Guidelines by IAP for COVID 19

Physiotherapy guidelines for patients with COVID- 19 in an Acute Care setting  by the members of The Indian Association of Physiotherapists

Dr Anjali R Bhise, Principal, Government Physiotherapy college, Government Spine Institute, Civil hospital, Ahmedabad, Gujarat

Dr KM Annamalai, chief Physiotherapist, Apollo hospitals International limited, Ahmedabad, Gujarat

Dr G Arun Maiya, Professor and Dean, Physiotherapy, MCHP, MAHE Deemed University, Manipal

Dr Chinmaya Kumar Patra, Principal, Abhinav Bindra Sports Medicine and Research institute (ABSMARI), Bhubaneshwar, Odisha

Dr Kanchan Anand, HOD Physiotherapy, Fortis Escorts Heart Inst, NewDelhi

Dr Mariya Prakash Jiandani, Assoc Professor, Physiotherapy School & Center, Seth GSMC & KEMH, Mumbai

Dr Narasimman Swaminathan, Professorin Physiotherapy,Vice Principal, Faculty of Allied Health Sciences, Sri Ramachandra Institute of Higher Education and Research, Chennai,TamilNadu

Dr Nehal Shah, Principal Incharge, SBB College of Physiotherapy, Ahmedabad, Gujarat

Dr Prem V, Associate Professor and HOD, Physiotherapy, MCHP, MAHE Deemed University, Manipal hospital, Bangalore

Dr Priyanka Rishi, Associate Professor, Head of Laboratories, Department of Physiotherapy, Lovely Faculty of Allied Medical sciences, Lovely Professional University, Punjab.

Dr Ruchi Varshney, Director Ruchi Advanced Physiotherapy and Wellness, New Delhi.

Dr Sanjiv K Jha, Director CCDR, Principal RD Gargi, Madhya Pradesh

Dr Umanjali Damke, Principal and Professor, Physiotherapy S & C, Government Medical College and Hospital, Nagpur

Dr Vishwa Prakash Gupta, Chief Physiotherapist, Head - CTVS Physiotherapy Unit, Addl. Charge-CIMR, AIIMS, New Delhi

Preamble:
Physiotherapist have been the frontline workers since the outbreak of the pandemic COVID19 a public health emergency creating a dramatic effect throughout the world in terms of economic health and social life. During this crisis phase where national and regional authorities have instituted extraordinary measures to contain the spread. Physiotherapists are constantly thriving to help patients to improve their lung functions, ability to ventilate and oxygenate better and reduce the external demand of supplemental oxygen.

The Indian Association of Physiotherapist hereby proposes to update the national consensus recommendations of physiotherapy management in COVID 19 in Acute care Indian Setup published (IJCCM OCT 2020 & Maharashtra state OTPT council June 2020) based on gathered experience, further consensus and literature and issue Guidelines for Pulmonary Physiotherapy in Acute care COVID 19 

Objective
The objective of this Guideline is to explain the role of respiratory physiotherapy in confirmed Covid 19 patients in acute hospital settings. Respiratory physiotherapy aims to

1) Optimize ventilation and Oxygenation thereby reducing the need of supplement al oxygen to maintain saturation. This would minimize the additional need of oxygen as resource.

2) Relieve dyspnea and work of breathing hence reducing the load on respiratory muscles.

3) Remove secretions if present and clear airways to facilitate breath ing and improve ventilation.

4) Alleviate anxiety and depression which would help in reducing the stress on breathing, making patients more comfortable and improve their ability to follow commands.

5) Reduce complications associated with bedrest and ICU admi ssion hence reducing the length of hospital stay and improve quality of life

Scope

This document provides fundamental information to physiotherapists involved in acute COVID - 19 care settings.

1) Screening and assessment for physiotherapy intervention

2 ) Indications and contraindications for respiratory physiotherapy

3) Pulmonary exercise interventions and

4) Safety and personal protection policy

Setting and Timing:

Early respiratory physiotherapy is not recommended for severely and critically ill patients if their conditions remain unstabilised or if progressive deterioration is seen. The timing of respiratory physiotherapy intervention should exclude contraindicati ons and should not aggravate infection. The staged respiratory management measures can be used during different stages for patients with different sequela.

Core viewers:

Physiotherapists involved in the care of adult COVID - 19 patients in intensive care un its, hospital care centers , jumbo centers, home ICUs and any other acute care settings.

Acute Care ICU & Step - down unit: These are high dependency units where individual patients need to be evaluated with close monitoring. Physiotherapist should use person al protective equipment (PPE) while treating patients with COVID 19. It may include geriatric patients, obese patients and patients with multiple co - morbidities, one or more organ failure, the physiotherapy team here should design a tailor - made rehab care plan based on individual problems of each patient.

Wards & Jumbo centers : Patients that are stable and do not need one on one monitoring can be treated with group therapy and contactless through the use of tele - physiotherapy , educational videos, remote co nsultations through sound systems, self - management booklets, exercise videos which are employed to reduce the usage of protective equipment and to avoid cross infections. During contact group therapy use of PPE is advocated.

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