Physiotherapists play an important role in a COVID-19 patient’s journey, both when they are in hospital and after they are discharged.

Here in Malta, physiotherapy starts as soon as the patient is admitted to Mater Dei Hospital, whether it is to a medical ward, the Infectious Disease Unit or to the Intensive Therapy Unit (ITU).

A number of patients with Long COVID and persistent symptoms such as shortness of breath, fatigue and decreased physical activity may need to undergo an eight-week outpatient pulmonary rehabilitation programme led by the physiotherapy department at Mater Dei.

Intensive care

Physiotherapists working in the ITU environment are crucial in providing respiratory care to patients affected by COVID-19.

They may provide airway clearance techniques for ventilated and non-ventilated patients who show signs of inadequate airway clearance and poor oxygenation. Physiotherapists can assist in positioning patients with severe respiratory failure associated with COVID-19.

Given the intensive medical management for some COVID-19 patients including prolonged protective lung ventilation, sedation and use of muscle relaxing agents, patients with COVID-19 who are admitted to ITU may be at high risk of developing ITU-acquired weakness, which may worsen their morbidity and increase their mortality risk.

It is, therefore, essential to start early rehabilitation, even when these patients are still on a ventilator.

These interventions consist of exercise, mobilisation and rehabilitation interventions to survivors of critical illness associated with COVID-19 in order to enable a functional return to home.

Physiotherapists address symptoms by teaching breathing techniques, provide physical rehabilitation, give advice on symptom management

All these physiotherapy interventions will limit the severity of ITU-acquired weakness, promote rapid functional recovery and facilitate future rehabilitation in the coming stages of the patient’s rehabilitation.

Wards

The patient journey continues in the wards at Mater Dei Hospital, particularly in medical wards such as the Infection Control Unit. Here, physiotherapists also play an important role as patients may present symptoms such as breathlessness, reduced mobility as well as ITU-acquired weakness.

Physiotherapists address patients’ symptoms by teaching breathing techniques, providing physical rehabilitation and giving advice on symptom management. They also have a critical role in improving exercise tolerance since many COVID-19 patients may need oxygen therapy in order to carry out the simplest of tasks such as getting out of bed, walking and bathing.

Physiotherapists are also consulted during discharge planning for patients who are medically stable and able to finish their isolation period at home.

Additionally, physiotherapists also work with post-COVID patients who, unfortunately,  would still have residual symptoms from their previous infection.

Pulmonary rehabilitation

Patients whose symptoms of Long COVID are still present after having been discharged from Mater Dei Hospital are referred for an eight-week pulmonary rehabilitation programme, which is led by physiotherapists at Mater Dei.

These clients would still be experiencing primarily decreased exercise tolerance, shortness of breath and may be oxygen-dependent directly due to COVID-19. Secondary presentations may include muscle wasting, generalised weakness, weight loss and some neurological conditions such as foot-drop.

Physiotherapists initially carry out exercise-tolerance testing, lung-function testing and breathlessness questionnaires to gauge that person’s level of ability and function at that point in time.

Following the initial assessment, referrals to other professionals within the multidisciplinary may take place. If the patient wishes, he/she is enrolled into a pulmonary rehabilitation programme or given a home exercise programme.

Pulmonary rehabilitation involves carrying out a supervised exercise class twice weekly for a period of eight weeks to challenge the client’s exercise tolerance and improve muscle strength, achieve breathing control and learn to adapt and be independent within their limitation. Some clients progress physically and exhibit minimal residual symptoms. 

Members of the public with any residual symptoms of COVID-19 can contact the Physiotherapy Department at Mater Dei Hospital on 2545 6600.

The physiotherapy departments at Mater Dei Hospital and Sir Anthony Mamo Oncology Centre form part of the Physiotherapy Services falling under the Directorate for Allied Health Services, Ministry for Health.