An Important Role For Physical Therapy With COVID and Frail Patients

Living in a Post-Covid 19 World 

Every facet of life has been affected by the pandemic. Following the Pandemic, there will be individuals who have been home and who are deconditioned. We here at Optimum Wellness Centers are open and taking the appropriate precautions to treat not only those recovering from Covid-19, but also, those whose health has been affected inadvertently following the stay at home orders.  

Background: 

Frailty Definition– When a person’s body does not move for a long period of time, he or she can suffer loss of strength, flexibility, endurance, balance, and mobility (the ability to move easily and perform common activities). In the elderly population in the United States, people develop frailty at a rate of 9.6% of the population. (1)

Frailty is a syndrome that results in an inability to perform everyday activities, such as preparing meals, washing, or caring for a family member. Debility is the loss of the ability to move around normally, or productively, in one’s home and community. Young people also can become frail and debilitated from trauma, disease, chronic pain, or any reduction in physical activity. Among critical care patients in hospitals, up to 30% are found to be frail (APTA). (1)

Frail people often are scared or reluctant to perform activities that make them tired and avoid doing them, which increases their frailty over time. Some frail people do not understand how to improve their condition, so they continue being inactive. (1)

Bed Rest– People in the hospital spend a lot of time in bed. One study found that hospital patients spend over 95% of their time in bed. Bed rest may be unavoidable for some people, based on their condition, but it’s harmful for most people. During bed rest, muscle mass decreases at a rate of 1%-2% per day, the risk of blood clots increases, and a person’s range of motion (the ability to move joints like knees, elbows, and shoulders) is likely to get worse. (1)

Precautions taken by Optimum Wellness Centers During COVID-19 Pandemic 

  1. All staff and patients are to wear masks due to the hands-on nature of physical therapy.
  2. All staff and employee temperatures are taken each day. 
  3. All patient temperatures will be taken prior to each therapy session. 
  4. Everyone must wash their hands before and after each therapy session. 
  5. All surfaces are cleaned every 30-60 minutes including doors, counters, and pens to prevent the spread of Covid-19.
  6. Keeping patients separated and social distancing in physical therapy is a priority for their own health and safety. 
  7. All equipment is cleaned after patient use.
  8. If a patient or employee is sick, they will be sent home.   

How can Physical Therapy Help Those Recovering from COVID, and those who are Frail?  

Physical therapists help individuals experiencing frailty and debility restore their strength, flexibility, endurance, balance, and overall mobility, reduce their chronic pain, and improve their daily function. (1)

  • Telehealth visits are available for patients using the HIPAA Compliant Doxy.Me platform.
  • Improvements in cognitive functioning and functional status were described by Jackson et al. when patients received cognitive, physical, and functional training in-home via a telemedicine system. (3) 
  • Increase oxygenation and recovery post mechanical ventilation for COVID-19 affected patients.  
  • Several observational studies involving patients with acute respiratory failure have demonstrated that early PT programs are both safe and feasible. (4 – 7) 
  • Help patients (COVID-19 related or from stay at home orders) recover from deconditioned status.  
  • Nydahl et al reported that early mobilization and physical rehabilitation for critically ill patients appear to be safe and have a low risk of potential adverse events. (8, 9) 
  • Physical therapy improves multiple aspects of physical function, including muscle strength, endurance, and the performance of functional activities. (10) 
  • Help patients suffering from frailty/debility. 
  • Older adults with mobility and frailty problems are able to safely increase physical activity in their own environment and reduce frailty.  
  • Physical therapy is cost-effective with a patient-centred approach. 
  • Physical activity promotion in older adults with mobility limitations is important. (11)  
  • Exercise programs should be individualized (strength, gait etc). Emphasis is on the most significant deficits, and the goals of the participant. A multidimensional exercise program should be implemented to prevent the deleterious effects of deconditioning. (12)  
  • Relatively long-lasting and high-intensive multicomponent exercise programs have a positive effect on ADL/IADL disability for moderate physically frail older persons. (13)  
  • For many older adults transitioning from the hospital to home settings, physical therapists are the right provider at the right time to assess and address post-hospitalization physical and functional deficits. Such approaches may contribute to reducing hospital readmissions, improving overall medical outcomes, and subsequently decreasing health care costs. (14, 15) 
  • There are recommended therapeutic activities and intensities by physical therapists for frail older adults to increase physical activity and  improve general health and well being, as well as reduce the risk of falls and manage chronic lifestyle conditions. (16) 
  • Physical therapy and physical activity can reduce the risk of falls, and promote cognitive health and self-management of chronic diseases. It can slow the deterioration in ability to perform ADLs and maintain quality of life in older adults. A meta-analysis  found that exercise is beneficial to improve balance, gait speed and abilities to carry out ADLs in the frail older adult population. (17 – 21)  
  • Physical therapists should play a large role in establishing appropriate and individualized exercise programs, as they have considerable experience in providing exercise therapy in the context of medical care for elderly people with varying conditions and risks. (21)

 

References:

  1. APTA. Physical Therapy Guide to Frailty and Debility. May 25, 2011. Accessed May 18, 2020. https://www.choosept.com/symptomsconditionsdetail/ physical-therapy-guide-to-sarcopenia-frailty. 
  2. BeinT, Weber-Carstens S, Apfelbacher C. Long-term outcome after the acute respiratory distress syndrome: different from general critical illness?. Curr Opin Crit Care. 2018;24(1):35‐40. doi:10.1097/MCC.0000000000000476.  
  3. Pawlik AJ, Kress JP. Issues affecting the delivery of physical therapy services for individuals with critical illness. Phys Ther. 2013;93(2):256-65. https://login.ezproxy.fgcu.edu/login?url=https://search-proquest-com.ezproxy.fgcu.edu/docview/1314722572?accountid=10919. doi: http://dx.doi.org.ezproxy.fgcu.edu/10.2522/ptj.20110445.  
  4. Moss M, Nordon-Craft A, Malone D, et al. A randomized trial of an intensive physical therapy program for patients with acute respiratory failure. American Journal of Respiratory and Critical Care Medicine. 2016;193(10):1101-1110. https://login.ezproxy.fgcu.edu/login?url=https://search-proquest-com.ezproxy.fgcu.edu/docview/1789279971?accountid=10919. doi: http://dx.doi.org.ezproxy.fgcu.edu/10.1164/rccm.201505-1039OC.  
  5. Bailey P, Thomsen GE, Spuhler VJ, Blair R, Jewkes J, Bezdjian L, Veale K, Rodriquez L, Hopkins RO. Early activity is feasible and safe in respiratory failure patients. Crit Care Med 2007;35: 139-145. 
  6. Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, Ross A, Anderson L, Baker S, Sanchez M, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure.CritCare Med 2008;36:2238-2243. 
  7. Nordon-Craft A, Schenkman M, Ridgeway K, Benson A, Moss M. Physical therapy management and patient outcomes following ICUacquired weakness: a case series. J Neurol Phys Ther 2011;35: 133-140.  
  8. Zhang L, Hu W, Cai Z, et al. Early mobilization of critically ill patients in the intensive care unit: A systematic review and meta-analysis.PLoSOne. 2019;14(10). https://login.ezproxy.fgcu.edu/login?url=https://search-proquest-com.ezproxy.fgcu.edu/docview/2300608357?accountid=10919. doi: http://dx.doi.org.ezproxy.fgcu.edu/10.1371/journal.pone.0223185.  
  9. Nydahl P, Sricharoenchai T, Chandra S, Kundt FS, Huang M, Fischill M, et al. Safety of Patient Mobilization and Rehabilitation in the Intensive Care Unit. Systematic Review with Meta-Analysis. Ann Am Thorac Soc. 2017; 14(5): 766–777. pmid:28231030  
  10. Escalante A, Miller L, Beardmore TD. Resistive exercise in the rehabilitation of polymyositis/dermatomyositis. JRheumatol1993; 20:1340-1344.  
  11. de Vries NM, Staal JB, van der Wees PJ, et al. Patient-centred physical therapy is (cost-) effective in increasing physical activity and reducing frailty in older adults with mobility problems: a randomized controlled trial with 6 months follow-up. J Cachexia Sarcopenia Muscle. 2016;7(4):422‐435.  
  12. Powers CM. Deconditioning Prevention.2nd. ed. ed. New York: Springer Publishing Company; 2008:4-202,R23. https://login.ezproxy.fgcu.edu/login?url=https://search-proquest-com.ezproxy.fgcu.edu/docview/189415215?accountid=10919. 
  13. Daniels R, van Rossum E, de Witte L, KempenGI, van den Heuvel W. Interventions to prevent disability in frail community-dwelling elderly: a systematic review. BMC Health Serv Res. 2008;8:278. Published 2008 Dec 30. doi:10.1186/1472-6963-8-278 
  14. Flavey JR, Burke RE, Malone D, Ridgeway KJ, McManus BM, Stevens-Lapsley JE. Role of Physical Therapists in Reducing Hospital Readmissions: Optimizing Outcomes for Older Adults During Care Transitions From Hospital to Community, Physical Therapy, Volume 96, Issue 8, 1 August 2016, Pages 1125–1134, https://doi.org/10.2522/ptj.20150526.  
  15. Falvey JR, Mangione KK, Stevens-Lapsley JE. Rethinking hospital-associated deconditioning: proposed paradigm shift. Phys Ther. 2015; 95: 1307–1315.
  16. Frail Elderly: The Physiotherapist’s Role in Preventing Hospital Admission. (2020, January 17. Physiopedia,. Retrieved 18:27, May 19, 2020 from https://www.physio-pedia.com/index.php?title=Frail_Elderly:_The_Physiotherapist%27s_Role_in_Preventing_Hospital_Admission&oldid=228618. 
  17. Department of Health. Start active, stay active: report on physical activity in the UK. https://www.gov.uk/government/publications/start-active-stay-active-a-report-on-physical-activity-from-the-four-home-countries-chief-medical-officers (accessed 18 May 2020).
  18. The British Heart Foundation National Centre for Physical Activity and Health. Interpreting the UK physical activity guidelines for older adults in transition. http://www.bhfactive.org.uk/older-adults-resources-and-publications-item/39/429/index.html (accessed 18 May 2020).
  19. The British Heart Foundation National Centre for Physical Activity and Health. Interpreting the UK physical activity guidelines for frailer older adults. http://www.bhfactive.org.uk/resources-and-publications-item/39/430/index.html (accessed 18 May 2020).
  20. Stares A, Bains M. The Additive Effects of Creatine Supplementation and Exercise Training in an Aging Population: A Systematic Review of Randomized Controlled Trials. Journal of geriatric physical therapy (2001). 2019 Feb.
  21. Kohei M, Yoshiteru A. Role of Physical Therapists in Health Care of the Elderly, Nippon Eiseigaku Zasshi (Japanese Journal of Hygiene), 2016, Volume 71, Issue 2, Pages 126-132, Released May 27, 2016. https://doi.org/10.1265/jjh.71.126.