Physical therapy intervention for an individual with post-COVID symptoms: A case report

ABSTRACT

BACKGROUND AND PURPOSE: The major symptoms during COVID-19 are acute, but a significant portion of patients now increasingly have long term multisystem sequalae. However, most research is centered around care in the hospital. Research to further inform treatment of patients with post-COVID symptoms is vital. The purpose of this case report is to provide the physical therapist management for a patient with post-COVID symptoms in an outpatient setting. CASE DESCRIPTION A 50-yearold woman tested positive for SARS-CoV-2 but did not require hospitalization. Ten weeks post COVID, she participated in an outpatient physical therapist evaluation that revealed deficits in exercise capacity, global decrease in strength, impaired breathing pattern, poor pulmonary education, decreased endurance;and mild anxiety with activity. Patient demonstrated some emotional breakdown due to decreased strength and current condition. On initial evaluation, 6-munte walk test distance (6MWD) was 79.5 m (substantially less than age-predicted value), the UCSD Shortness of Breath Questionnaire (SOBQ) score was 72/120 and the Patient Health Questionnaire (PHQ-9) score was 6/27 (mild depression). Spirometry data revealed mild restrictive disease. Patient's goal was to partake in daily activities without shortness of breath and feeling fatigued to allow return to full-time job. The patient participated in biweekly, 60-min sessions (n = 20) and a HEP was provided. These sessions included aerobic training, strengthening exercises, diaphragmatic breathing techniques, and patient education. During the first three treatment sessions, the patient often complained of “fogginess” as she approached fatigue. Education on breathing and energy conservation techniques allowed to overcome these symptoms and for compliance with HEP. OUTCOMES: The patient's exercise capacity, physical function, muscle strength improved following the 20 sessions. At discharge, the 6-Minute walk distance improved to 335 m (324%). Scores on SOBQ improved beyond the MID to 34/120;and PHQ-9 to 1/27 (minimal depression). At discharge, patient could perform household tasks without fatigue, allowing her to eventually return to work safely. DISCUSSION: Following 20 sessions of outpatient physical therapy, our patient with post-COVID symptoms showed substantial improvements in exercise capacity, SOBQ and PHQ-9. This case report highlights the importance of addressing fatigue and anxiety related to physical symptoms in the plan of care for patients with post-COVID symptoms. Further research is needed to define the ideal interventions to manage this condition. While the treatment of patients post-COVID symptoms presents significant challenges, this report provides some insight in designing physical therapy interventions in the outpatient setting for this population.