By now, it’s no secret that COVID-19 has changed the world forever. Physical therapy, like the rest of the healthcare sector, is no exception. Patients are desperately seeking coronavirus treatment both before and after illness. Throughout the course of COVID, physical therapists have played an important role in reducing strain on the healthcare system by keeping their patients out of emergency rooms. They have also been assisting patients, who have had major surgeries delayed, lessen their pain and make it until they can have their previously approved procedures.
However, physical therapy’s part in fighting COVID won’t end with simply helping patients as usual. Physical therapists across the country are now seeing patients who have actually recovered from COVID and are engaging them in rehab as part of their coronavirus treatment. Coronavirus treatment is by no means simple, and contains layers of recovery that can last far longer than recovery from other illnesses. We’ve collected some feedback from expert physical therapists on the ongoing pandemic and how they can help patients get back to life after coronavirus.
What coronavirus treatment techniques have PTs implemented?
“Once patients recover from COVID symptoms, their journey is not over. They may still require coronavirus treatment in order to get back to normal after their initial recovery. A percentage of patients require hospitalization, meaning bed rest is necessary in order for them to recover. Although this is necessary, it can lead to complications of the musculoskeletal system including strength loss, atrophy and contracture.
These deficits can lead to difficulty standing from a seated position, walking and performing daily activity, as well as increases in pain. Physical therapy can help improve these deficits through a personalized exercise prescription. Illness and hospitalization also lead to decreased endurance and reduced lung capacity post recovery. Physical therapy can address this by using exercise to improve aerobic capacity while patients’ levels of exertion are being monitored. Physical therapy clinics creates a safe environment for patients to return to daily activity with improved strength and endurance via a supervised exercise program.”
– Lauren Stiles, PT, DPT, OCS
What are some of the biggest challenges post-COVID patients face during coronavirus treatment?
“Depending on the severity of the illness, patients will benefit from a variety of activity and exercise-based rehabilitation. Patients who have been in the ICU due to COVID may experience post-intensive care syndrome (PICS) which involves health problems from the ICU stay that may persist after the patient leaves the hospital. These problems can involve general body weakness, cognitive or brain dysfunction, and mental health conditions. ICU-acquired body weakness is muscle weakness that occurs in:
- 33% of all patients on ventilators
- 50% of all patients admitted with severe infection
- Up to 50% of patients who stay in the ICU for at least one week
The second edition of the Physical Activity Guidelines for Americans (PAGA), reports that approximately 80% of US adults and adolescents are insufficiently active. Many of these individuals have mobility issues or aches/pains preventing them from achieving these activity guidelines. As a result, many Americans are more likely to experience chronic diseases, including heart disease, diabetes, obesity, and depression. The good news is that regular physical activity can prevent and improve many of these conditions.”
– Kevin Wait, PT, DPT, OCS, SCS
According to the PAGA guidelines, the following physical activity is recommended in order to maintain a healthy lifestyle:
- Preschool-aged children (ages 3 through 5 years) should be physically active at least for three hours per day, if not more. Adult caregivers should encourage active play that includes a variety of activity types and limits sitting-around time, such as screen time.
- Children and adolescents (ages 6 through 17 years) need at least 60 minutes or more of activity a day. This includes activities to strengthen bones, build muscles, and get the heart beating faster.
- Adults should do at least 150 minutes of moderate-intensity aerobic activity a week, and at least 2 days for muscle-strengthening activities. Adding more time provides further benefits.
- Older adults (ages 65 and older) should do at least 150 minutes of aerobic activity a week and include muscle-strengthening activities 2 days a week. You should also add components, such as balance training as well. If you have limitations due to preexisting conditions, consult with a health care provider and be as physically active as your abilities allow.
How has COVID changed your approach to helping patients?
“Keeping patients and staff safe is our number one priority in the clinic. Physical therapists do this physically by maintaining a secure and controlled environment as well as limiting potential for falls or other accidents. Patients may be anxious about attending physical therapy in a communal space; it is our job to keep them, and everyone in the clinic, safe and healthy. Above-standard cleanliness must be performed as patients utilize the same equipment and space throughout the day. The care of the workspace and behaviors of patients and staff should be the driving forces of change.
The comfort level of the patient and necessity of certain therapeutic techniques will guide the approach to therapy. As a physical therapist, extra diligence must be given to hand hygiene, as manual therapy is essential on the majority of patients that come to the clinic. It may also help put our patient’s minds at ease to physically see us wash and sanitize our hands and equipment. For those patients who are still skeptical about returning, encouragement and creativity is needed for home exercise programs, prescription of frequency and duration of visits, and for general compliance.”
– Michael Orlowski, PT, DPT
How do you think COVID has changed healthcare?
“The healthcare landscape will be forever changed because of COVID. As Plato said, ‘necessity is the mother of invention,’ so in this case, societal disruption has forced the acceleration of change in healthcare. Physical therapists have been forced into adapting their practices to see fewer patients and adapt from the obvious ‘physical’ aspect of their job into a more distance-based model. This is not all negative as opportunity emerges to enhance the delivery of healthcare and physical therapy for many patients. David Rockefeller complemented Plato’s famous quote with ‘if necessity is the mother of invention, discontent is the father of progress.’
New delivery mediums have emerged. Therapists and doctors have been forced to become comfortable behind a computer screen and honed their listening abilities to truly hear patient’s concerns. The busy patient schedule has been replaced with fewer appointment slots and a greater focus on empathy and creativity to help people. Telehealth and ‘telerehab’ have become a common practice for many of us, and we are learning how effective this can be in treating many common conditions.
While there are certainly limitations with healthcare delivery via the internet, the future is likely a mix of both with greater emphasis on safety and appropriate distancing for higher-risk patients. Greeting patients with a handshake may be replaced with the ‘elbow bump,’ technology will be featured more regularly to decrease costs and improve safety. A new and improved ‘hybrid’ model of healthcare will likely exist, and we may all be better off for it.
The physical aspect of a physical therapist’s role will never be replaced, but things have and will continue to be different for our profession.”
– Kevin Wait, PT, DPT, OCS, SCS