Patients who have been infected with the coronavirus and admitted to the hospital for this reason should receive physiotherapy as soon as their condition allows. Seriously ill patients who are on ventilators and are confined to a hospital bed for long periods experience problems with breathing and other physical issues, due to their protracted inactivity. Physiotherapists can be of great value to patients and their care in this regard. This is the view expressed by physiotherapists and researchers from the Radboudumc in a set of joint treatment recommendations.
In the current crisis period, it is easy to assign low priority to the long-term effects of hospital admission on patients with the coronavirus. As the literature on the SARS outbreak in 2003 has taught us, however, this had major consequences for the organization of rehabilitation care in the countries that were most affected by that epidemic. Healthcare systems were not sufficiently prepared to provide adequate treatment for the long-term consequences of SARS. Given the large numbers of patients with the coronavirus in intensive care units in the Netherlands, we can also expect an increase in the number of patients needing rehabilitation following admission to an intensive-care unit. It is therefore important to address this issue promptly.
For this reason, the researchers—including Karin Felten-Barentsz and Thomas Hoogeboom —have compiled a set of national treatment recommendations, distinguishing four phases of treatment. Prompt preparation for the influx of large numbers of patients is important.
Phase 1: Patient in the intensive-care unit receiving ventilation in the prone positionNo treatment is provided in this phase, due to the scarcity of personal protective equipment and the risk of virus transmission. Although patients lose a great deal of muscle mass in this phase, the risk of contractures (the shortening of muscles or tendons, leading to limitations in motion) is low. Nurses could possibly exercise the joints passively.
Phase 2: Patient in the intensive-care unit whose condition has improvedIn this phase, the patient is recovering. The patient is eligible for physical therapy to promote early mobilization and activation, but is not yet disconnected from the ventilator. It is obviously important to observe infection-prevention measures.
Phase 3: Recovery after intensive careAt first, patients in this group have little energy. People on bed rest for the entire day lose about 5% of their total muscle mass and general condition each day. These patients are given exercises aimed at improving lung function by strengthening the respiratory muscles, coughing up phlegm more effectively and breathing more deeply, thereby improving the ventilation of the lungs. They are also given motion exercises. Whenever possible, this is done through pamphlets, online videos and telerehabilitation.
Phase 4: Follow-up programPatients who have been seriously ill need intensive rehabilitation care, even after they have been discharged from the hospital. Following intensive-care treatment, patients may experience respiratory problems resulting from long-term physical inactivity due to illness. This condition is known as “post-intensive care syndrome” (PICS). Recovery can take months, or even years, and proper guidance is needed.
These recommendations have been endorsed by the Royal Dutch Society for Physiotherapy (KNGF), the Dutch Association of Physical Therapy in Hospitals (NVZF), and the Dutch Society of Intensive Care (NVIC). The treatment recommendations were compiled by Radboudumc researchers from the Paramedical Sciences research group, within the Departments of Rehabilitation and IQ Healthcare: physiotherapists Karin Felten-Barentsz, Roel van Oorsouw, Emily Klooster and Niek Koenders—all of whom are specialized in intensive care and/or cardiopulmonary physical therapy—and researchers Thomas Hoogeboom and Philip van der Wees.
Related news items
The Postdoctoral Networking Tour in artificial intelligence2 July 2020
You are a postdoctoral researcher in the field of artificial intelligence? The Postdoc-NeT-AI offers you the opportunity to participate in one week of on-site visits to leading German universities, research institutes and companies. Apply now to this year's tour until 16 August 2020.read more
Register for Phd courses via gROW What does this mean for you?2 July 2020
From now on you can arrange everything related to the general RU PhD courses via gROW. Because of this there will be some changes in the registration! What does this mean for you?read more
Experts on metabolic diseases still an unknown major problem...1 July 2020
Six Dutch UMCs and a patient association contribute to treating and solving this major, often unknown, problem. Timely detection of metabolic diseases is vital. Therefore, Radboudumc is also part of the consortium “United for Metabolic Diseases”.read more
Radboud Pluim for Lionne Ekers ambassador for the RIMLS institute30 June 2020
Lionne Ekers received the Radboudpluim for her special merits for the Radboudumc. She is a born ambassador for our Institute.read more
Stefan Listl member Lancet Commission on Oral Health29 June 2020
In recognition of the global public health importance, woeful neglect of oral diseases, and the need for a broader understanding and commitment to global oral health within medicine and global health agendas, The Lancet recently established a Commission on Oral Health.read more
Trained immunity: a tool for reducing susceptibility to and the severity of SARS-CoV-2 infection29 June 2020
In a review in Cell Mihai Netea, Frank van de Veerdonk, Reinout van Crevel and Jorge Dominguez Andres propose that induction of trained immunity by whole-microorganism vaccines may represent an important tool for reducing susceptibility to and severity of SARS-CoV-2.read more