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Importance of physiotherapy in pulmonary rehabilitation in COVID -19


A new coronavirus (SARS-CoV-2) outbreak occurred in December 2019, which caused various clinical symptoms leading to a syndrome called “Coronavirus disease of 2019 “ (“COVID-19”).


COVID-19 can lead to the occurrence of symptoms such as fever, cough, increased airway secretions, dyspnea, and others. Patients experience muscle weakness, shortness of breath, fatigue, and decreased exercise tolerance due to long-term bed rest in isolation or treatment in the ICU.


COVID-19 mainly damages the respiratory system, importing great significance to respiratory rehabilitation and physical therapy interventions.





Main goals of respiratory physiotherapy


  • Reduce the symptoms of dyspnea,

  • Improve lung capacity

  • Counteract the complications resulting from respiratory failure and immobilization

  • Decrease the level of anxiety and counteract depression


As a highly infectious respiratory tract disease, coronavirus disease 2019 (COVID-19) can cause respiratory, physical, and psychological dysfunction in patients. Therefore, pulmonary rehabilitation is crucial for both admitted and discharged patients of COVID-19.


Pulmonary rehabilitation.


Pulmonary rehabilitation refers to the individualized rehabilitation treatment of patients with chronic pulmonary diseases after a detailed assessment.


With exercise training as its core, pulmonary rehabilitation comprises comprehensive interventions, including but not limited to psychological and nutritional support, as well as education and behavioral changes. The goal of pulmonary rehabilitation is to not only improve the patient's physical and mental conditions but also help the patient return to family and society more promptly.


The benefits include,

  • Improved exercise tolerance in patients with chronic pulmonary diseases

  • Reduced number of hospital admissions and length of hospital stays

  • Enhanced health-related quality of life

  • Improved respiratory muscle function and relieving dyspnea

  • Alleviated disease-related anxiety and depression

  • Enhanced skeletal muscle function of upper and lower limbs.


The necessity of pulmonary rehabilitation for patients with COVID-19


The three major components of the medical system.

  • Prevention

  • Treatment

  • Rehabilitation


These three components are equally important.


The primary clinical manifestations of COVID-19 are,

  • Fever

  • Cough

  • Dyspnea

  • Myalgia


However, severe cases can rapidly progress to acute respiratory distress syndrome (ARDS). In addition, some patients can develop acute myocardial and kidney injuries. The latest pathological reports indicate that the predominant pathological changes in early-18 and late-stage patients are diffuse lung injuries, although some patients also suffer from intra-alveolar fibrous exudate and pulmonary interstitial fibrosis. Moreover, the virus also affects other organs such as the heart, liver, and kidneys to various degrees. These changes contribute to hypoxemia and impaired cardiopulmonary and organ functions throughout the body.


In addition, because COVID-19 has caused a public emergency, patients with COVID-19 may demonstrate different degrees of psychological disorders, such as anger, fear, anxiety, depression, insomnia, and loneliness, as well as a lack of cooperation and abandonment of treatment due to fear of the disease. Even when discharged, the patients may experience post-traumatic stress syndrome. Therefore, prompt introduction and continuous availability of pulmonary rehabilitation services are critical for patients with COVID-19.


The goals of pulmonary rehabilitation


The short-term goals


  • Alleviate dyspnea.

  • Relieve anxiety and depression.


The long-term goal

  • Preserve the patient's function to the maximum extent.

  • Improve his/her quality of life.

  • Facilitate his/her return to society.


It is necessary to perform comprehensive assessments before starting the rehabilitation program.


The results of these assessments can then be combined with the patient's aerobic endurance, muscle strength, balance, and flexibility to formulate an individualized and progressive rehabilitation prescription.


The prescription content mostly includes,


  • Aerobic exercises

  • Strength training

  • Balance training:- Patients with balance dysfunction should be involved in balance training

  • Respiratory training for the patients with shortness of breath, wheezing, and difficulty in expectoration after discharge

  • Respiratory mode training, such as body position management, adjustment of respiratory rhythm, traction of respiratory muscle group breathing exercise, and expectoration training, should be arranged in combination with the evaluation results.


References


Yang, L.-L., & Yang, T. (2020). Pulmonary rehabilitation for patients with coronavirus disease 2019 (COVID-19). Chronic Diseases and Translational Medicine, 6(2), 79–86.


Zhu, Y., Wang, Z., Zhou, Y., Onoda, K., Maruyama, H., Hu, C., & Liu, Z. (2020). Summary of respiratory rehabilitation and physical therapy guidelines for patients with COVID-19 based on recommendations of World Confederation for Physical Therapy and National Association of Physical Therapy. Journal of Physical Therapy Science, 32(8), 545–549.



Nayani sulakkhana

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