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Cited by 105COVID-19 Clinical Research StudiesIntensive Care Unit Cognitive DisordersMedical Practices and Rehabilitation

Recommendations for Hospital-Based Physical Therapists Managing Patients With COVID-19

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Felten-Barentsz, Karin M, van Oorsouw, Roel, Klooster, Emily, Koenders, Niek, Driehuis, Femke, Hulzebos, Erik H J, van der Schaaf, Marike, Hoogeboom, Thomas J +1 more·2020·Physical Therapy
DOI 10.1093/ptj/pzaa114PMC PMC7337861
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Abstract

Objective: The COVID-19 pandemic is rapidly evolving and has led to increased numbers of hospitalizations worldwide. Hospitalized patients with COVID-19 experience a variety of symptoms, including fever, muscle pain, tiredness, cough, and difficulty breathing. Elderly people and those with underlying health conditions are considered to be more at risk of developing severe symptoms and have a higher risk of physical deconditioning during their hospital stay. Physical therapists have an important role in supporting hospitalized patients with COVID-19 but also need to be aware of challenges when treating these patients. In line with international initiatives, this article aims to provide guidance and detailed recommendations for hospital-based physical therapists managing patients hospitalized with COVID-19 through a national approach in the Netherlands. Methods: A pragmatic approach was used. A working group conducted a purposive scan of the literature and drafted initial recommendations based on the knowledge of symptoms in patients with COVID-19 and current practice for physical therapist management for patients hospitalized with lung disease and patients admitted to the intensive care unit. An expert group of hospital-based physical therapists in the Netherlands provided feedback on the recommendations, which were finalized when consensus was reached among the members of the working group. Results: The recommendations include safety recommendations, treatment recommendations, discharge recommendations, and staffing recommendations. Treatment recommendations address 2 phases of hospitalization: when patients are critically ill and admitted to the intensive care unit, and when patients are severely ill and admitted to the COVID ward. Physical therapist management for patients hospitalized with COVID-19 comprises elements of respiratory support and active mobilization. Respiratory support includes breathing control, thoracic expansion exercises, airway clearance techniques, and respiratory muscle strength training. Recommendations toward active mobilization include bed mobility activities, active range-of-motion exercises, active (assisted) limb exercises, activities-of-daily-living training, transfer training, cycle ergometer, pre-gait exercises, and ambulation.

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  • Respiratory rehabilitation was recommended only for patients with moderate to severe COVID-19-related respiratory symptoms.

    “The study included only the patients with moderate to severe COVID-19-related respiratory symptoms because respiratory rehabilitation was recommended only for these patients according to previous literature [15–18].”

    From Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19: a quasi-experimental study (2022) · cites this paper as [17]

    The Scope and Treatment sections focus respiratory-support recommendations on hospitalized patients who are severely or critically ill with COVID-19. They do not recommend respiratory rehabilitation for patients with moderate symptoms as a group or state that it is recommended only for patients with moderate-to-severe respiratory symptoms. Page numbers are unavailable in our copy. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • At the time of writing, there is limited evidence about the effects of respiratory rehabilitation in the acute stage of COVID-19 treatment and cardio-respiratory recovery in patients with COVID-19.

    “At the time of writing, there is limited evidence about the effects of respiratory rehabilitation in the acute stage of COVID-19 treatment and cardio-respiratory recovery in patients with COVID-19 [15–18].”

    From Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19: a quasi-experimental study (2022) · cites this paper as [17]

    The Pragmatic Methodology section (page unavailable) describes the evidence base for treating hospitalized patients with COVID-19 as rapidly evolving and says the recommendations draw partly on practice for other lung diseases and ICU patients. This supports the general point that COVID-specific evidence was limited at the time, but the paper does not specifically assess the evidence for respiratory rehabilitation’s effects during acute treatment or on cardiorespiratory recovery. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Respiratory rehabilitation should be considered when there are no signs of progressive deterioration and patients are hospitalised, as recommended by Chinese, the Netherlands, Italian, and UK rehabilitation professionals [6, 10, 15, 17, 33].

    “Respiratory rehabilitation should be considered when there are no signs of progressive deterioration and patients are hospitalised, as recommendations by Chinese, the Netherlands, Italian, and UK rehabilitation professionals [6, 10, 15, 17, 33].”

    From Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19: a quasi-experimental study (2022) · cites this paper as [17]

    The Treatment recommendations (Section 2: Patient Is Severely Ill and Admitted to the COVID Ward; page unavailable) recommend respiratory support for hospitalized patients with COVID-19, and the Abstract identifies the paper as Dutch guidance. The passages do not make an absence of progressive deterioration a condition for considering respiratory rehabilitation. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Both scientific and anecdotal reports have highlighted the importance of breathing exercises for maintaining respiratory function [15-18].

    “Both scientific and anecdotal reports have highlighted the importance of breathing exercises for maintaining respiratory function [15–18].”

    From Effects of short-term breathing exercises on respiratory recovery in patients with COVID-19: a quasi-experimental study (2022) · cites this paper as [17]

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Authors
Felten-Barentsz, K. M., van Oorsouw, R., Klooster, E., Koenders, N., Driehuis, F., Hulzebos, E. H. J., van der Schaaf, M., Hoogeboom, T. J., & van der Wees, P. J.
Affiliations
  • Department of Rehabilitation , Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein 21, Nijmegen 6500 HB, the Netherlands
  • Department of Rehabilitation , Radboud Institute for Health Sciences, Radboud University Medical Center
  • Deventer Ziekenhuis (NL)
  • Radboud University Medical Center (NL)
  • Koninklijk Nederlands Genootschap voor Fysiotherapie (NL)
  • University Medical Center Utrecht (NL)
  • Department of Rehabilitation , Amsterdam Movement Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands, and Faculty of Health, ACHIEVE-Centre of Applied Research, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
  • Department of Rehabilitation , Radboud Institute for Health Sciences, Radboud University Medical Center and IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center
ORCID
Venue
Physical Therapy
Publisher
Oxford University Press (OUP)
Published
2020-06-18
Volume
100
Issue
9
Pages
1444-1457
ISSN
  • 0031-9023 (ISSN-L)
  • 1538-6724
DOI
10.1093/ptj/pzaa114
PMC
PMC7337861
OpenAlex
W3036633599
Cited by
105
References
5
Citations by year
2026: 3 · 2025: 3 · 2024: 7 · 2023: 23 · 2022: 33 · 2021: 28 · 2020: 8
FWCI
3.02
Type
journal article
Language
en
Open access
Licence
Locations
  • Physical Therapy (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion, other-oa)
Funders
The Royal Dutch Society for Physical Therapy
Topics
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
Keywords
COVID-19 pandemic, hospitalized patients, deconditioning, intensive care unit, respiratory support, active mobilization, airway clearance, respiratory muscle strength training, range of motion exercises, activities of daily living, transfer of training, ambulation, hospital discharge
MeSH terms
Betacoronavirus, COVID-19, SARS-CoV-2, Aged, Aged, 80 and over, Humans, Netherlands, Physical Therapy Department, Hospital, Pneumonia, Viral, Coronavirus Infections, Patient-Centered Care, Physical Therapy Modalities, Pandemics, Physical Therapists

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