By Anjelo Ratnachandra
In Feb 2021 World Physiotherapy collaborated with Long COVID Physio to develop a briefing paper on safe rehabilitation for people living with Long COVID. A brief summary of our learnings from this paper is as follows:
“Long COVID impacts people’s functional ability, social and family life, ability to work, and quality of life. Dealing with such complexity requires a multidisciplinary approach and patients’ involvement.”
What we know is that Long COVID is an emerging condition that is not well understood, however, can be severely disabling, impacting regardless of illness severity or presence of hospitalisation. Current knowledge demonstrates that Long COVID can affect multiple body systems including he respiratory, cardiac, renal, endocrine, and neurological systems.
Comparisons have been drawn between the symptoms and experiences of people living with Long COVID and other infections such has SARS, MERS, and Ebola. Selected symptoms also overlap with ME/CFS, which is often triggered by infection and immune activation. Currently, it is unknown when and by what amount physical activity is safe or beneficial for those living with Long COVID, and caution should be exercised with any rehabilitation program.
Before Rehab,
– Individuals should be screened for post-exertional symptom exacerbation through careful monitoring of signs and symptoms
– Cardiac impairment and Exertional Oxygen Desaturation should be excluded before using physical activity as rehab
– Individuals should be screened for autonomic nervous system dysfunction, with continued monitoring of signs and symptoms
During Rehab,
– Client centred approach is a must
– A Multidisciplinary/Interdisciplinary approach is the key
– Rehab should include education about resuming every activity conservatively, at an appropriate pace. Exertion should not be pushed to the point of fatigue or symptom exacerbation, both during and in the days following exertion.
– In the presence of post-exertional symptom exacerbation, “Stop. Rest. Pace.”, Activity management, HR monitoring may be effective
– Rehab should aim to prevent desaturation on exertion
– When Orthostatic hypotension is present, consider – autonomic conditioning therapy, non-upright exercises, isometric exercises, compression garments, and patient education and safety
– Physical activity should be prescribed with caution
– Aim should be to achieve sustainable symptom stabilisation
Reference: World Physiotherapy. World Physiotherapy Response to COVID-19 Briefing Paper 9. Safe rehabilitation approaches for people living with Long COVID: physical activity and exercise. London, UK: World Physiotherapy; 2021.
