Authors (including presenting author) :
CHAO YLC, Yu TWD, Luk KYH, Leung KPA, Lee KWS, Chan CMA
Affiliation :
Physiotherapy Department, Queen Elizabeth Hospital
Introduction :
The COVID-19 pandemic is rapidly evolving and has led to increased numbers of hospitalizations worldwide. Hospitalized patients with COVID-19 experience a wide range of symptoms and discomfort such as fever, cough with or without sputum, dyspnea, tiredness, and physical deconditioning. In Hong Kong, apart from elderly and those with underlying health conditions are considered to be at higher risk of developing severe symptoms, middle-aged person was also greatly affected in the fourth wave outbreak for developing seriously or critically ill and severe complications. This lead to the healthcare system facing greater demand for intensive care and rehabilitation services. Physiotherapy play an important role in supporting hospitalized patients with COVID-19 to alleviate their symptoms and facilitate early hospital discharge.
Objectives :
To review the cases profile and physiotherapy management strategies for symptomatic COVID-19 patients during the in-patient hospitalized period.
Methodology :
A special team colleagues was formed to provide physiotherapy management in the acute phase for patients with confirmed COVID-19 in the Queen Elizabeth Hospital (QEH) on roster basis. All of them were experienced staff with at least 5 years of experiences and competency for managing critically ill cardiopulmonary patients. Regular discussion and sharing on cases management, review updated international guideline, infection control measures and physiotherapy management strategies were conducted among the team. The demographic profile,physiotherapy interventions, patient responses and discharged destination were analyzed.
Result & Outcome :
From 30 March to 31 December 2020, 174 COVID-19 confirmed cases (97 men, 77 women) were referred for in-patient acute physiotherapy management in the QEH. The mean age was 68.513.7 years old (range 32 to 100). Among these 174 cases, 46 (26.4%) of them required mechanical ventilation support in the intensive care unit (ICU). Physiotherapy interventions was broadly classified as respiratory or physical support. Telecare was also provided in 6 selected cases. Respiratory support included bronchial hygiene techniques, sputum mobilization and removal, breathing and chest expansion exercise and respiratory muscle strength training. Sixty-three (36.2%) of the patients required suctioning, a kind of aerosol generating procedures for sputum removal. Physical support included active / active-assisted / passive limbs mobilization exercises, bed mobility and transfers activities training, cycle ergometer, limbs strengthening exercise, stepping, ambulation training and fall prevention. Fatigue, breathlessness, and psychological distress were the most commonly reported symptoms. During physical training, it was learnt that COVID-19 patients were easily desaturation upon mobilization, especially for those post-ICU and on high-flow oxygen patients and therefore frequent resting with graded exercise was suggested to gradual build up their endurance and physical capacity. For discharge designation, 76 patients can directly discharge home of which 15 of them required further out-patient pulmonary rehabilitation training, 45 patients required download to extended hospitals for further rehabilitation, 11 patients were death and 42 patients were still having active physiotherapy management at QEH as at 31 Dec 20. Nil physiotherapist treated this group of confirmed cases get infected with the virus. The current suggested infection control measures were effective to combat against the virus. Acute physiotherapy management for patients hospitalized with COVID-19 comprises elements of respiratory and physical support. Interventions aimed to improve symptoms of dyspnea, mobilize and remove sputum, minimize complications and disability, preserve function, and improve health-related quality of life. Outpatient post-hospitalization pulmonary rehabilitation should be considered in selected hospitalized patients with COVID-19.
