o physio he apy in pos -in ensi e ca e uni s (ICU) and pos -
discha ge eco e y. COVID-19 can a ec many pa s o he body and lead o bo h sho - e m and long-
e m heal h p oblems, including physical and men al challenges. Physical he apis s need o be pa o he
e o o help pa ien s eco e hei physical abili ies and ge back o wo k as quickly, sa ely, and e ec i ely
as possible (Paz e al., 2021).
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The pandemic su p ised he heal hca e indus y, and i needed o adjus o he si ua ion
immedia ely. This equi ed immedia e changes in he sys ems and p o ocols o ca e o he in lux o pa ien s
seeking medical a en ion. Acco ding o Wasilewski e al. (2020), many COVID-19 pa ien s who eco e ed
su e om long e m symp oms ha a ec bo h physical and men al heal h. To eco e , physical he apy
is ecommended, as i is p o en o imp o e unc ional abili y. The apy can p o ide com o and suppo o
hose who ha e di icul y eco e ing om COVID-19. The apy can be pa o he in e en ion o many o
hese como bidi ies such as exe cises o obesi y, deep b ea hing exe cises and d ainage o espi a o y
disease, and o he ch onic pain. Due o he ci cums ances, many in e en ions mus be modi ied o ca e o
he pa ien ’s needs and abili y. Modi ica ion o he schedules and he equi ed p o ec ion a i e mus be
conside ed o con inue wi h he sessions.
COVID-19 is a highly con agious i us and di e en ehabili a ion se ings mus be included in
he modi ica ions such as modi ying he asks, oles, use o p o ec i e gea , and he scheduling o he
ehabili a ion eam; c ea ing he associa i e COVID eams ha made up o physicians, nu ses, espi a o y
physio he apis s (RTs), and physio he apis s (PTs); changes in scheduling; educing s a membe s o
add ess he sho age o p o ec i e equipmen (PPE); delega ing ask based o p o essional skills, pu ing
oge he an in e ne communica ion sys em o acili a e email and documen p in ing, and equi ing PPE
o pa ien s going h ough ehabili a ion. Physical he apis s play a c i ical ole in supplying ac i e suppo
o he espi a o y sys em mobiliza ion o COVID-19 pa ien s in hospi als. Physio he apy ca e is
indi idualized in e ms o equency, in ensi y, ype, and iming o in e en ion, especially in pa ien s wi h
se e e / se ious illness, pa ien s o e 70 yea s o age, obesi y, and o he complica ions. Pa ien s wi h
COVID-19 who a e hospi alized p esen a ange o symp oms, including muscle pain, e e , a igue, cough,
and b ea hing di icul ies. I is hough ha hospi alized pa ien s who a e elde ly o who ha e unde lying
medical condi ions a e mo e likely o ha e se e e symp oms and a highe isk o physical decondi ioning.
To p e en u he decondi ioning, pa ien s should be encou aged o engage in physical ac i i y h ough
ac i e mobiliza ion as much as possible while hey a e in he hospi al. Physical he apis s a e impo an in
ea ing pa ien s wi h COVID-19 and can o e indi iduals specialized exe cises and aining ha sui hei
needs and p e e ences. The ea men guidelines apply o bo h c i ically unwell people admi ed o he
in ensi e ca e uni and se iously ill pa ien s admi ed o he COVID wa d. Pa ien s wi h COVID-19 who
a e hospi alized ecei e ac i e mobiliza ion and espi a o y suppo om a physio he apis . Ai way
clea ance p ocedu es, ches dila ion, espi a o y s eng h aining, and espi a o y con ol a e all examples
o espi a o y assis ance. I is ad ised o engage in ac i i ies o daily li ing, mobili y aining, ixed bike,
p e-walking, and walking exe cises in addi ion o bed ange o mo ion, ac i e ange o mo ion, ac i e
assis i e limb exe cise, and ac i e ange o mo ion (Fel en-Ba en sz e al., 2020).
Physical he apis s o physio he apis s ac a signi ican ole on pa ien s ha a e diagnosed wi h
and wi hou co ona i us disease as hey p o ide physical ehabili a ion and espi a o y ehabili a ion.
Du ing he espi a o y ehabili a ion, physical he apis s mus wea a PPE sui and an addi ional ull- ace
mask o addi ional sa e y as espi a o y he apy echniques we e conside ed ae osol-gene a ing p ocedu es.
I was also s a ed by Thomas e al. (2020) ha physio he apis s and o he hospi al s a mus educa e he
pa ien s abou cough e ique e whe e pa ien s who a e able o mo e dependen ly mus use issue when
coughing and dispose o he issue p ope ly ollowed by p ope hand washing. Fo he pa ien s ha a e
unable o mo e independen ly, he s a should assis . Physical he apis s ough o also posi ion hemsel es
wo me e s away om he pa ien when coughing and mus a oid e-using espi a o y equipmen . When
ea ing pa ien s wi h espi a o y illness, he physical he apis s ocus on p e en ing spu um e en ion,
espi a o y limb exe cises o inc ease muscle s eng h, maximizing ai way pa ency, and unc ional mobili y.
Each session o physical he apy includes posi ioning, espi a o y managemen , and mo emen exe cises
and he e we e no eco ded ad e se e ec s associa ed wi h physical he apy in e en ions. Fo COVID-19
pa ien s, physical he apis s had a di e en ole in pulmona y ca e because hey ook s ong p e en a i e
measu es o educe he possibili y o spu um e en ion and he onse o espi a o y muscle weakness. Fo
pa ien s who do no ha e COVID-19, ea men s we e based on assessmen esul s, which a e physical
he apis managemen p ocesses o pa ien s wi h COVID-19 in in ensi e ca e uni s. The main aims we e
SDCA Jou nal o Physical The apy, Volume 3, June 2022
ISSN 2815-164X
40
o imp o e ai way openness, lung and limb s eng h, and mo emen abili y while a oiding spu um
e en ion.
Ra he han ocusing on speci ic symp oms o heal h issues seen in indi idual pa ien s, a one-
size- i s-all ea men plan was used o all pa ien s. The ollowing ea men s show di e en p o ocols in
ea ing pa ien s om se e e o c i ical condi ions. Be o e s a ing he in e en ion, he physical he apis
used p o ec i e gea be o e en e ing ICU ooms. Physical he apis s use PPEs whene e physical he apis
in e en ions a e ca ied ou . Du ing espi a o y physical he apy echniques ha we e belie ed o be
ae osol-gene a ing p ocedu es, a second ull- ace mask was used. Be o e and a e each pa ien ’s ea men ,
p ope hand washing was done.
The main in e en ion ha has been used in c i ically ill pa ien s wi h COVID-19 is o maximize
ai way pa ency and p e en spu um e en ion. In his in e en ion, pa ien s who could b ea he on hei own
we e made o s ay up igh o 20 minu es each day. Fo 20 minu es wice a day, hese pa ien s who needed
deep seda ion o who had poo consciousness we e posi ioned wi h hei heads ele a ed a 30 deg ees. All
pa ien s unde going mechanical en ila ion we e placed in he p one posi ion o 12 hou s each day up o
ex uba ion. E e y pa ien who could b ea he on hei own was gi en an oscilla o y posi i e expi a o y
p essu e de ice, like he Acapella Po ex om Smi hs Medical in Ash o d, Ken , UK, and was old o use
i o 10 minu es, h ee imes a day, o whene e hey el ha mucus was building up in hei lungs. All
pa ien s who could b ea he on hei own also ecei ed ins uc ion in ac i e cycle b ea hing echniques and
we e gi en a es ic ed inspi a o y muscle aining (IMT) de ice. They all pe o med a s anda dized IMT
p o ocol wi h ou se s o eigh b ea hs a a speci ic in ensi y wi h wo minu es o es , eigh imes pe day
a ei he a 30 o 50 pe cen MIP. The maximum inspi a o y p essu e (MIP) o each pa ien was calcula ed,
and he pe cen age o he expec ed alues was measu ed. The e o e, he aining in ensi y o he i s pa ien
assigned o physical he apy is 30% MIP, ollowed by 50% o he second, 30% o he hi d, and so on.
The physical he apis s and espi a o y he apis s adminis e ed a en ila o hype in la ion p o ocol o hose
pa ien s who we e being en ila ed mechanically. The en ila o hype in la ion p ocedu e in ol ed
deli e ing olume-con olled b ea hs a a low a e o 20 L/min, g adually inc easing he idal olume by
200 mL wi h each b ea h un il he maximum ai way p essu e eached 40 cm o H2O, p o iding six
consecu i e mechanical b ea hs, and epea ing hese h ee s eps o six cycles. Hype in la ion o he
en ila o was employed o main ain and boos lung in ol emen . The o he main in e en ion ha was
used was Neu omuscula Decondi ioning. Each o he 16 pa ien s ollowed a speci ic p o ocol o
mo emen , which included egula ly olling o e and shi ing on he bed, si ing up in bed, si ing by he
bed, si ing in a chai , s anding, and walking along a 7-me e walkway in he ICU. The ollowing mobili y
s age was only pe mi ed when each mobili y s age was inished (Li e al., 2021).
I is ob ious ha physical he apis s a e in ol ed in he COVID-19 pandemic. A physio he apis
should ou inely e alua e a pa ien ’s espi a o y symp oms and exe cise ole ance in an acu e ca e se ing.
T ea men o c i ically ill pa ien s should be s a ed as soon as possible o limi u he ou comes.
Respi a o y ea men , p one posi ioning, ea ly mobiliza ion, and pa ien educa ion we e among
in e en ions. Pa ien s equen ly exhibi ed ins abili y, wi h as symp om escala ion and an e a ic and
sluggish eco e y. Addi ionally, subs an ial weakness, pos -ex uba ion, weaning ailu e, anxie y, and
deli ium we e common in c i ically sick pa ien s. These symp oms we e o en uns able and equi ed egula
moni o ing du ing physio he apy o ensu e sa e deli e y. Physical he apy equi ed specialized and
pe sonalized ea men s a egies. Mos pa ien s ollowed he p oposed ea men s a egies, and hei lung
unc ion and physical s eng h ac ually imp o ed (Eggman e al., 2020).
Demeco e al. (2020) examined andomized ials, e e als, semi- andomized o p ospec i e
con olled clinical ials, epo s, guidelines, ield upda es, and le e s o he edi o using a signi ican
esea ch da abase. Pa ien s wi h mode a ely se e e COVID-19 diagnosis should be eleased as soon as
easible because o he challenging clinical ci cums ances and he apid sp ead o co ona i us. To enhance
hei quali y o li e, i is impo an o de elop ehabili a ion p og ams o pa ien s wi h mul iple heal h
condi ions, hose who li e alone, o hose in emo e a eas (Demeco e al., 2020).
