Anyone surviving treatment for the coronavirus in the ICU will face a long period of recovery. It is important for patients to receive physiotherapy as soon as possible, according to researchers and physiotherapists from the Radboud university medical center. ‘You lose 5% of your muscle strength for every day that you spend in bed’.

As explained by researchers from the Radboud university medical center, corona patients who must be treated in the ICU need physiotherapy as soon as possible in order to recover. ‘For those who survive, rehabilitation will take a long time’, says Karin Felten-Barentsz, an intensive-care physiotherapist. For this reason, Felten-Barentsz is working with a group of fellow researchers to develop national treatment recommendations for all physiotherapists in Dutch hospitals.

The treatment plan was compiled based on scientific research and the best practices of several hospitals in the Netherlands. ‘We have also based our plan on experiences in Brabant, where the hospitals are actually in the lead’, notes Felten-Barentsz. The therapist further states that the treatment recommendations have been completed, and a scientific publication is nearly ready for submission. Felten-Barentsz is also a PhD candidate in research on physiotherapy in the ICU.

Heavy demand for care

Around 5% of all people with the coronavirus end up in the ICU. Each of these patients will stay on a ventilator for an average of two to three weeks. ‘That is a relatively long time’, observes Felten-Barentsz. ‘Particularly in light of the fact that you lose about 5% of your muscle strength for every day that you have to spend in bed’. In addition to the serious lung damage caused by the coronavirus, the process of ventilation inactivates the respiratory muscles.

This is a major problem, and not just for the patient. As more and more people leave the ICU, physiotherapists are suddenly facing a heavy demand for care. The national recommendations are intended to support physiotherapists in this regard.

‘The ultimate goal is to get the person out of that bed’

When asked whether presenting the plan now might be too late, Felten-Barentsz explains that it is not. Currently, the most seriously ill corona patients are still on ventilators and receive anaesthetics and muscle relaxants. ‘At that point, they are so sick that we can’t do much for them. Our job doesn’t start until the patient wakes up, but is still on the ventilator’.

Physiotherapists can help get people moving a little bit at a time. This starts with passive exercise, for example, stretching the arm of a patient who is incapable of doing so. ‘The ultimate goal is to get the person out of that bed and to have them stand up, or perhaps sit on a chair’, explains Felten-Barentsz. ‘Then they’ll be using the muscles that haven’t been in motion for a long time’.

Infection

One problem, however, is how to teach patients all of these exercises, given the need to maintain distance from corona patients. ‘If someone in the ICU is capable of rehabilitation, physiotherapy is truly indispensable’, observes Felten-Barentsz. ‘We therefore have to go into the unit, protective gear and all’. As a rule, once the patient has left the ICU and is in the nursing ward with other corona patients (i.e. the ‘corona ward’), a physiotherapist can no longer provide bedside assistance, due to the risk of becoming infected.

Fortunately, the researchers from Radboud have found a solution. Felten-Barentsz explains, ‘We already had a lot of hard-copy instructions and video materials. They can be used to explain to people the benefits of staying in motion. Videos can be used to share some breathing exercises that can help patients cough up phlegm more effectively’.

Physiotherapists are strongly advised not to provide such guidance at the bedside. Felten-Barentsz adds that nurses who are already present in the ward could also help with the instructions. ‘The physiotherapist doesn’t visit the corona ward unless it is absolutely necessary’.