Physiotherapeutic management for patients with Covid-19

Physiotherapeutic management for patients with COVID-19 emphasizes the importance of improving respiratory function by reducing respiratory effort and optimizing oxygenation. The need for an approach specific to patients who exhibit symptoms associated with infection with COVID-19 is shown in the main fact that patients who develop medium and severe forms of this disease have oftentimes one or more diagnosis in the cardiorespiratory, oncology, renal, metabolic, etc. fields. Such treatment must be individualized, taking into account the conditions associated with the health state of the patient. The treatment is drafted by overlapping the efforts of a multidisciplinary team: physician, assistants, and physiotherapist, all of them having the same achieved goal: ensuring, at discharge from the hospital, a patient with improved signs and symptoms, able to continue their daily activities on their own. Early rehabilitation therapy for patients with COVID-19 with critical stages and average stages aims to decrease breathing difficulties, provide relief of symptoms, relieve anxiety and depression, and decrease the incidence of complications. The intervention process of early rehabilitation is applied after a general clinical assessment. The functional respiratory assessment (the evaluation of the activity of the thoracic cage, the amplitude of diaphragm activity, the pattern and breathing frequency), the heart status, the capacity to mobilize, and the ability to realize ADL must be highlighted. The rehabilitation therapy of the patients with COVID-19 includes mainly the posture management and respiratory physiotherapy. Change of posture can change the ratio of ventilation/perfusion and may lead to an improvement in the exchange of gases, but may lead to an unexpected worsening. It is recommended to use the pillows and auxiliary devices which permit a comfortable, stable position, without the need of any effort of the patient. The postural drainage can reduce the influence of sputum on the respiratory tract, which is particularly important to improve the ratio V/Q (ventilation/perfusion). The patients need to be educated to get themselves in a position that will allow gravity to assist in draining the excretions of the pulmonary lobes or the lung segments. Standing is the best position of the body for breathing in the state of rest. Physical exercises can completely expand the lungs and help in removing secretions in the lung alveoli and respiratory ways. Also the vital capacity increases and improves the respiratory function. The breathing exercises are based on deep and slow breathing (in inspiration the patient must move the diaphragm actively) and on thoracic expansion combined with the mobilization of the scapular girdle (the inspiration must be deep and slow, during the inspiration the thoracic cage is moving forward and with the raising of the upper limbs; in the expiration the thoracic cage is moving rear, and the upper limbs return to the initial position). The active cycle of the respiratory techniques is composed of three phases (control of breathing, the thoracic expansion, and the expiration). The modality of a breathing cycle must be developed regarding the patient’s health status. Even if it is estimated that at the current time approximately 80% of patients who contact the virus do not develop symptoms and will recover without having any special treatment, the given repercussions due to prolonged hospitalization or quarantine at home will represent the beginning regarding the establishment of a respiratory recovery program, which will have as objectives the improvement of the quality of life, combating a sedentary lifestyle, and bringing some benefits in the psychosocial sphere of the individual, etc. The early mobilizations and the return to an active life must be encouraged for patients with COVID-19. The prevention of the complications due to prolonged immobilization, the transfers (changing position from sitting in standing and vice versa), obtaining the static and dynamic balance, and the realization of ADL are very important.