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Background Pulmonary physiotherapy (PPT) is an important treatment in the management of patients with different types of pulmonary disorders. We aimed to evaluate safety and efficacy of PPT in hospitalized patients with severe COVID-19 pneumonia. Methods In this randomised, single-blind, controlled trial, we enrolled hospitalized, non-intubated patients (18 to 75 years with oxygen saturation (Spo2) in free-air breathing ≤90%) with COVID-19 pneumonia at a referral hospital. Participants were randomly assigned (1:1) to receive PPT (six sessions PPT with breathing exercises and airway clearance techniques) or basic care. The primary outcomes were venous blood O2 (pO2) and CO2 (pCO2) pressures, Spo2, and three-minute walking test (3MWT) that were assessed before and end of sixth session. Secondary outcomes included level of dyspnea, venous blood PH, one-month mortality, three-month mortality and short form-36 (SF-36) after one and three months. The assessor was blinded to the assignment. This trial is registered with ClinicalTrials.gov (NCT04357340). Findings In April-May 2020, 40 participants were randomly assigned to PPT or basic care groups. While at the end of intervention, pO2 (adjusted mean difference to baseline measure (AMD) 6.43 mmHg [95%CI 2.8, 10.07], P<0.01), Spo2 (AMD 4.43% [95%CI 2.04, 6.83], P = 0.0011), and 3MTW (AMD 91.44 m [95%CI 68.88, 113.99], P<0.01) were higher in PPT group and basic care group, pCO2 was not improved (AMD -2.1 mmHg [95%CI-6.36, 2.21], P = 0.33). Based on the logistic model adjusted to baseline Spo2, the risks of mortality were reduced 81% ([95%CI: 97% reduction to 30% increase], P = .09) and 84% ([95%CI 74% reduction to 5% increase], P = .06) at one-month and three-month, respectively. There were no significant differences in most SF-36 domains scores after one and three months. No serious adverse event was observed during PPT sessions. Conclusion Early PPT can be considered a safe and relatively effective therapeutic choice for patients with severe COVID-19.

Background: Pulmonary physiotherapy (PPT) is an important therapeutic tool in the management of patients with different types of pulmonary disorders. We aimed to evaluate safety and efficacy of PPT in hospitalized patients with severe COVID-19 pneumonia. Methods: In this randomised, single-blind, controlled trial, we enrolled hospitalized, non-intubated patients (18 to 75 years with oxygen saturation(Spo2) in free-air breathing ≤90%) with COVID-19 pneumonia at a referral hospital. Participants were randomly assigned(1:1) to receive PPT (six sessions PPT with breathing exercises and airway clearance techniques) or basic care. The primary outcomes were venous blood O2(pO2) and CO2(pCO2) pressures, Spo2, and three-minute walking test(3MWT) that were assessed before and end of sixth session. Secondary outcomes included level of dyspnea, venous blood PH, one-month mortality, three-month mortality and short form-36 (SF-36) after one and three months. The assessor was blinded to the assignment. This trial is registered with ClinicalTrials.gov(NCT04357340). Findings: In April and May 2020, 40 participants were randomly assigned to PPT or basic care groups. At the end of intervention, pO2(adjusted mean difference to baseline measure (AMD) 6⸱43 mmHg [95%CI 2⸱8, 10⸱07], P<0.0001), pCO2(AMD -2⸱1 mmHg [95%CI-6⸱36, 2⸱21], P=0.0011), Spo2(AMD 4⸱43% [95%CI 2⸱04, 6⸱83], P=0.0011), and 3MTW (AMD 91⸱44 m [95%CI 68⸱88, 113⸱99], P<0.0001) were improved higher in PPT group and basic care group. While the mortality rate was not different at one month, at three months it was 25% lower in the PPT group (P=.05). There were no significant differences in most SF-36 domains scores between groups after one and three months. No serious adverse event was observed during PPT sessions. Conclusion: Early PPT can be considered as a safe and effective therapeutic choice for patients with severe COVID-19.

Introduction: Using Simulated Patients (SPs) in clinical skills education is a common method of training students to improve their skills for future client encounters. This systematic review aims to provide an overview of the SP strategy in Physical Therapy (PT) education. Materials and Methods: PubMed, Scopus, and Web of Science databases were searched from January 1980 up to November 2019. Different keywords related to the topic were selected using MeSH. Any types of quantitative study design which had used simulation-based learning in physical therapy were eligible for inclusion. Two reviewers read studies and appraised them critically. Results: A total of 1049 abstracts were retrieved and after reviewing the full-text paper, 11 full- text articles met the inclusion criteria. These studies had used simulated patients for various objectives, including replicate different aspects of knowledge, self-perceived skills, real clinical practice, attitudes, and feasibility. Based on the result of studies, SP as an educational technique can improve student’s clinical reasoning skills, communication, and motivation in  a safe environment. Conclusion: SP is a useful learning strategy to deliver learning activities in medical education and physical therapy curricula, facilitating feedback on students’ performance with opportunities to interact with real patients and environments.