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Table of Contents
REVIEW ARTICLE
Year : 2021  |  Volume : 3  |  Issue : 2  |  Page : 72-75

Global effect of novel coronavirus on physiotherapy profession: A scoping review


Department of Rehabilitation Sciences, Jamia Hamdard University, New Delhi, India

Date of Submission05-Jul-2021
Date of Decision15-Dec-2021
Date of Acceptance28-Dec-2021
Date of Web Publication12-Jan-2022

Correspondence Address:
Dr. Deepika Singla
Jamia Hamdard University, Hamdard Nagar, New Delhi - 110 062
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijptr.ijptr_44_21

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  Abstract 


IndiaPhysiotherapy (PT) is a well-established profession throughout the world. The COVID-19 pandemic has transformed several elements of PT and has had a personal and professional influence on physiotherapists (PTs). This article aims to discuss the impact of novel coronavirus (nCov) on physical therapists and to emphasize the relevance of physiotherapy. Health-care providers were severely impacted in every aspect, including physically, psychologically, socially, and financially. Using keywords such as coronavirus, physiotherapy, exercise, and rehabilitation, a search was conducted on PubMed, Google Scholar, and Cochrane database. Forty-eight reviews were identified, out of which 22 were included in the study. PTs have a crucial role in the physical recovery of patients with nCov during the pandemic, which necessitates a multidisciplinary approach by the rehabilitation team. Telephysiotherapy is a new scope of practice for physical therapists to provide health-care services to patients. Exercises improve immune response and mental health while minimizing the consequences of viral infection. As a result, physical therapists assist in the treatment of COVID-19 patients and provide support to the health-care system.

Keywords: Healthcare, Multidisciplinary, Pandemic, Physical therapy


How to cite this article:
Kaushik H, Gupta S, Singla D. Global effect of novel coronavirus on physiotherapy profession: A scoping review. Indian J Phys Ther Res 2021;3:72-5

How to cite this URL:
Kaushik H, Gupta S, Singla D. Global effect of novel coronavirus on physiotherapy profession: A scoping review. Indian J Phys Ther Res [serial online] 2021 [cited 2022 Jan 25];3:72-5. Available from: https://www.ijptr.org/text.asp?2021/3/2/72/335666




  Introduction Top


On February 11, 2020, the World Health Organization (WHO) labeled the novel coronavirus (nCov) as COVID-19, which presented with pneumonia of unknown etiology that was first seen in Wuhan City, Hubei, China, on January 31, 2019.[1],[2] It was subsequently declared as a universal health crisis on January 30, 2020, and global pandemic on March 11, 2020.[3] This contagious condition has its mode of transmission through respiratory secretions, i.e., cough droplets, nasal droplets/secretions, and contact on contaminated surfaces followed by touching the mouth, eyes, and nose.[4] The airborne molecules remain suspended for up to 180 min in air and sustain for over 960 min on surface materials.[4] The disease process varies in individuals with 80% of COVID-positive patients being asymptomatic or having minimal affections, 15% of patients demonstrating severe affections requiring O2, and 5% of patients demonstrating critical features requiring ventilator support.[5] Common presentations noted globally across all ethnicities are influenza, pyrexia, dyspnea, lethargy, expectoration, and cough.[6]

As of 2021, on December 15, the WHO reported more than 270 million confirmed cases of COVID-19, including 5,310,502 deaths.[7] Data from China's largest case series showed that the majority of survivors (87%) were aged 30 and 79 years, 1% were 9 years of age or younger, 1% were between 10 and 19 years of age, and 3% of survivors were aged 80 years and older.[8] Geriatric patients (aged >65 years) in the United States constitute 31% of all the cases, 45% of inpatient departments, 53% of admissions in intensive care units (ICUs), and 80% of all deaths.[9] In India, first case was detected in Kerala on January 30, 2020, and from March 22, 2020, 360 cases of nCov were reported, including 7 deaths across the 23 states of India.[10],[11] Indian government announced the Janta curfew on March 22, 2020, and from March 24, 2020, the government ordered lockdown for 21 days and extended for 3 months in response to control this pandemic situation and resulted in the world's largest lockdown.[12] Following that, some nations had no alternatives other than lockdown to prevent widespread disease and improve hospital preparedness for the pandemic, such as India.[11],[13] However, these steps have a significant adverse effect on the normal, personal, social, and professional life of the citizens.[13]

COVID-19 pandemic has changed many aspects of health-care professionals including physiotherapists and has impacted the lives of physiotherapists (PTs) professionally as well as personally. None of the previous studies have shown the effect of COVID-19 on physiotherapy professionals and scope for physiotherapy. To the best of our knowledge, this is the first narrative review that aims to describe the effect of nCov on PT professionals and the importance of physiotherapy.


  Methods Top


Articles published between March 2020 and September 2021, were searched using keywords coronavirus, physiotherapy, exercise, and rehabilitation from PubMed, Google Scholar and Cochrane databases. Forty-eight reviews were identified, out of which 22 were included in the study. The study included clinical trials, reports, editorials, letters to editor, review articles, online guidelines or recommendations, and field updates or summaries written in English language.


  Impact of COVID-19 on Physiotherapists Top


The unexpected tempo at which nCov is spreading has changed the personal and professional lives of the population globally, with health-care professionals taking a part of its affections. Health-care professionals live with the fear of getting infected and passing the infection to others and their family members. It also affects their ability to make difficult decisions due to intense conditions taking a toll on mental health. It may also cause economical stress on PTs, especially for private practitioners. These factors may increase stress, anxiety, and depression and decline their quality of life.[14],[15]

nCov has changed many aspects of rehabilitation due to lockdown and social distancing by disrupting the provision of clinical rehabilitation services. COVID-19 outbreak prevents visits of the patients to physical therapists, leading to cancellation of appointments, alteration in working hours, unemployment, and pay reduction. Because PT interventions are based on manual or hands-on techniques, the affordability of personal protection equipment kits for PTs has increased the cost of PT services in the hospital and clinical setting.


  COVID-19 and Physiotherapy Management Top


Identification of the best treatment for COVID-19 is an ongoing process due to which clinical trial methods and assessments are being modified. The rehabilitation team of COVID-19 requires a multidisciplinary approach, and PT professionals play a crucial part in the team. Rehabilitation of nCov is focused on advising exercise programs and educating patients about the self-management strategies, such as breathing exercises, swallowing techniques, cognition and stress management techniques, use of assistive devices, and education to the caregivers and family members.[16]

On Friday, March 20, 2020, a group of international specialists in the cardiorespiratory PT team came together to rapidly prepare uniform global guidelines for acute PT care for COVID-19 survivors. However, suggestions in the management techniques of non-COVID patients were not considered.

Cardiorespiratory PT is focused on treating respiratory conditions which may be either acute or chronic and the main focus is to enhance the activity, health condition, and somatic recuperation. Physical rehabilitation programs may be useful in enhancing respiratory functions in COVID-19 cases. PT professionals who work in the ICUs may use airway clearance techniques for patients who are on ventilators, thereby assisting in weaning off the ventilators. For patients with critical respiratory failure, positioning is very beneficial because of the advantage of optimizing oxygenation in prone position.[17],[18]

Patients with nCov who are admitted to ICU might require sedation, prolonged protective lung ventilation, and the use of neuromuscular blocking agents, which may increase the risk of ICU-acquired weakness (ICU-AW).[19],[20] It is important to manage the severity of ICU-AW that may occur due to acute respiratory distress syndrome; exercises help in reducing the ongoing disability of compromised oxygen levels in hypoxemic patients of the ICU and also facilitate the functional recovery of nCov patients.[20],[21] Hence, PT professionals play an essential role in improving respiratory functions, early mobilization of the patients, and decreasing the ICU-AW of the COVID 19 survivors admitted in the hospitals.


  Telephysiotherapy Top


In outpatient departments (OPDs) and the private sectors/clinics, PT treatment can be provided through telerehabilitation programs by working within the new confines of infection management, by rethinking the new standard recommendation for the examination and treatment of patients with nCov. Telerehabilitation may prove a feasible alternative to continue the wide range of services for OPD patients.[14] Patients who can be treated by PTs in group therapy can be remotely treated using tele-PT. Many types of research already exist on PT telerehabilitation programs such as for stroke patients, chronic respiratory disease, musculoskeletal conditions, cognitive problems, and dementia.[22],[23],[24],[25]

Researchers suggest that living in isolation has resulted in different psychological problems, sleep disorders, mental health problems, and physical activity (PA) restriction during the COVID-19 pandemic. In old age, mild cognitive impairment and dementia also increase the load on family and caregivers. Telerehabilitation programs for cognitive impairment and dementia patients have proved to be helpful in the present pandemic and also reduced the caregiver's burden of patient transfer for treatment sessions to the OPDs. Studies also conclude that cognitive stimulation exercises through telerehabilitation improve the mental health and physical fitness of the patients during exceptional circumstances, such as the current nCov outbreak. A telerehabilitation program was introduced to teach exercise protocol to COVID-19 survivors in the quarantine period. Individualized guided 20 min exercise sessions were given and in which patients were advised to wear pulse oximeters while exercising. These types of telerehabilitation technologies are useful and feasible for survivors in hospital settings and communities.[26],[27]


  Benefits of Exercise During COVID Times Top


Exercise has positive effects on normal body function and immune responses. A single bout of a cardiorespiratory exercise instantly mobilizes billions of immune cells, particularly those capable of fighting the viruses.[28] Exercise also helps release various proteins in the body that can help improve and maintain the immune system.[28] Exercise is also necessary to maintain muscle mass via activation of protein synthesis of muscles.[29] Physical inactivity during a quarantine period of 14 days may lead to muscle atrophy, particularly in the geriatric population due to lack of muscular contractile activities.[30] Exercise is particularly effective in geriatric population who are generally more prone to infection.[28] There is also an impact on the brain functions, leading to mental illness, depression, dementia causing disruptions in the learning skills, memory, and emotions, whereas regular exercising enhances the neuroprotection mechanism, neurogenesis process, immune response, release of endorphins, neurotrophic factors, good learning skills, and memory and increases the antioxidant defense and anti-inflammatory response.[29]

As the nCov usually affects the lungs and respiratory tract, in severe cases, it leads to systemic failure of the human body.[29] Mortality and morbidity are common in people with comorbidities or pre-existing pathological conditions.[29] PA and its outcome lead to a positive effect on the cardiorespiratory system, immune system, mental health, psychological well-being, etc.[31] Hence, PA/exercise could be a supportive therapy for nCov patients.[31]

Nonpharmaceutical therapy may be considered a preventive therapy in this pandemic to bring down the spread of nCov.[32] It is a simple and effective method to prevent both noncommunicable and communicable diseases.[32] According to the WHO, 2 h 30 min and 1 h 15 min of moderate-intensity and vigorous-intensity PA in a week, respectively, or a combination of both is beneficial to retain a healthy lifestyle.[33] For children/adolescents, the guidelines state a minimum of 1 h of moderate- or vigorous-intensity exercise in a day.[33] At least 60 min of moderate-intensity aerobic exercise results in an antipathogen process due to a rise in circulating immunoglobulin, cytotoxic T cells, anti-inflammatory cytokines, immature B cells, neutrophils, and natural killer cells;[34],[35] this helps in the defense system of the human body.[32] The geriatric population and people with chronic illness are recommended to do multi-training programs involving aerobic, strengthening, flexibility, and balance exercises.[36]


  Conclusion Top


The present scoping review shares the information about the impact of COVID-19 on the lives of physiotherapy professionals and their contribution to rehabilitation during the pandemic by physical recuperation of patients.

Rehabilitation of COVID-19 patients is a multidisciplinary approach where PTs play an important role in physical recovery. Cardiorespiratory PT along with early exercises and mobilization expedites the recovery of acute and chronic respiratory conditions and prevention of ICU-AW. Exercises improve the immune response and mental health and help in reducing the debilitating effects of viral infections for all age groups. Telephysiotherapy is a new dimension of PT practice that provides health-care services to the needful economically and safely.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Abstract
Introduction
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Impact of COVID-...
COVID-19 and Phy...
Telephysiotherapy
Benefits of Exer...
Conclusion
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