The covid-19 pandemic has been hard for all of us, with the constant anxiety about the disease, and not being completely able to know the long-term effect of a new infection is dreadful. All we can do is prepare ourselves to lessen the severity of the effects that we may face.

Even though the impairment and disability are not yet known, still patients will require rehabilitation during the entire course of the disease. Many patients who are recovering, particularly those with severe symptoms or who were hospitalized,  are challenged with issues of shortness of breath, decreased lung capacity of upwards of 30%, deconditioning, loss of mobility, loss of balance leading to increased fall risk, general fatigue, muscle aches, and inability to do the things they want and need to do.

Prolonged hospitalization of patients has caused many deleterious effects, such as pulmonary, cardiovascular, muscle, and cognitive changes. Patients who recover from COVID-19 should undergo pulmonary rehabilitation during and after hospitalization, to reverse the adverse effects of the disease and as part of post corona precautions.

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Benefits of Post Covid Rehabilitation

The rehabilitation process that includes exercise, strengthening, cardiovascular training, functional training, education and manual therapy has been proven to have a positive effect on health outcomes in patients with severe covid. Post covid physiotherapy can not only reduce symptoms in patients with respiratory diseases through breathing techniques but with individualized and properly dosed progressive exercise programs that can improve patients’ quality of life significantly. Major benefits can be categorized as:

1. Optimizing Health and Functioning Outcomes

Patients with severe underlying health conditions and older people with lower immunity are at a higher risk of severe illness post covid too. Post covid rehabilitation can reduce Intensive Care Unit -admission related complications, such as Post Intensive Care Syndrome (PICS), Intensive care unit acquired weakness (ICUAW). Physiotherapy improves functionality, facilitates faster recovery, and has long-term benefits to improve physical and cognitive impairments and provides psychological support.

2. Reducing the risk of readmission

Post covid patient care is mostly done in a hospital ward or a rehabilitation facility. With reduced hospital beds and a widespread pandemic, rehabilitation is essential to reduce the chances of readmission so that patients’ health does not deteriorate after discharge. Physiotherapists as rehabilitation professionals are frontline healthcare professionals who make sure the patients have the strength and stamina that they need.

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Physiotherapy techniques used for Pulmonary Rehabilitation

Every patient has a different rate and severity of the infection and needs to be physically viable to be able to undergo post covid physiotherapy. If approved, patients can use these techniques for pulmonary rehabilitation:

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Deep breathing

Covid primarily affects the lungs and deep breathing exercises play an important role in the post-covid recovery process. Breathing exercises not only help to increase lung capacity but also relieves stress and anxiety which is common during and post quarantine period. If done daily, deep breathing or alternate nostril pranayama (yoga technique) builds up the ability to breathe deeply during any activity or during rest. Deep breathing as a post covid physiotherapy exercise also improves oxygenation which is an important component of pulmonary rehabilitation.

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Bronchial hygiene techniques

A respiratory complication is the most common symptom of covid-19 and requires careful attention. Cleaning of nasal airways at regular intervals to avoid blockage or difficulty in breathing is essential. During post covid physiotherapy, airway clearance techniques like forced expiratory techniques to expel the sputum and reduce coughing and energy consumption, and positive expiratory pressure to assist forced expiration is used. It also optimizes lung compliance, and ventilation-perfusion ratio and prevents it from collapsing. Bronchial hygiene improves respiratory functions and quality of life in patients with COVID-19, especially after discharge.

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Early mobilization

Acute covid patients have a prolonged ICU stay leading to the development of muscle weakness and decreased functionality. Physiotherapists do a functional assessment to evaluate the motor condition of the patient. Early mobilization includes posture change in upright, semi-sitting, and forward-leaning depending on the patient's condition. Bed mobilization, bed-to-chair transfer, sit-to-stand training, assisted walking, neuromuscular electrical stimulation in limb muscles, quadriceps muscle function, walking capacity, and proprioceptive neuromuscular facilitation is also checked in the rehabilitation. These can also be graded by the physiotherapists to monitor progress.

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Endurance training

Muscle-strengthening exercises should be done by patients once they are discharged from the hospital. Post covid, resistance training is started by the physiotherapists with a reduced load and repeated 8-12 times, 1-3 times a day, with 2-min rest in between the sets, 2-3 sessions per week for 6 weeks. Load is increased by around 5 to 10% each week. 

The patient is also made to do balance exercises to improve balance. Aerobic exercises like individualized walking, brisk walking, slow jogging, and swimming programs are also started with low intensity, for a short duration, 3-5 sessions per week, each session lasting for 20 - 30 min.

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Choose the Best Treatment Option at Physiotattva

It’s important to handle every patient with care and assess their post covid physiotherapy rehabilitation separately and chart a treatment plan. At physiotattva, physical therapists are experts in musculoskeletal examinations and functional assessment and are well trained in respiratory assessments and treatments.  All the necessary equipment is kept to keep the patient safe and physically and psychologically healthy.