Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR)
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Respiratory physiotherapy in patients with COVID-19 infection in acute setting: a Position Paper of the Italian Association of Respiratory Physiotherapists (ARIR) On February 2020, Italy, especially the northern regions, was hit by an epidemic of the new SARS-Cov-2 coronavirus that spread from China between December 2019 and January 2020. The entire healthcare system had to respond promptly in a very short time to an exponential growth of the number of subjects affected by COVID-19 (Coronavirus disease 2019) with the need of semi-intensive and intensive care units.
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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 [15]
The section “Procedures NOT to be applied in the Acute Phase” says that diaphragmatic and pursed-lip breathing are not recommended for patients with COVID-19 during the acute phase because treatments must not add to the work of breathing. The paper therefore makes the contrary point for the acute setting it addresses; it does not establish that breathing exercises are unhelpful in other settings. (LLM, conf=0.85)
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Experimental — accuracy not yet measuredAt 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 [15]
The Introduction (page not provided) anticipates that guidance on acute COVID-19 physiotherapy will need updating as further evidence on treatment approaches becomes available, which supports the claim that evidence was limited at the time. The paper does not specifically assess evidence about respiratory rehabilitation’s effects on cardio-respiratory recovery. (LLM, conf=0.78)
Experimental — accuracy not yet measuredRespiratory 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 [15]
In the section on preventing physical disability (page unavailable), the Italian position paper recommends early mobilization once the patient's condition is clinically stable; its Conclusions describe physiotherapy for hospitalized patients with severe COVID-19. This supports considering mobilization during hospitalization when the patient is stable, but it does not expressly recommend respiratory rehabilitation as a whole under that condition. (LLM, conf=0.82)
Experimental — accuracy not yet measuredRespiratory 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 [15]
The paper’s “Procedures NOT to be applied in the Acute Phase” section discourages several respiratory physiotherapy techniques during acute COVID-19, while its “7th ADVICE” discusses mobilization as sedation is reduced. Neither section states that respiratory rehabilitation is recommended only for patients with moderate-to-severe respiratory symptoms. Searches for that severity threshold and for recommendations concerning mild cases found no such passage in our copy. (LLM, conf=0.76)
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“, physician, Physiotherapist, occupational therapist, and nurses) can increase positive outcomes [6, 15, 19].”
BackgroundMethodInfluential
- Authors
- Lazzeri, M., Lanza, A., Bellini, R., Bellofiore, A., Cecchetto, S., Colombo, A., D'Abrosca, F., Del Monaco, C., Gaudellio, G., Paneroni, M., Privitera, E., Retucci, M., Rossi, V., Santambrogio, M., Sommariva, M., & Frigerio, P.
- Affiliations
- Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
- Azienda Ospedaliera Universitaria Integrata Verona (IT)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- Istituti Clinici Scientifici Maugeri (IT)
- Corresponding author
- Lazzeri, Marta
- Lanza, Andrea
- Bellini, Raffaella
- Bellofiore, Angela
- Cecchetto, Simone
- Colombo, Alessia
- Gaudellio, Giuseppe
- Paneroni, Mara
- Privitera, Emilia
- Retucci, Mariangela
- Santambrogio, Martina
- Sommariva, Maurizio
- Frigerio, Pamela
- ORCID
- Venue
- Monaldi Archives for Chest Disease
- Publisher
- PAGEPress Publications
- Published
- 2020-03-26
- Volume
- 90
- Issue
- 1
- ISSN
- 1120-0391 (ISSN-L)
- 2532-5264
- 1122-0643
- OpenAlex
- W3013903592
- Cited by
- 295
- References
- 0
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 16 · 2023: 35 · 2022: 42 · 2021: 98 · 2020: 97
- FWCI
- 8.92
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- Locations
- Monaldi Archives for Chest Disease (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- INFM-OAR (INFN Catania) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- respiratory physiotherapy, COVID-19 pandemic, SARS-CoV-2, acute care, intensive care unit
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Hypoxia, Critical Care, Dyspnea, Humans, Italy, Pneumonia, Viral, Pronation, Respiration, Artificial, Respiratory Distress Syndrome, Respiratory Insufficiency, Respiratory Protective Devices, Respiratory Therapy, Infection Control, Infectious Disease Transmission, Patient-to-Professional, Coronavirus Infections, Physical Therapy Modalities, Pandemics, Noninvasive Ventilation
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