The government, the media and the general public are obviously very focused on Coronavirus (Covid 19) but the attention is all on how to manage the acute stages of the disease but what about afterwards, the rehabilitation phase?
As a Physiotherapist, I often work with patients who are de-conditioned and struggling with their mobility due to various reasons, some of this rehab work is to get people back to normal function after an acute illness. This is vital for people on an individual level and now more than ever this is vital for society as a whole due to the huge number of people who have been affected by the Covid 19 Coronavirus. It isn’t just as simple as getting discharged from hospital and that’s the end of that. We have seen clapping and elation for people being wheeled out of the hospital, which is great but nobody has thought, “hang on why are they in a wheelchair?”
In a study in Seattle in March 2020, they have reported that 25% of people hospitalised were ventilated. The reality is that if you are ventilated for a few days, a week or several weeks then you are going to need an immense amount of rehab to get back to normal life. The wasting of your muscles including those that power your rib cage and lungs will be heavily affected. Not too mention the damage to the lungs themselves. This will require a long progressive program of exercise rehabilitation to build up exercise tolerance, strength, flexibility, balance and cardiovascular fitness to get back to basic functional levels never mind if that person’s job is physically demanding!
How can Physiotherapy help Covid 19 Coronavirus patients?
Not everybody realises this but Physiotherapy is working with Covid 19 patients at every step from the very first point. I have worked as a respiratory physio in my early days and part of that work was to assist the clearance of a patients lungs so that they could breathe easier or to help the ventilator to be weaned etc. Now the secretions of Covid 19 patients are low so Physiotherapists are more focussed on non-invasive ventilation support and their focus is very much on getting people mobile and up as fast as possible due to the rapid deterioration of truly immobilised individuals (Moses 2020). This being said there will still be a big proportion of patients that will have underlying conditions such as COPD and these individuals will have more secretions to clear so Physio will still play a role in this according to Lazzeri et al (2020). Getting people mobile will always be the top priority of a Physio, I remember once being one of four physios assisting a still ventilated patient into a standing position! Our goal was to get them up and moving as soon as we possibly could. At the beginning just sitting was challenging never mind walking or stairs or going back to work.
Now the reality is going to be difficult because an already stretched NHS is going to have all this on their plate both in hospitals and in the community setting. The harsh reality is that this will be the overwhelm possibly more than the acute phase. Personally, I can’t see how everybody is going to be rehabilitated fully and thoroughly. I anticipate that in my private physio practice that for the next few years I will be seeing more rehabilitation work, doing more home visits than ever before to help to take up the slack that the NHS can’t fully support due to being so physically and financially stretched.
Even the Chartered Society of Physiotherapy (CSP) has expressed concerns and has even been pushing onto system leaders and policymakers to sort this problem out and they have even described this as ‘a marathon and not a sprint’ and they have even described the rehab needs as a ‘tsunami’!
This is what they have been pushing specifically:
Commit to the right to rehabilitation as a fundamental element of our health and care system.
Don’t leave patients behind because they are out of sight.
Where possible maintain community rehabilitation services during the pandemic to minimise the negative impact on patients without Covid-19 and to help patients with Covid-19 continue to recover after discharge.
Plan for the tsunami of rehabilitation needs as the country recovers from the pandemic.
Commit to providing the expanded high-quality, multi-condition community rehabilitation services we will need.
Recognise that physiotherapy is essential to treating Covid-19 now and in the long term, and commit to training and retaining the multi-disciplinary workforce we will need to deliver ongoing rehabilitation.
Ensure that physiotherapists delivering rehabilitation receive the right PPE, particularly in high-risk settings and working with highly vulnerable people.
What about the non-Covid 19 Coronavirus Physiotherapy needs?
There have been many Physiotherapy and rehabilitation needs that have been postponed, delayed by the powers that be or by the individuals need to social distance or self-isolate. These individuals needs haven’t gone away magically and in fact, may have been exacerbated by this pandemic. This alone is going to create a massive demand on the system too once this can re-commence. The system may not cope especially when you consider that this is added to the rehab of the Covid 19 patients! Again I am expecting this to be an area where my private physio clinics in Stoke-on-Trent may become extremely busy because of this. I have had many patients postpone and delay their post-op care or put off treatment, which is not ideal in the longer term but is understandable in the current situation. However, the CSP has strenuously recommended that current rehabilitation needs to be met for non-Covid 19 patients right now during this pandemic as delaying this will only cause longer and more severe long term issues for individuals and the system as a whole.
Face to face Physiotherapy?
This is why the guidance from the governing bodies is that Physiotherapy for non-Covid 19 is still vital but they have specified that patients can still access face to face Physiotherapy if they meet the following:
They are in hospital and require physiotherapy
They have a high suspicion of risk of serious deterioration from underlying pathology and you are unable to determine this remotely
They have urgent rehabilitation needs, which if not met, will require care from General Practice, secondary care or social care agencies. This is particularly important if they are themselves a carer for someone vulnerable.
They require rehabilitation to support their rapid discharge from secondary care.
Another way to access Physiotherapy is remotely and this is something that we have been offering here at Hawkes Physiotherapy. Check out our blog on this below:
This type of Physiotherapy is effective and is considered applicable for the following:
For clinicians who are self-isolating
To maintain social distancing
For patients with symptoms of or confirmed COVID-19 infection
For patients who are at high risk of COVID-19 infection
For patients who are worried about attending appointments or having visitors, or with heightened anxiety (video consultation may be more reassuring than a phone call)
Obviously, nobody fully knows yet the full extent of what the short-term never mind long-term consequences of Covid 19 will be but the NHS and various governing bodies are already anticipating major long term issues that need planning for now and even with this the ability of the whole system, both public and private sectors may be very, very busy. This being said Physiotherapists like ourselves are going to be a major cornerstone in the treatment of Covid-19 patients not just now but going forwards.
Anyway, hopefully, everything will work out well, fingers crossed!
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The content in this blog article is provided for general information purposes only and is not meant to replace a physiotherapy or medical consultation.