Rehabilitation of COVID-19 patients

Abstract

This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm REHABILITATION OF COVID-19 PATIENTS The coronavirus-2 (SARS-CoV-2) pandemic has dramatically transformed the organization of public and private health organizations of the Lombardy region, the Italian region where the viral spread has been more quick and intense (1). According to the data available on the 8 th of April 2020 from the beginning of the epidemic at the end of February, 139,422 cases and 17,669 deaths have been reported in Italy, which may underestimate the real incidence. The rapid spread of the virus has upset all hospital organizations. The Rehabilitation Hospitals, as well as the rehabilitation units of multidisciplinary institutes, have considerably changed their activity. The need for medical assistance to an increasingly higher number of patients forced the hospitals to improve the volume of intensive care beds and to convert the rehabilitation departments in COVID-19 beds. San Raffaele Scientific Institute, a large tertiary hospital and research centre in Milan, Italy, was immediately involved in the management of the public health emergency (1). After the first COVID-19 case of San Raffaele Scientific Institute of Milan, dated back on 25 th February, the 3 Rehabilitation Units were merged to create dedicated beds for coronavirus cases in less than one week. Furthermore, regional laws relieved the outpatient activities of the Rehabilitation Departments to reduce the viral spread. The nurse staff have been sent to the new COVID-19 Rehabilitation Department created for those patients coming from the Intensive Care Units. At this moment, about 40 patients are hospitalized in the Rehabilitation Department at San Raffaele Hospital. The acute respiratory syndrome caused by SARS-CoV-2 syndrome may be characterized by mild respiratory diseases or moderate-to-severe pneumonia, which can cause Acute Respiratory Distress Syndrome (ARDS) and multi-organ failure. In SARS-CoV-2 pneumonia, bilateral interstitial infiltration with serious alteration of the ventilationperfusion ratio and probably shunt, cause hypoxic respiratory insufficiency (2). Acute hypoxemia may cause obstinate dyspnoea with the need of oxygen therapy administration through High-flow nasal oxygen (HFNO), or through the application of a non-invasive positive pressure, c-PAP or NIV (with oronasal or face masks, helmets) (2, 3). Unfortunately, in case of O 2 saturation worsening, orotracheal intubation and invasive mechanical ventilation are mandatory. The pulmonary parenchyma presents focal haemorrhages and necrosis, even up to a haemorrhagic infarction. The alveolar exudate can consolidate causing

Role of Physiotherapy in Long Term Physical and Mental Health of People Recovered From COVID 19: A Systematic Review Protocol

“…Many studies has been published to suggest different types of physiotherapy advices for fast recovery of patients in both acute as well as chronic setting (16,17). Here, with different studies published on the physiotherapy and respiratory management of COVID-19 patients, we would be able to review them and nd the difference in the physical as well as mental health of patients after recovery who underwent physiotherapy and who did not.…”

Management of Hand Surgery Services during the Novel Coronavirus Disease 2019 Pandemic

“…Due to increased demand on the hospital due to COVID-19 pandemic, we are having to make significant changes to our services which may require cancellation of hand therapy appointments. 25 Hand rehabilitation services are likely to be very limited, most departments of clinical physical and rehabilitation medicine have now closed part of their activities, at least for outpatients, and keep in contact with patients via telephone or telemedicine. 25 Considerations for service delivery must balance risk of transmission with both the availability of resources to provide care and the patient's acuity, level of urgency, and potential for harm if services were postponed or altered.…”

“…25 Hand rehabilitation services are likely to be very limited, most departments of clinical physical and rehabilitation medicine have now closed part of their activities, at least for outpatients, and keep in contact with patients via telephone or telemedicine. 25 Considerations for service delivery must balance risk of transmission with both the availability of resources to provide care and the patient's acuity, level of urgency, and potential for harm if services were postponed or altered. 25 The delay of posthand surgery rehabilitation (e.g., splinting, active, and passive mobilization), in which an early start strongly correlates with the best clinical and functional recovery, or rehabilitation of bone fractures with prolonged immobility is related to poor functional recovery with possible development of complex regional pain syndrome-type complications.…”

“…25 Considerations for service delivery must balance risk of transmission with both the availability of resources to provide care and the patient's acuity, level of urgency, and potential for harm if services were postponed or altered. 25 The delay of posthand surgery rehabilitation (e.g., splinting, active, and passive mobilization), in which an early start strongly correlates with the best clinical and functional recovery, or rehabilitation of bone fractures with prolonged immobility is related to poor functional recovery with possible development of complex regional pain syndrome-type complications. 25 If telemedicine is unavailable, patients should be advised of links to helpful online information from their health care facility or elsewhere to optimize quality, availability, and accessibility of physical and rehabilitation services.…”

Warum der rehabilitativen Versorgung auch und gerade während der COVID-19 Pandemie besondere Beachtung geschenkt werden muss: Ein Statement der Deutschen Gesellschaft für Physikalische und Rehabilitative Medizin (DGPRM)

“…Dies betrifft auch die rehabilitative Versorgung in praktisch allen ihren Dimensionen. Das Nach allem was bisher bekannt ist, haben Patientinnen und Patienten mit schweren Verläufen der CoVID-19-Erkrankung einen hohen Bedarf an rehabilitativen Interventionen [1]. Diese beinhalten in der Akutphase und der frühen Rehabilitation im Krankenhaus v. a. atemtherapeutische und Lagerungsmaßnahmen [2].…”