ABSTRACT
OBJECTIVES: To evaluate short-term change in oxygenation and feasibility of physiotherapy-assisted prone or modified prone positioning in awake, ward-based patients with COVID-19. DESIGN: Retrospective observational cohort study. SETTING: General wards, single-centre tertiary hospital in Australia. PARTICIPANTS: Patients were included if ≥18 years, had COVID-19, required FiO2â¯≥â¯0.28 or oxygen flow rate ≥4â¯l/minute and consented to positioning. MAIN OUTCOME MEASURES: Feasibility measures included barriers to therapy, assistance required, and comfort. Short-term change in oxygenation (SpO2) and oxygen requirements before and 15â¯minutes after positioning. RESULTS: Thirteen patients, mean age 75 (SD 14) years; median Clinical Frailty Scale score 6 (IQR 4 to 7) participated in 32 sessions of prone or modified prone positioning from a total of 125 ward-based patients admitted with COVID-19 who received physiotherapy intervention. Nine of thirteen patients (69%) required physiotherapy assistance and modified positions were utilised in 8/13 (62%). SpO2 increased in 27/32 sessions, with a mean increase from 90% (SD 5) pre-positioning to 94% (SD 4) (mean difference 4%; 95%CI 3 to 5%) after 15â¯minutes. Oxygen requirement decreased in 14/32 sessions, with a mean pre-positioning requirement of 8â¯l/minute (SD 4) to 7â¯l/minute (SD 4) (mean difference 2â¯l/minute; 95%CI 1 to 3â¯l/minute) after 15â¯minutes. In three sessions oxygen desaturation and discomfort occurred but resolved immediately by returning supine. CONCLUSION: Physiotherapy-assisted prone or modified prone positioning may be a feasible option leading to short-term improvements in oxygenation in awake, ward-based patients with hypoxemia due to COVID-19. Further research exploring longerterm health outcomes and safety is required.