Summary of respiratory rehabilitation and physical therapy guidelines for patients with COVID-19 based on recommendations of World Confederation for Physical Therapy and National Association of Physical Therapy.
Yuetong Zhu, Zimin Wang, Yue Zhou and 4 others
PMID 32884178WHAT IT FOUND
For adults with COVID-19, respiratory physiotherapy is recommended by disease stage: prone ventilation in critical care, monitored low-intensity exercise in isolation, and six weeks of home aerobic and resistance training after discharge.
Key findings
01In critical care, prone ventilation is recommended for patients with PaO2/FiO2 below 150 mmHg, for at least 16 hours daily until oxygenation and ventilator settings improve.
02During stable isolation, the summary recommends mild exercise with a Borg score of 3 to 4 or VAS score 5 to 6 for 30 minutes, plus progressive resistance training at 50 to 70% of 1 repetition maximum.
03After discharge, the summary recommends aerobic exercise for at least 6 weeks, five times a week, 30 to 60 minutes daily, with weekly intensity increases of 10% and a maximum heart rate limit of 70%.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
It summarizes existing guidelines and articles rather than reporting new patient outcomes, so it does not show that the recommended treatments work. The methods do not report how many articles were found or included, nor a quality or evidence grade for each recommendation. The search was limited to English and retrievable full-text articles, which may omit relevant guidance. It was prepared with searches ending April 16, 2020, early in the pandemic, so safety thresholds and recommendations may have changed. The discussion makes broad claims about shorter ICU stays, lower costs, and societal benefit, but the paper does not test those outcomes.
Declared interests
The authors declare no conflicts of interest related to this work.
The easy way to misread this
Do not read this as evidence that physical therapy improves mortality, ICU stay, or costs in COVID-19. The paper summarizes recommendations and safety thresholds; the discussion's positive outcome claims are not tested in the article.