Covid19 - Physiotherapy - Management - Information - Guidance
Covid19 - Physiotherapy - Management - Information - Guidance
Covid19 - Physiotherapy - Management - Information - Guidance
PHYSIOTHERAPY
MANAGEMENT
24/3/2020
COVID 19
PHYSIOTHERAPY MANAGEMENT
INFORMATION AND GUIDANCE
The World Health Organisation has declared the coronavirus (COVID-19) a pandemic requiring
a global coordinated effort. Confirmed Case of COVID-19:
Patient Under Investigation (PUI) of COVID-19 Fever OR acute respiratory infection (sudden
onset of respiratory infection with at least one of: shortness of breath, cough or sore throat)
AND
Travel to or reside in affected countries1 in the 14 days before the onset of illness
OR Close contact in 14 days before illness onset with a confirmed case of COVID19
(Malaysian Ministry of Health, 2020)
As front-line health care service providers, physiotherapists play a crucial role in:
1. Infectious disease symptom recognition.
2. Patient education and direction to support appropriate and timely treatment
decisions.
3. Treating and advising patients who have experienced adverse outcomes, in both the
acute phase and in longer term recovery; and
4. Treating respiratory conditions due to the infection, and in maintaining function,
flexibility, strength, and mobility while mitigating secondary complications from
isolation conditions, such as muscle wasting, blood clots, weakness due to de-
conditioning, and negative effects on psychological well-being.
(Canadian Physiotherapy Association, 2020)
• Ensure that all clinical and non-clinical staff have a good understanding of infection
control principles.
• Know the signs of the coronavirus and place information posters in your clinic or
workplace. Share a message with your patients to remind them not to come into the
clinic if they experience symptoms - What are the symptoms of infection? COVID-19
(KKM, 2020).
• Advise patients to delay/cancel treatment if they have flu like symptoms or have
travelled to internationally known hot spots in recent weeks.
• Wash your hands often, before and after providing treatment. Encourage patients to
wash their hands often while in the clinic. Place additional signage in and around the
clinic to encourage regular handwashing - 6 Steps of Handwash Technique (KKM,
2020).
• Wear gloves and use alcohol-based hand sanitiser before and after wearing gloves
• If unwell, avoiding contact with others (including touching, kissing, hugging, and other
intimate contact); and coughing or sneezing into your elbow.
• Guidance on the use of medical masks: Advice on the Use of Masks in the Community,
During Home Care, and in Health Care Settings (WHO, 2020).
• If you are working in hospital, ongoing review of outpatient activity during Movement
Restricted Order 2020 (18 – 31 March 2020). Potential reduce number of ‘non-
essential’ outpatient in order to reduce footfall of patients and visitors into hospital
environment and potential transmission of virus. It will also release clinical staff to
support inpatient activity.
• If you are working in private physiotherapy centres, NGOs and house call, kindly
coordinate with and check on your patient/client if continuance of service is needed
and possible. As a healthcare professional, it is your duty to advise your patient/client
the best option/s given all the necessary considerations (telerehabilitation, home
exercise program).
• Management of Healthcare Worker (HCW) During Covid-19 Outbreak. Retrieved form:
http://www.moh.gov.my/index.php/pages/view/2019-ncov-wuhan-guidelines
• COVID-19: Management Guidelines for Workplaces. Retrieved form:
http://www.moh.gov.my/index.php/pages/view/2019-ncov-wuhan-guidelines
• Personal Protective Equipment (PPE) is compulsory where contact occurs with
confirmed case of COVID-19 patient.
Screening:
• Wear a face mask all the time.
• Ask your patient/client if he/she has any flu-like symptoms, has been exposed to
someone who has been diagnosed or suspected of COVID-19, or if he/she has any
recent travel on COVID-19 affected areas
Many patients presenting with COVID 19 will have no specific airway clearance needs. It is
important that staff contact is kept to a minimum with positive patients to help reduce the
risk of transmission (follow usual on call policies and criteria) COVID 19 patients (to date) who
require hospitalisation are presenting with pneumonia features and bilateral patchy shadows
or ground glass opacity in the lungs.
There have not been reports that COVID 19 positive patients have high secretion loads
requiring intensive respiratory physiotherapy/airway clearance. This may change as things
evolve and for that reason all presenting patients should be discussed with Consultant
Respiratory Clinicians/Critical Care Consultants before any mechanical devices are used with
patients and hospital/centre guidance on this followed. It is important to note some
therapeutic interventions will be contraindicated for COVID 19 positive patients.
There may be patients with existing respiratory conditions who require personalised
physiotherapy treatments which may include mechanical airway clearance or oscillating
devices. In this scenario it is important that the risk and benefit of continuing with the regime
is discussed with Consultant Respiratory Clinicians/Critical Care Consultants.
It may be decided that airway clearance regimes are continued in this scenario ensuring
COVID 19 suspected/positive patients are managed in isolation and full PPE and
decontamination advice.
We are now in the late containment stage of the COVID 19 government action plan. This
requires all hospital/centre to take all active measures to slow the spread of the virus and
prepare for potential escalation. This includes plans to meet the needs of an increasing
number of patients requiring acute care. This will involve individual teams, departments and
professions to prepare their workforce. The context of the planning is in relation to both
qualified physiotherapists and support workers except for respiratory specific interventions
and out of hours working
Fit mask testing is an essential part of pandemic planning to ensure the safety of staff treating
suspected and positive COVID 19 patients when carrying out high risk procedures. It is advised
all staff should have had a recent fit mask test performed and be confident in the application
of both the FFP3 (or equivalent) mask and Personal Protection Equipment (PPE) when working
in high risk clinical areas including critical care.
As always, please ensure good practice with hand hygiene before and after patient contact,
and before entering and exiting any clinical area. When treating a COVID 19 positive patient
you must be extra vigilant as this is a primary source of transmission.
Planning
Practicalities
PHYSIOTHERAPY WORKFORCE
• Respiratory weekend working will continue as usual and additional staff will be offered
shifts as clinical activity increases. This will be monitored carefully however to ensure
staff have appropriate rest and to prevent burnout
This document will be updated and amended with emerging advice; evidence and opinion so
please bear this in mind. This is not designed to be guidance for all, and it may not be
appropriate for your hospital/centres. Local discussions and decisions should be made in your
own hospital/centres.
ACKNOWLEDGEMENT
COVID 19: Respiratory Physiotherapy Management Information and Guidance. Adapted form:
Rachael Moses, Consultant Respiratory Physiotherapist, Claire Granato, Professional Lead for
Physiotherapy, Sarah Cullen Nursing, Midwifery and Allied Health Professionals Director
Lancashire Teaching Hospitals. Version 1 15th March 2020
REFERENCES
Canada Physiotherapy Association. (2020) CPA Update: Advocacy Statement - The Role of
Physiotherapy in Keeping Canadians Safe During the COVID-19 Pandemic. Retrieved from:
https://physiotherapy.ca/cpa-update-advocacy-statement-role-physiotherapy-keeping-
canadians-safe-during-covid-19-pandemic
Guidance on the use of medical masks: Advice on the Use of Masks in the Community,
During Home Care, and in Health Care Settings Retrieved from:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-
guidance/infection-prevention-and-control.
Malaysian Ministry of Health (2020). What are the symptoms of infection? COVID-19 (KKM,
2020). Retrieved form: http://www.moh.gov.my/index.php/pages/view/2019-ncov-wuhan-
infografik
World Confederation Physical Therapy. (2020) Information and resources about COVID-19
Retrieved from: https://www.wcpt.org/news/Novel-Coronavirus-2019-nCoV