Physiotherapy practices when treating patients with COVID-19 during a pandemic: A survey study

How did COVID-19 pandemic impact on healthy behaviours among Polish professionally active physiotherapists aged 20-50?

BACKGROUND

Due to the introduction of a number of changes to the health care system and the work nature of medical staff, theCOVID-19 pandemic still pose a public health challenge. The objective of the study was to characterize the health behaviours of Polish professionally active physiotherapists during the COVID-19 pandemic.

METHODS

The study included 104 Polish licensed and professionally active physiotherapists in whom health behaviours were assessed using an original questionnaire contained, among others, questions from the Global Physical Activity Questionnaire (GPAQ), the Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS), available via social media platforms.

RESULTS

Among the physiotherapists, 34% worked directly with COVID-19 patients and 49% with those who had survived COVID-19. There were no statistically significant differences in most of the rates of physical activity undertaken by the physiotherapists surveyed (P > 0.05). Men were more likely to report taking up movement-related physical activity than women (P > 0.05). However, they spent more time sitting or lying down on a typical day (P > 0.05). The average time spent on the above-mentioned physical activities was also higher among the male participants than in the group of women (P > 0.05). There was an increase in the proportion of physiotherapists working over 40 h per week, from 29% before the pandemic to 38% during the pandemic. Statistically significant differences were observed for the products constituting the basison which of the diet of the examined physiotherapists was based (P < 0.05). The majority of the respondents reported no problems with falling asleep (p > 0.05). Stress related to the risk of contracting COVID-19, as well as concerns about the health of loved ones were more common and severe in the group of female subjects (P < 0.05).

CONCLUSIONS

During the COVID-19 pandemic, the health behaviours in some physiotherapists changed. Further studies are required to assess whether physiotherapists' health behaviours returned to baseline levels or slightly improved compared to the initial results. Also, it is necessary to introduce health-promoting initiatives that would focus on physiotherapists, support their positive health behaviours and provide special recommendations helping them to maintain health during a pandemic.

Knowledge, Attitude, and Practice of Physiotherapists in COVID-19 ICUs: A National Survey

Background

COVID-19 belongs to the beta-corona cluster that spreads enormously via aerosols. Physiotherapists must be knowledgeable about the symptoms, mode of transmission, risk mitigation strategies, and practice guidelines for COVID-19.

Objective

This study aimed to assess physiotherapists' knowledge of COVID-19 guidelines, their attitude toward this new evolving field, and their practice routines in India's COVID-19 ICUs.

Methods

It was a cross-sectional study. A total of 600 questionnaires were distributed through e-mail and WhatsApp to physiotherapists using Google Forms between February 2022 and January 2023. The questionnaires consisted of demographics and 23 questions in three sections about the knowledge, attitude, and practice of physiotherapists working in the COVID-19 ICU. Data analysis was carried out using Jamovi.

Results

A total of 136 responses were obtained from 18 states of India. Of 136 participants, 89 were female (65.4%) and 47 were male (34.6%). The highest level of qualification was BPT (n = 69 (50.7%)), followed by MPT (n = 62 (45.6%)) and Ph.D. (3 (3.7%)). The knowledge about COVID-19 guidelines is fair. Only 21.3% of the physiotherapists received training before being deployed in COVID-19 ICUs, and the CARP protocol was well known by only as few as 10.3%. The criteria advised for close monitoring of patients during treatment was aware by 29.4%. Most physiotherapists have a good attitude toward treating COVID-19 patients; 70.63% strongly agree that physiotherapy is vital in these patients despite the risk of self-exposure, and 64.7% agree that physiotherapy should be initiated during all phases of COVID-19. Physiotherapists follow good practices for COVID-19 patients in the ICU, which is as per the guideline recommendation.

Conclusion

Physiotherapists working in COVID-19 ICUs have a fair knowledge of the existing physiotherapy guidelines for COVID-19, and they exhibit good attitudes and practice patterns.

[Ventilatory management of SARS-CoV-2 acute respiratory failure]

COVID-19 pneumonia presents several particularities in its clinical presentation (cytokine storm, silent hypoxemia, thrombo-embolic risk) and may lead to a number of acute respiratory distress syndrome (ARDS) phenotypes. While the optimal oxygenation strategy in cases of hypoxemic acute respiratory failure (ARF) is still under debate, ventilatory management of COVID-19-related ARF has confirmed the efficacy of high-flow oxygen therapy and restored interest in other ventilatory approaches such as continuous positive airway pressure (CPAP) and noninvasive ventilation involving a helmet, which due to patient overflow are sometimes implemented outside of critical care units. However, further studies are still needed to determine which patients should be given which oxygenation technique, and under which conditions they require invasive mechanical ventilation, given that delayed initiation potentially burdens prognosis. During invasive mechanical ventilation, ventral decubitus and extracorporeal membrane oxygenation have become increasingly prevalent. While innovative therapies such as awake prone position or lung transplantation have likewise been developed, their indications, modalities and efficacy remain to be determined.

Chest physiotherapy techniques administered by certified specialists to hospitalized patients with COVID-19 in Brazil: A look towards future practice

BACKGROUND

Chest physiotherapy for hospitalized patients with COVID-19 has been poorly reported. Although recommendations were published to guide physiotherapists, practice might have differed depending on education and training.

OBJECTIVE

To analyze the differences in chest physiotherapy applied for hospitalized patients with COVID-19 between certified specialists and non-certified specialists.

METHODS

An online questionnaire survey was developed for physiotherapists involved in the management of hospitalized patients with COVID-19. The questionnaire inquired about professional information and characteristics of physiotherapy practice.

RESULTS

There were 485 respondents, yielding a completion rate of 76%. Of these, 61 were certified specialists and 424 non-certified specialists. The certified specialists were older, had more years of professional experience, were more qualified, and had better job conditions. For mechanically ventilated patients, the certified specialists used the ventilator hyperinflation maneuver more frequently (50.4% vs 35.1%, p = 0.005), and the hard/brief expiratory rib cage compression (ERCC) (26.9% vs 48.3%, p = 0.016), soft/long ERCC (25.2% vs 39.1%, p = 0.047), and manual chest compression-decompression (MCCD) maneuver (22.4% vs 35.6%, p = 0.001) less often. For spontaneously breathing patients, the certified specialists used the active cycle of breathing technique (30.8% vs 67.1%, p<0.001), autogenic drainage (7.7% vs 20.7%, p = 0.017), and MCCD maneuver (23.1% vs 41.4%, p = 0.018) less frequently.

CONCLUSIONS

Certified specialists with higher levels of expertise seem to prefer the use of chest physiotherapy techniques that are applied with the mechanical ventilator over manual techniques. Furthermore, they use techniques that could potentially increase the work of breathing less frequently, mitigating the risk of exacerbating respiratory conditions in patients with COVID-19.