Early Rehabilitation Interventions and Physical Therapy in Adults Who Were Critically Ill With COVID-19 Pneumonia: A Retrospective Observational Study.

OBJECTIVE: The primary objective of this observational study was to analyze the time to the first edge-of-bed (EOB) mobilization in adults who were critically ill with severe versus non-severe COVID-19 pneumonia. Secondary objectives included the description of early rehabilitation interventions and physical therapy delivery. METHODS: All adults with laboratory-confirmed COVID-19 requiring intensive care unit admission for ≥72 hours were included and divided according to their lowest PaO2/FiO2 ratio into severe (≤100 mmHg) or non-severe (>100 mmHg) COVID-19 pneumonia. Early rehabilitation interventions consisted of in-bed activities, EOB or out-of-bed mobilizations, standing, and walking. The Kaplan-Meier estimate and logistic regression were used to investigate the primary outcome time-to-EOB and factors associated with delayed mobilization. RESULTS: Among the 168 patients included in the study (mean age = 63 y [SD = 12 y]; Sequential Organ Failure Assessment = 11 [interquartile range = 9-14]), 77 (46%) were classified as non-severe, and 91 (54%) were classified as severe COVID-19 pneumonia. Median time-to-EOB was 3.9 days (95% CI = 2.3-5.5) with significant differences between subgroups (non-severe = 2.5 days [95% CI = 1.8-3.5]; severe = 7.2 days [95% CI = 5.7-8.8]). Extracorporeal membrane oxygenation use and high Sequential Organ Failure Assessment scores (adjusted effect = 13.7 days [95% CI = 10.1-17.4] and 0.3 days [95% CI = 0.1-0.6]) were significantly associated with delayed EOB mobilization. Physical therapy started within a median of 1.0 days (95% CI = 0.9-1.2) without subgroup differences. CONCLUSION: This study shows that early rehabilitation and physical therapy within the recommended 72 hours during the COVID-19 pandemic could be maintained regardless of disease severity. In this cohort, the median time-to-EOB was fewer than 4 days, with disease severity and advanced organ support significantly delaying the time-to-EOB. IMPACT: Early rehabilitation in the intensive care unit could be sustained in adults who are critically ill with COVID-19 pneumonia and can be implemented with existing protocols. Screening based on the PaO2/FiO2 ratio might reveal patients at risk and increased need for physical therapy.

Primary care physiotherapists' performance in the fight against COVID 19: an experience report / Atuação do Fisioterapeuta na saúde primária no enfrentamento da COVID 19: relato de experiência / Actuación del fisioterapeuta en la atención primaria de salud para el afrontamiento de la COVID 19: relato de experiencia

Objetivo: Relatar a experiência de residentes de fisioterapia em saúde coletiva no enfrentamento multidisciplinar e desenvolvimento de ações frente à coronavirus disease 2019 (COVID-19). Síntese dos dados: Trata-se de um relato de experiência a partir da vivência prática dos residentes, em decorrência da pandemia da COVID 19, em duas cidades, Datas e Presidente Kubitschek, no interior de Minas Gerais, Brasil. As atividades ocorreram de março a junho de 2020. As ações foram realizadas por meio de orientações, roda de conversa, atendimento por videochamadas e fôlderes. As propostas sintetizaram: Ações de prevenção à saúde; Atenção à saúde mental e física dos trabalhadores da saúde; Educação em saúde aos trabalhadores de outros setores das prefeituras; Monitoramento de pacientes crônicos; e Educação permanente dos agentes comunitários de saúde. As atividades colaboraram com a prática clínica dos residentes, permitindo a construção com a equipe de saúde de propostas para um enfrentamento seguro no manejo da COVID 19. Conclusão: As propostas elaboradas no início da pandemia permitiram realizar ações que auxiliaram a atuação da equipe de Saúde da Família no enfrentamento à COVID 19. A experiência dos residentes contribuiu para a construção dos saberes e da experiência de gestão no enfrentamento da pandemia, colaborando para a formação dos residentes.

Objective: To report on the experience of public health physiotherapy residents in the multidisciplinary fight and development of actions against the coronavirus disease 2019 (COVID-19). Data synthesis: This is an experience report on the practical work develop by the residents during the COVID-19 pandemic in two cities, Datas and Presidente Kubitschek, located in countryside of Minas Gerais, Brazil. The activities took place from March to June 2020. The activities consisted of guidelines, conversation circles, video calls, and flyers. The proposals summarized: Disease prevention actions; Health workers' mental and physical health care; Health Education for workers in other sectors of city halls; Monitoring of chronic patients; and Permanent education of community health workers. The activities contributed to the residents' clinical practice and allowed them to partner up with the health care team for the development of proposals for safely tackling and managing COVID-19. Conclusion: The proposals developed at the beginning of the pandemic allowed taking action to help the Family Health Team to tackle COVID-19. The residents' experience contributed to the development of knowledge and management experience in tackling the pandemic, thus contributing to the residents' training.

Objetivo: Relatar la experiencia de residentes de fisioterapia en salud colectiva para el afrontamiento multidisciplinar y el desarrollo de acciones contra el coronavirus disease 2019 (COVID-19). Síntesis de los datos: Se trata de un relato de experiencia a partir de la práctica de los residentes decurrente de la pandemia de la COVID 19, en dos ciudades, Datas y Presidente Kubitschek del interior de Minas Gerais, Brasil. Las actividades se dieron entre marzo y junio de 2020. Se realizaron las acciones a través de orientaciones, rueda de conversación, atención por video-llamadas y folletos. Las propuestas sintetizaron: Acciones de prevención a la salud; Atención a la salud mental y física de los trabajadores sanitarios; Educación en salud para los trabajadores de otros sectores de los ayuntamientos; Monitoreo de pacientes crónicos; y Educación permanente de los agentes comunitarios de salud. Las actividades colaboraron con la práctica clínica de los residentes permitiendo la construcción de propuestas para el afrontamiento seguro del manejo de la COVID-19 con el equipo de salud. Conclusión: Las propuestas elaboradas en el principio de la pandemia permitieron la realización de acciones que ayudaron la actuación del equipo de Salud de la Familia para el afrontamiento de la COVID 19. La experiencia de los residentes ha contribuido para la construcción de los saberes y de la experiencia de gestión para el afrontamiento de la pandemia contribuyendo para la formación de los residentes.

Physiotherapeutic evaluation of patients with post COVID-19 condition: current use of measuring instruments by physiotherapists working in Austria and South Tyrol.

BACKGROUND: The implementation of standardized assessments in physiotherapeutic practice strongly supports diagnostic and treatment plans. Previous studies reported insufficient usage of standardized assessments due to lack of time, lack of knowledge, lack of resources and other barriers. Physiotherapy in outpatient settings became essential for the rehabilitation of patients with post COVID-19 condition but it remains unknown to what extent assessments are implemented into the evaluation of these patients. In this study, we explored the current use and barriers regarding the implementation of physiotherapeutic assessments to evaluate patients with post COVID-19 condition. METHODS: A cross-sectional online survey was carried out among 180 physiotherapists working in outpatient settings in Austria and South Tyrol. RESULTS: The majority of physiotherapists (88%) indicated that standardized assessments are useful, though less than a fifth of participants actually implement assessments in practice. Among implementation barriers, "insufficient experience" (41.8%) and "lack of knowledge" (36.6%) were mentioned most often. Concerning specific post COVID-19 assessments, the evaluation of "physical and respiratory function", "quality of life" and "activities of daily living" were stated to be of particular relevance. CONCLUSIONS: Our study revealed a low implementation rate and identified the main barriers regarding the non-usage of standardized assessments for post COVID-19 patients. TRIAL REGISTRATION: The Private University for Health Sciences and Health Technology (UMIT TIROL), and the Research Committee for Scientific Ethical Questions granted approval for the survey (RCSEQ, Hall in Tirol, Austria, Number 2834).

Utilidad de la virtualidad en las prácticas profesionales de fisioterapia en el contexto de la pandemia COVID-19 (Usefulness of virtuality in physiotherapy professional practices in the context of the COVID – 19 pandemic)

Introduction: Vocational training in health faces great challenges since social distancing became one of the strategies controlling the COVID-19 pandemic. Physiotherapy education has a practical component that requires contact with patients and through which students acquire professional skills. This face-to-face learning modality has had to be replaced by new pedagogical strategies, such as attention mediated by information and communication technology (ICT), case-based teaching, clinical simulation and tele-rehabilitation, trying to maintain patient-student interaction and compliance with professional training. Method: Descriptive cross-sectional study, in 143 practice students of a physiotherapy program in the city of Cali - Colombia, which evaluates their perception after a professional training practice mediated by ICTs. Results: 82.5% of the students answered that, if it was possible to perform tele-rehabilitation during the virtual practices, considering it as useful in 36.4%. The most used virtual platforms were Google Meet and Zoom with 81.1%. More than half of the students (58%) agreed that synchronous and asynchronous virtual activities led to significant learning. Conclusion: Vocational training mediated by ICTs emerged in the face of the pandemic and reinforced this strategy as a learning tool for meeting professional training objectives and competencies, the quality is perceived as a viable strategy that implies a paradigm shift in traditional education within the training process. Alternate : Introducción: La formación profesional en salud enfrenta grandes desafíos desde que el distanciamiento social se volviera una de las estrategias para el control de la pandemia por COVID-19. La educación en fisioterapia tiene un componente práctico que requiere contacto con los pacientes y mediante el cual los estudiantes adquieren competencias profesionales. Esta modalidad presencial de aprendizaje ha tenido que ser reemplazada por nuevas estrategias pedagógicas, como la atención mediada por tecnologías de información y comunicación (TICs), la enseñanza basada en casos, la simulación clínica y la telerehabilitación, intentando mantener la interacción paciente – estudiante y el cumplimiento de la formación profesional. Método: Estudio descriptivo de corte transversal, en 143 estudiantes de práctica de un programa de fisioterapia de la ciudad de Cali – Colombia, que evalúa su percepción luego de realizar una práctica de formación profesional mediada por TICs. Resultados: El 82,5% de los estudiantes respondieron que, si fue posible realizar telerehabilitación durante las prácticas virtuales considerándola cómo útil en un 36,4%. Las plataformas virtuales más usadas fueron Google Meet y Zoom con 81,1%. Más de la mitad de los estudiantes 58%, estuvo de acuerdo en que las actividades virtuales sincrónicas y asincrónicas propiciaron el aprendizaje significativo. Conclusión: La formación profesional mediada por TICs surgió ante la pandemia y reforzó esta estrategia como una herramienta de aprendizaje para el cumplimiento de objetivos y competencias de formación profesional, la cual es percibida como una estrategia viable que implica un cambio de paradigma en la educación tradicional dentro del proceso formativo.Alternate :Introdução: A formação dos profissionais de saúde enfrenta grandes desafios, uma vez que o distanciamento social passou a ser uma das estratégias para o controle da pandemia COVID-19. O ensino da fisioterapia tem uma componente prática que requer contato com o paciente e por meio da qual o aluno adquire habilidades profissionais. Essa modalidade de aprendizagem presencial teve que ser substituída por novas estratégias pedagógicas, como o cuidado mediado por tecnologias de informação e comunicação (TICs), ensino baseado em casos, simulação clínica e tele-reabilitação, buscando manter a interação paciente-aluno. e cumprimento da formação profissional. Método: Estudo transversal descritivo com 143 alunos de um programa de fisi terapia na cidade de Cali - Colômbia, que avalia sua percepção após a realização de uma prática de formação profissional mediada por TICs. Resultados: 82,5% dos alunos responderam que, se era possível realizar a tele-reabilitação durante as práticas virtuais, considerou-a útil em 36,4%. As plataformas virtuais mais utilizadas foram Google Meet e Zoom com 81,1%. Mais da metade dos 58% dos alunos concordou que as atividades virtuais síncronas e assíncronas levaram a uma aprendizagem significativa. Conclusão: a formação profissional mediada pelas TIC surgiu face à pandemia e reforçou esta estratégia como ferramenta de aprendizagem para o cumprimento dos objetivos e competências da formação profissional, que é percebida como uma estratégia viável que implica uma mudança de paradigma na educação tradicional. processo de treinamento.

Workplace exercise in telework: implementation of distance postural health actions in times of pandemic.

Introduction: Telework, adopted by some companies as an alternative measure to ensure the continuity of services during the 2019 coronavirus disease pandemic, can have an impact on workers' health, contributing to the onset of work-related musculoskeletal disorders and/or repetitive strain injuries. In this context, companies were required to develop strategies to ensure the implementation of occupational health actions through different means. Objectives: To discuss our experience of implementing a remote workplace exercise program. Methods: The experience report was based on the development and implementation of a remote workplace exercise intervention project for the employees of a bank who are working from home. Results: The remote workplace exercise program proved to be feasible, providing benefits in terms of saving resources, extending the reach of actions and increasing the number of employees involved, improving adherence of workers to health promotion programs, and enhancing their awareness of postural habits beyond the occupational setting. Conclusions: Interventions in occupational health and safety by technological means, associated with telework, can be seen as a new perspective during and after the pandemic, especially in banks, where remote work has proven to be efficient.

Introdução: O regime de teletrabalho, adotado por algumas empresas como medida alternativa para continuidade dos serviços durante a pandemia causada pela doença do coronavírus 2019, pode gerar repercussões na saúde dos funcionários, contribuindo para o desencadeamento das doenças osteomusculares relacionadas ao trabalho e/ou lesões por esforços repetitivos. Nesse contexto, empresas precisaram criar estratégias para garantir a implantação de ações em saúde do trabalhador através de diferentes meios. Objetivos: Discutir a experiência de implementação de atividades de ginástica laboral remota. Métodos: O relato de experiência foi baseado na construção e implementação de um projeto de intervenção de ginástica laboral remota junto aos funcionários de uma instituição bancária que atuam em regime de teletrabalho. Resultados: A ginástica laboral remota se mostra viável, evidenciando economia de recursos, ampliação do alcance e quantidade de funcionários, melhor adesão dos trabalhadores a programas de promoção da saúde e conscientização sobre sua postura para além do âmbito ocupacional. Conclusões: As intervenções em saúde e segurança do trabalho por meios tecnológicos, associados ao teletrabalho, vêm se estabelecendo como uma nova perspectiva durante e após a pandemia, especialmente nas instituições bancárias, onde a jornada remota vem se revelando mais eficiente.

Post-COVID-19 Rehabilitation: Perception and Experience of Austrian Physiotherapists and Physiotherapy Students.

The rehabilitation needs of COVID-19 survivors are increasingly recognized, with a focus on combating respiratory and neuromuscular dysfunctions. The aim here was to explore the perception of Austrian physiotherapists and physiotherapy students on post-COVID-19 rehabilitation care and to identify barriers for the application of sufficient rehabilitation. We analysed current knowledge and practical skills in respiratory physiotherapy, performing a cross-sectional national survey among physiotherapists working in outpatient settings and physiotherapy students in their last academic year of bachelor-level education in Austria. Out of 255 survey participants, one-third already had inquiries to treat post-COVID-19 patients, and the majority of respondents expected a further increased inflow of patients with rehabilitation needs (64.2%). Only 11.2% of respondents reported feeling sufficiently informed about post-COVID-19 rehabilitation. A total of 68.2% of students and up to 48.1% of physiotherapists favoured a COVID-19-specific adaptation already in the basic academic education, and 74.1% of survey participants indicated interest in attending specific training. Concerning respiratory physiotherapy, our data showed discrepancies between the estimation of the importance of specific examination and treatment techniques and the level of current experience. There is a clear lack of experience in implementing effective device-based respiratory therapy. Our data indicate an urgent need to develop new education and training programs with a focus on the interdisciplinary rehabilitation of patients with post-COVID-19 syndrome.

Effects of a remotely supervised motor rehabilitation program for individuals with Rett syndrome at home.

PURPOSE: In this study, the effect of a remotely supervised, home-based, family-centered individualized rehabilitation program of motor activities for individuals with Rett syndrome (RTT) was evaluated. MATERIALS AND METHODS: Thirteen participants with classic genetically confirmed RTT followed by a three-month program of motor activities at home. A total of 47 rehabilitative goals were set. Goals achievement, motor function, and parental satisfaction were evaluated. Each program was carried out by the participant's parents and remotely supervised via Skype calls, twice by a therapist experienced in RTT rehabilitation. RESULTS: Thirty-seven (78.7%) rehabilitative goals were achieved or overachieved. Ten participants (76.9%) significantly increased their gross motor functional level with a medium size effect (0.604). Parental reports of the involved families suggest, on average, a high level of usefulness of the program (4.4/5), adherence to the program (4.4/5), and general satisfaction (4.5/5). CONCLUSIONS: Our findings strongly support the implementation of such programs for this population. As these programs were remotely supervised, they can be implemented when the children are away from referenced facilities for long durations, such as during long holidays or a Covid-19 type lockdown.Implications for rehabilitationA remote supervised motor activity program carried out by the primary caregiver supports motor functioning in RTT.Therapists should consider family members' motivation to carry out the activities and integrate them into the family's daily routine.The program should be flexible to adapt to any sudden change in medical and environmental conditions, functional ability, and family members' motivational levels.

Short-Term Effects of a Respiratory Telerehabilitation Program in Confined COVID-19 Patients in the Acute Phase: A Pilot Study.

The COVID-19 pandemic has caused distress for healthcare providers due to the respiratory problems it causes, among others. In this situation, rehabilitation of the respiratory system has been suggested and implemented in different COVID-19 patients. This study evaluated the feasibility and effectiveness of a novel program based on breathing exercises through telerehabilitation tools in COVID-19 patients with mild to moderate symptomatology in the acute stage. Forty subjects were randomized in an experimental group, based on pulmonary rehabilitation, and in a control group, of which the subjects did not perform physical activity. Thirty-eight subjects, with nineteen in each group, completed the one-week intervention. We performed measurements using the Six-Minute Walk Test, Multidimensional Dyspnoea-12, Thirty-Second Sit-To-Stand Test, and Borg Scale. Both groups were comparable at baseline. Significant differences were found for all of the outcome measures in favour of the experimental group. Ninety percent adherence was found in our program. A one-week telerehabilitation program based on respiratory exercises is effective, safe, and feasible in COVID-19 patients with mild to moderate symptomatology in the acute stage.

Therapeutic pulmonary telerehabilitation protocol for patients affected by COVID-19, confined to their homes: study protocol for a randomized controlled trial.

BACKGROUND: In December 2019, 27 cases of pneumonia, of unknown cause, were identified in the province of Hubei (China). The WHO declared the situation as a Public Health Emergency of International Concern, and it was finally declared a global pandemic on March 11, 2020. The Spanish Government obliges the entire population to remain confined to their homes, with the exception of essential basic services, to stop the spread of COVID-19. Home isolation implies a notable physical deconditioning. Telerehabilitation methods have reported positive experiences, and we propose to study in affected patients of COVID-19, due to the general house confinement of the entire Spanish population. METHODS: Patients will be recruited in the regions of Andalusia, Murcia, and Valencia (Spain). Patients will remain confined to their homes, and there, they will carry out their assigned exercise program, which will be controlled telematically. Evaluators will attend to carry out all measurements at the beginning, during, and end of the study, telematically controlled. The patients will be randomly divided into three groups, two of them will perform a home exercise program (breathing exercises or non-specific exercises for muscle toning) and the third group will perform sedentary activities, using mental activation techniques, and will act as a sham group. We will evaluate respiratory variables and other variables of the physical state through physical tests, effort, and perceived fatigue. The data will be statistically analyzed, and the hypotheses will be tested between the groups, using the SPSS software, v.24, considering a 95% confidence interval. DISCUSSION: We will analyze the results, in terms of the level of fatigue and perceived exertion, physical health, and maintenance of respiratory activity of two types of exercise programs, toning and respiratory, applied in patients affected by COVID-19 during the period of home confinement. We intend to investigate a field not previously studied, such as the repercussion of carrying out a toning and respiratory exercise program in these patients, in historical circumstances that no one had previously observed in Spain, since the general population has never been forced to remain confined in their homes, due to a pandemic infection, by a coronavirus (COVID-19). Observing the effects that these two home exercise programs could produce in patients infected with COVID-19, we will try to better analyze and understand the mechanisms that are associated with the worsening of breathing in this type of patient. TRIAL REGISTRATION: Brazilian Clinical Trial Registry RBR-6m69fc . Registered on March 31, 2020.