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Nilsson BB, Bø E. Early physiotherapy management of patients with Covid-19 admitted to a university hospital in Norway (March 2020 to July 2021). PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e1998. [PMID: 36825303 DOI: 10.1002/pri.1998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/30/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
AIM The aim of this retrospective observational study was to describe the scope of physiotherapy, the population and the physiotherapy management of Covid-19 patients referred to physiotherapy at a university hospital in the period from March 2020 to July 2021. METHOD A descriptive observational study with access to data from a quality register, which contains clinical data of all patients admitted with Covid-19 to a university hospital in Norway. Data was obtained from electronic data sheets, where daily parameters for physiotherapy treatment were registered. RESULTS In total, 729 Covid-19 patients were admitted during this period. Of these, 507 (69.6%) received treatment by a physiotherapist (3510 sessions). The physiotherapy treatments were performed on intensive care units (ICU) (50%), intermediate care units (11%) and general medical units (39%), respectively. Patients were mainly treated during the day (98.5%) and 21% of the sessions were given on weekends or holidays. Within the 3510 sessions, 9459 interventions were performed in total (one to seven interventions per session). The most common intervention provided was positioning (35.4%). The most common interventions in medical units and intermediate care units were training with a positive expiratory pressure device (17.3% and 15.9% respectively), and techniques for reducing work of breathing (13% and 15% respectively). The most common intervention in the ICUs was passive mobilization (21.3%), mostly in combination with positioning, manual techniques and/or airway clearance. CONCLUSION This study provides characteristics of, and experiences with early physiotherapy, in sequentially hospitalized patients at a university hospital in Norway.
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Affiliation(s)
- Birgitta Blakstad Nilsson
- Section for Physiotherapy, Department of Clinical Services, Division of Medicine, Oslo University Hospital, Oslo, Norway
- Department of Rehabilitation Science and Health Technology, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Elisabeth Bø
- Section for Physiotherapy, Department of Clinical Services, Division of Medicine, Oslo University Hospital, Oslo, Norway
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Privitera E, Gambazza S, Rossi V, Santambrogio M, Binda F, Tarello D, Caiffa S, Turrin V, Casagrande C, Battaglini D, Panigada M, Fumagalli R, Pelosi P, Grasselli G. Association of ventilator-free days with respiratory physiotherapy in critically ill patients with Coronavirus Disease 2019 (COVID-19) during the first pandemic wave. A propensity score-weighted analysis. Front Med (Lausanne) 2022; 9:994900. [PMID: 36172535 PMCID: PMC9510617 DOI: 10.3389/fmed.2022.994900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background Respiratory physiotherapy is reported as safe and feasible in mechanically ventilated patients with severe Coronavirus Disease (COVID-19) admitted to Intensive Care Unit (ICU), but the short-term benefits remain unclear. Methods We performed a retrospective observational study in four ICUs in Northern Italy. All patients with COVID-19 admitted to ICU and under invasive mechanical ventilation (MV) between March 1st and May 30th, 2020, were enrolled into the study. Overlap weighting based on the propensity score was used to adjust for confounding in the comparison of patients who had or had not been treated by physiotherapists. The primary outcome was the number of days alive and ventilator-free (VFDs). The secondary outcomes were arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio (P/F) at ICU discharge, ICU length of stay, ICU and hospital mortality, and survival at 90 days. The trial protocol was registered on clinicaltrials.gov (NCT 05067907). Results A total of 317 patients were included in the analysis. The median VFDs was 18 days [interquartile range (IQR) 10; 24] in patients performing physiotherapy and 21 days (IQR 0; 26) in the group without physiotherapy [incidence rate ratio (IRR) 0.86, 95% confidence interval (CI): 0.78; 0.95]. The chance of 0 VFDs was lower for patients treated by physiotherapists compared to those who were not [odds ratio (OR) = 0.36, 95% CI: 0.18–0.71]. Survival at 90 days was 96.0% in the physiotherapy group and 70.6% in patients not performing physiotherapy [hazard ratio (HR) = 0.14, 95% CI: 0.03–0.71]. Number of VFDs was not associated with body mass index (BMI), sex, or P/F at ICU admission for individuals with at least 1 day off the ventilator. Conclusion In patients with COVID-19 admitted to ICU during the first pandemic wave and treated by physiotherapists, the number of days alive and free from MV was lower compared to patients who did not perform respiratory physiotherapy. Survival at 90 days in the physiotherapy group was greater compared to no physiotherapy. These findings may be the starting point for further investigation in this setting.
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Affiliation(s)
- Emilia Privitera
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Rossi
- Thoracic Surgery and Lung Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Santambrogio
- Internal Medicine Department, Respiratory Unit and Adult Cystic Fibrosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Martina Santambrogio
| | - Filippo Binda
- Healthcare Professions Department, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Tarello
- Respiratory Physiotherapy Equipe, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Salvatore Caiffa
- Intensive Care Respiratory Physiotherapy, Rehabilitation and Functional Education, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Valentina Turrin
- Rehabilitation Department, Santa Chiara Hospital, APSS di Trento, Trento, Italy
| | - Carolina Casagrande
- Rehabilitation Department, Santa Chiara Hospital, APSS di Trento, Trento, Italy
| | - Denise Battaglini
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Mauro Panigada
- Department of Anaesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Fumagalli
- Department of Anesthesia and Intensive Care Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | - Giacomo Grasselli
- Department of Anaesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Rossi V, Del Monaco C, Gambazza S, Santambrogio M, Binda F, Retucci M, Privitera E, Mantero M, Bottino N, Laquintana D, Blasi F. Time to active sitting position: One-year findings from a temporary COVID-19 intensive care unit. Respir Med 2022; 194:106773. [PMID: 35203010 PMCID: PMC8843323 DOI: 10.1016/j.rmed.2022.106773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/18/2022] [Accepted: 02/13/2022] [Indexed: 01/08/2023]
Abstract
Objective To investigate the association between time to active sitting position and clinical features in people with COVID-19 admitted to intensive care unit (ICU) and referred to physiotherapists. Method Prospective study conducted in the largest temporary ICU in Lombardy (Italy) between April 2020 and June 2021. All individuals with COVID-19 who received physiotherapy were included. Multivariable Cox proportional hazard model was fitted to explore the statistical association between active sitting position and characteristics of patients referred to physiotherapists, also accounting for the different multidisciplinary teams responsible for patients. Results 284 individuals over 478 (59.4%) had access to physiotherapy, which was performed for a median of 8 days, without difference between multidisciplinary teams (P = 0.446). The active sitting position was reached after a median of 18 (IQR: 10.0–32.0) days. Sex was the only characteristic associated with the time to active sitting position, with males showing a reduced hazard by a factor of 0.65 (95% CI: 0.48–0.87; P = 0.0042) compared to females. At ICU discharge, nearly 50% individuals increased Manchester Mobility Score by 3 points. During physiotherapy no major adverse event was recorded. Conclusion Individuals with COVID-19 take long time to reach active sitting position in ICU, with males requiring longer rehabilitation than females.
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