Katie Knapton, Founder of PFO, explains why online physiotherapy is helping survivors of COVID-19 continue to recover
The vital role of physiotherapists in treating patients with COVID 19 has been well publicised with life saving techniques supporting the fight against this deadly virus. However, patients who have recovered from coronavirus may well have a wide range of needs in terms of rehabilitation, especially if they are elderly or with an underlying health condition.
Patients who were treated in the ICU will most likely be affected by muscle weakness associated with rapid early muscle mass loss (up to 20%), which worsens in the presence of multi-organ failure. Physical weakness may well also occur in those not admitted to critical care as a result of deconditioning and this is particularly apparent in the frail and pre-frail population.
Spending time is bed, not moving, can also result in a significant decline in muscle mass and strength and this has been linked to falls, functional decline, increased frailty and immobility, all of which increases the risk of pressure ulcers and subsequent infection.
This needs to be addressed and online physiotherapy or ‘telerehabilitation’ can play a key role here as face to face appointments are not currently possible during the lockdown.
Online physio services also address the issues of travel distance and lack of care resources which can be a frequent barrier to accessing care. For many patients, it is also convenient, particularly if fatigue is an issue which is a key feature of Covid 19 along with breathlessness. With this in mind tolerance to exercise will need to be in short bursts, paced to individual needs and take place several times a day. Resilience building this will need to be at their own pace and will benefit from support to progress to self-management.
There is no doubt that regaining mobility and balance to its former level must be a priority for rehabilitation as figures from the Royal Society for the Prevention of Accidents show that in 2016-17 there were 316,669 hospital admissions in England of people aged 65 and over because of falling – the equivalent of more than 867 each day across the country.
This could involve a variety of bed-based exercises to increase joint mobility and strength, to chair exercises, to standing which will include balance work and repetitive more advanced exercises. If breathlessness is an issue then some breathing exercises will need to be given. Pacing is essential and patients must be encouraged to listen to their body – it is after all a marathon not a sprint.
Movement is key to fully recovering and patients will need to be encouraged to engage in a rehab programme and gently increase activity levels and set goals. My advice to them, their carers and their family is to be patient and keep positive. It may well be slow progress but remember any extra activity is good, but it will feel like an uphill battle sometimes and this is totally normal. It is understandable that patients will feel low but this too will improve. Other things to consider are nutrition, ensuring a healthy and varied diet although it is not unusual for appetites to be small. Finally remember that sleep is a great healer and plenty of rest is required following any sort of viral infection.
Finally, the current UK government advice for vulnerable people and the elderly is still to stay at home as much as possible and this advice is unlikely to change in the near future. With this in mind online treatments may well become part of the ‘new normal’.