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  • Where Things Stand: COVID-19 and Practice Guidance

    Information and resources around physical therapy and COVID-19 continue to develop. Here's what we're recommending. (April 21 update)

    While APTA continues to point PTs, PTAs, and physical therapy students to the latest CDC guidance related to the COVID-19 pandemic, the association and other groups are creating more refined guidance related to specific practice settings and situations. Here are recommended resources to date.

    Outpatient (Added April 21)
    Here's a recap of resources APTA has developed to help outpatient practices.

    Home Health (Added April 14)
    HPSO, APTA's official provider of professional liability insurance for members, has created a resource that emphasizes the importance of CDC guidance and PT professional judgment, but dives deeper into considerations that need to be weighed when considering home health physical therapy — particularly during the COVID-19 health emergency.

    Nursing Homes (Added April 6)
    The U.S. Centers for Medicare & Medicaid Services issued new recommendations for nursing homes around the COVID-19 pandemic that urge states to attend to the personal protection equipment needs of long-term care facilities, and press nursing homes to establish separate staff teams for COVID-19-positive residents. The recommendations also include universal testing in the facilities and use of PPE "to the extent PPE is available."

    Physical Therapist Management of Patients With Diagnosed or Suspected COVID-19 (Updated April 8)
    This APTA resource provides perspectives on issues such as when a PT should tell patients not to come in for their outpatient PT visits, as well as management of patients diagnosed with COVID-19 in inpatient facilities, home health settings, experiencing post-intensive care syndrome, and in need of wound care. The guidance also includes information on preparation of physical space to reduce infection risk, use of PPE, and helping patients to stay active while at home.

    Pediatric Physical Therapy
    Physical therapist services to the pediatric population may have special considerations during the COVID-19 pandemic. APTA put together this information for PTs and PTAs who manage these patients, particularly in school settings. Topics include school closings and IEP services, remote learning, and a discussion of factors that need to be considered in providing pediatric physical therapy via telehealth.

    Acute Hospital Physical Therapy
    A new set of recommendations for provision of physical therapist services related to COVID-19 in the acute hospital setting acknowledges the necessity of involvement of PTs well-trained in respiratory physical therapy, but cautions that facilities should be judicious in their use. The recommendations have already been endorsed by APTA, its Cardiovascular and Pulmonary Section, and the APTA Academy of Acute Care Physical Therapy, albeit with a few caveats that not all of the Australia-based guidance will apply in the U.S.

    Long-Term Care Facilities
    The American Health Care Association and the National Center for Assisted Living released a joint document focused on changes to physical therapy, occupational therapy, and speech-language pathology services to reduce the spread of COVID-19. Recommended changes to be considered by LTC facilities include discontinuation of group and concurrent therapy, delivery of therapy in resident rooms rather than therapy gyms, and the use of social distancing "as practicable." AHCA and NCAL also advise against therapists moving between buildings if COVID-19 is discovered in one building.

    Wound Care
    The Alliance of Wound Care Stakeholders, a group that includes APTA, the American Association of Nurse Practitioners, the Amputee Coalition, and others, issued a statement countering hospital decisions to shut down outpatient-based wound care departments as "non-essential" during the coronavirus pandemic.

    Dementia Caregivers
    The Alzheimer’s Association, in collaboration with Academy of Geriatric Physical Therapy and others, developed tips for dementia caregivers in long-term or community-based settings.

    AHCA/NCAL: Making Decisions on Essential Staff Entering Your Building
    The guidance helps nursing facilities assess the risks versus benefits in working with various essential services such as rehabilitation therapy, labs, and portable x-ray.

    Comments

    • What about outpatient PT? Should it be closed down if they can’t do tele conference or skipe?

      Posted by C on 3/31/2020 5:05 PM

    • I work for an out patient clinic specialized in back care. We are primarily manual therapy and work in close proximity to mult patients a day. We are not being provided any PPE. The ones they have are being saved for patients. I was told today if I want a mask I need to provide one myself. I am having difficulty finding any. Any advice?

      Posted by Shannon Garrett on 3/31/2020 5:28 PM

    • Where is your guidance for the outpatient facilities? Why have you not taken a stance and provided guidance to those who you wish to be members of your service? This looks bad on your part.

      Posted by N/A on 4/1/2020 8:03 AM

    • Please provide guidance about OUTPATIENT.

      Posted by C on 4/1/2020 9:53 AM

    • Please make a solid decision about outpatient PT! We are working with NO PPE & providing manual therapy! If CDC guidelines cannot be met, please call for a shutdown!

      Posted by N/A on 4/1/2020 10:37 AM

    • this site specific practice guidance does not include home health.

      Posted by Diane Huss -> @MWZD on 4/1/2020 11:52 AM

    • We need information on outpatient PT as well. Direct contact with patients is occurring every day without an increase in PPE being sent. What about secretaries? They should not be required to be exposed in a PT office. What if a coworker is tested positive and business does not shut down? What are the laws?

      Posted by Marina on 4/1/2020 12:31 PM

    • I am in agreement with the above concerns. Should we be evaluating in outpatient clinics in rooms without a mask on? should we be In a gym instead with more space between and what are the HIPPA concerns? Or should we be in PPE like nurses due to the uncertainty of how easily the virus is spreading. Thanks, Stephanie

      Posted by Stephanie on 4/1/2020 1:48 PM

    • Why is APTA purposely avoiding having a stance on outpatient. It seems rexkless to expose our communities to many unnecessary and non-urgent treatments. Any APTA guidance? Multiple other people are asking the same question

      Posted by Tb on 4/1/2020 2:07 PM

    • The lack of information from the APTA in regard to "best-practices" for outpatient physical therapy services during this COVID-19 crisis would be akin to the AMA only disseminating information to ER physicians and hospitalists while neglecting the primary care and orthopedic physicians. As a physical therapy private practice owner, I am only able to make decisions based on the opinions and actions of fellow practice owners in regard to continuing operations (and believe me, opinions are VARIED WIDELY...and some PT's have become quite vocal about those of us who have chosen to remain open with limited services). I have been in this profession for 34 years and have always been supportive of the APTA. However, I don't think I stand alone in my disappointment of our national organization's lack of response to outpatient physical therapy practitioners during this crucial time.

      Posted by Don Freehafer, PT on 4/1/2020 3:47 PM

    • What is the guidance for the outpatient facilities? Should we continue to treat patients? If so do therapists and patients need to wear masks?

      Posted by Heather on 4/1/2020 4:54 PM

    • Very disappointing! This is an incredibly poor and unclear stance from the APTA. At this time of crisis, ethically speaking and in my professional judgement, all outpatient physical therapy clinics should temporarily close down. Unless the APTA will specifically address outpatient clinics to shutdown, then unfortunately, physical therapy clinics will remain open and cause more harm to their patients, providers and the community. I realize these are incredibly turbulent and stressful times but an immediate action and firm words by our leaders are essential. At this time of crisis physical therapists are NOT essential health care providers!

      Posted by Arik on 4/1/2020 6:19 PM

    • Agree with other comments - those of us in outpatient private practice need updated guidance. We need our professional organization to take a firmer stand and give more specific guidance. You are putting us private practice owners in a dilemma - our employees and our patients need clarity, and it's unfair to leave us hanging. Thank you!

      Posted by robin ryan on 4/1/2020 7:23 PM

    • I agree with prior posts- please include guidance and support for outpatient PTs.

      Posted by RN on 4/1/2020 7:35 PM

    • Ya what? No OP PT recommendations? We are doing what we feel is prudent and necessary anyway. Limiting treatment to only very critical cases and taking appropriate precautions. HEPs are extra important. Every single patient has all been understanding of us doing our part to avoid possible spread.

      Posted by Gary Hofmann on 4/1/2020 8:28 PM

    • Yes, I too am curious about APTA’s thought related to orthopedic outpatient care that, although considered “essential” by state guidelines, does not provide true emergent care. What is the clinic’s responsibility in regard to protection from exposure to employees and patients. I am in a clinic that supplies glove and procedural masks although no gowns for manual contact. Also, due to patient volume and clinic set up, we are not able to follow social distancing guidelines a majority of the time. I do continue to provide treatment but wrestle with the question of at what point does the risk out weigh benefits?

      Posted by Jen on 4/1/2020 8:47 PM

    • I do not see any guidelines for home health PTs seeing Covid-19 + or patients with symptoms yet not confirmed. What is your clinical recommendations for treating at community level. Should a PT seeing + cases only treat this specific patient population to decrease transmission risks from home to home. Is home health even indicated and essential/safe at this time to avoid cross contamination. We do see frail patients and would welcome some professional guidelines. How about Hippa privacy when PPE has to be put on outside of patients’ homes? Thank you.

      Posted by Johanne on 4/2/2020 12:14 PM

    • Where is the home health guidance? Please address Hipaa when PPE has to be donned outside of home, infection control and clinical guidelines to safely treat + patients and patients showing symptoms and awaiting test results. Are we essentials? What about the risk of cross contamination going from home to home. Please help us clarify our role and establish better safety measures to provide care. Thank you.

      Posted by Johanne on 4/2/2020 12:21 PM

    • Should we see patients in outpatient PT practice or not? What are the guidelines for outpatient PT practice.

      Posted by C on 4/2/2020 2:13 PM

    • I am highly disappointed in the lack of support from the APTA in this time of crisis. I work in a SNF and feel I am being asked to compromise my patients myself and my family as well as potentially do things that are not in the up and up. I am not essential at this time.

      Posted by Nik on 4/2/2020 4:35 PM

    • I too would like to call for some guidance regarding home health PT best practice at this time. If someone is recovering from a hospitalization resultant from COVID should they even be receiving therapy at that time or do we know yet if this is going to exacerbate their condition (i.e. pulmonary fibrosis)? It’s awkward being put beneath a blanket statement provided by the CDC regarding healthcare being essential when I have a hard time rationalizing to patients why I am, indeed, essential at this time. Some have flat out refused visits and I cannot say I blame them!

      Posted by Jeff on 4/2/2020 6:25 PM

    • Stop doing what you're not comfortable doing! You don't have to do manual therapy. Keep your space and don't treat sick people. Perhaps you keep patients out of the ER if you can manage their orthopedic pain. Use your professional judgement with yourself and your clients. Stop asking for someone else to tell you what to do.

      Posted by Mark Zamora on 4/2/2020 10:35 PM

    • @Jeff : Physical therapists are a critical, essential part of the health care ecosystem. One of the primary concerns regarding patients in home health is that they are at significant risk of falling, and if visits are not done, then hospitalizations may increase and/or their impairments can become permanent. That said, if you can safely or effectively deliver home care remotely or with technology, then you should explain that to your employer to discuss options for telehealth or remote services. If possible, you also could provide home programs for the patient to follow to prevent deconditioning. However, for those patients who require the hands-on, in person skills of the therapist, below are some criteria to consider before visiting the home: • Contact the patient ahead of time and ask screening questions (see CDC guidance) before going to the home • Use standard transmission-based precautions • Ensure you and your staff have adequate PPE o If you are treating a patient who is suspected or confirmed to have COVID19 or if you or the patient are in a high risk category use recommended personal protective equipment (facemask, gloves, follow the CDC Standard Precautions) o If protective gear is not available cancel treatment or provide phone consultation/contact CDC provides strategies for optimizing the supply of facemasks, including conventional capacity strategies, contingency strategies, and crisis capacity strategies, as well as the CDC guidance when no facemasks are available.

      Posted by APTA staff on 4/3/2020 9:02 AM

    • Ok I am an out patient owner in NY I treat every patient wearing a N95 mask Treating a patient without a mask is very risky My secretaries wear masks Most patients are not coming to PT anyway Down 70% it’s crazy. I always ask my patients how they are feeling when they first come in ie no fever cough loss of smell fatigue chest tightness hard to breathe Today I called 40 patients after hours to see how they were feeling. We discussed their diagnosis and reviewed their home program I guess I can bill the using telemedicine But I am not sure of the codes

      Posted by John on 4/3/2020 7:30 PM

    • If you clinic on the hyperlink of the "General Guidance for PT management with Diagnosed or Suspected Covid-19," it speaks to guidelines and recommendations for outpatient physical therapy clinics. Take a second to breath and read. Everyone is trying their best here.

      Posted by Daniel Chelette on 4/5/2020 3:52 PM

    • @John: John: Calls placed to patients as a general follow-up are not a billable service however there are several codes that can be used by physical therapists for communication with patients. The primary consideration in billing these codes is that the services are patient initiated. You can advise your patients that these services are available to them so they can reach out to you if needed. The services include e-visits (which require the use of and online portal), virtual check-ins (which can be performed using a number of different technologies including telephone only) and telephone assessment and management services. Additionally, many payers have now adopted policies for true telehealth provided by physical therapists which provides the opportunity for therapists to evaluate or provide treatment to patients through audio-visual technology. Please see the information provided at this link to assist you in determining how you might best support your patients http://www.apta.org/Telehealth/

      Posted by APTA staff on 4/6/2020 8:53 AM

    • @daniel, the information regarding outpatient PT is too basic, and not updated. I just read it and re-read it. PTs need specific instructions for outpatient PT regarding use of PPE in light of asymptomatic carriers. I agree with so many others posting here. Please make a new section for "outpatient and private practice PT." Please make some specific recommendations such as: patient and clinician to wear simple surgical or cloth mask, stay 6 feet apart, follow CDC cleaning and screening precautions, in ALL communities, as transmission is currently widespread in the U.S. If N95 mask is available, wear during manual techniques or when closer than 6 feet from patient, otherwise, both patient and clinician to wear cloth or level 1 surgical mask. We KNOW asymptomatic transmission is a reality, so asking if someone has a fever, some shortness of breath, cough, or an area of community transmission is simply not enough at this point in time. Risk vs benefit, do no harm all come into play in the current situation. Please make a checklist...an "if-then" flow chart for routing patients to home or clinic, as well as recommendations and use of PPE (even if BASIC). It can be something therapists can take to employers so that health of patients and staff comes first. Thank you for all you are doing!

      Posted by M-A on 4/6/2020 2:54 PM

    • Why is the APTA completely neglecting recommendations for OUTPATIENT? This is very frustrating.

      Posted by KW, DPT on 4/6/2020 6:58 PM

    • Outpatient guidance is not provided because no one knows what to do. Manual therapy requires constant close contact. With 20-50% of infectious Covid-19 patients not showing symptoms, we must assume, no matter how careful our screening is, that all patients entering the clinic are infectious. That means we are having constant close contact with someone suspected of having Covid-19. So what is the CDC guidance on that? Look it up. No outpatient clinic currently has such capability. Full droplet and airborne precautions, at minimum. HEPA filters with the ability to filter air 10 times per hour in all spaces are advisable. Additionally, any patient with a known risk factor should be excluded from clinic. At all costs, infectious persons and persons with risk factors that increase chance of hospitalization or death if infected must be kept apart. What is the need of a patient for physical therapy services? Invert that question: What is the risk to the patient if they do not receive face to face physical therapy care? Then compare that risk with the risk of potential exposure to coronavirus while receiving that care. In how many instances does the risk/reward ratio justify care? By how much does the risk decrease if full droplet and airborne precautions are taken? Do those precautions adequately shift the risk/reward ratio in favor of a face to face visit?

      Posted by PPE is not enough on 4/7/2020 12:13 PM

    • If physical therapists want to be seen and treated as valued members of the healthcare team, then we need to show initiative in how we will protect our patients and PTs in the outpatient setting. We must remember to use empirical evidence when making such decisions and protect the sustainability of our profession. The APTA must stop sitting on the fence, get in the ring, and protect us outpatient therapists! We have no guidance to bring to employers regarding how to keep us safe with patient care that has occurred within less than six feet of the patient since orthopedic physical therapy began. Please protect this profession from the wide variety of actions and opinions that will likely disgrace this profession after this COVID-19 pandemic.

      Posted by Dr. Laura Perry, DPT on 4/7/2020 12:42 PM

    • I agree with most of the above comments. Therapists need to think out of the box because the APTA is not doing it for us. I am the only one in my office treating acute and post op patients. Patients are given an online covid-19 questionnaire with all pertinent questions the day before their appointment and then asked before they enter the office. I have been unable to procure a forehead thermometer, ( it is on back order for over 3 weeks) The questionnaire asks about foreign and domestic travel, contact with suspected persons, their own health etc. IF all negative they are asked to wear a mask before the enter the office and not touch anything until they wash their hands for 40 seconds per WHO guidelines. Then they go into one treatment room I already have on a long sleeved, high neck shirt, a very tightly woven full length apron ( from neck to mid thigh underneath two hospital gowns gloves goggles n95 mask This does not adhere to Osha standards so none of my staff could do this, but I think its pretty good protection, I also am very careful to take the gowns off so as not to spread any possible contaminant and place carefully in an open plastic bag. Goggles and face mask get washed and dried before next patient. And everything including the chair the patient sat on, the treatment table including the face hole and the metal below the face hole, the sinks, pens and everything the patient touched is wiped down with the disinfectant wipes. Goniometers, tape measures etc are washed. This takes a minimum of 1/2 hour and up to 45 min to do the cleaning but I want to be safe and keep my patients safe. And I change clothing before leaving the office and shower when I get home. Mentally exhausting. And I still want to know if we can or cannot do telehealth for medicare patients!

      Posted by Elizabeth Scarpelli on 4/7/2020 4:29 PM

    • Local clinics are advertising sports rehab and treating elderly clients with multiple medical conditions; the homeland security and CDC documents note that clinician DISCERNMENT is needed, and that non-urgent care must be weighed against the risk. I am a practice owner with 23 empoyees. I GET IT. And in our area with highly educated clients, they are cancelling due to avoiding the risk, and there are still pregnant and elderly clients who are seeking care. Our responsiblity is to DO NO HARM. As an APTA member for 33 years, I am waiting for you to do the right thing. Promote EXAMPLES of CLINICAL DISCERNMENT of when in person care with PPE is OK (and that absence of PPE shoudl result in CANCELLING CLIENTS). Come on folks, grow some balls, review the literature and take a stand. You are actively disenfranchising a generation of young PT's who are reading your inaction and silence as a complete disregard for their safety and your willingness to choose revenue over safety.

      Posted by Elizabeth Hampton -> =GY_EF on 4/8/2020 7:21 PM

    • It is much more difficult to walk the right rope between risk and benefit for each patient than it is to simply be told to close. Many have said "do not harm". Not treating a patient that wants treatment is harm too, especially when the alternatives the patient may be less safe than physical therapy and reduce quality of life. There is no definite timeline for this, the risk in some parts of the country may very well be higher 8 months from now as this virus either becomes endemic or becomes seasonal. This will likely be a threat at some level until sufficient people have caught it to create herd immunity or a vaccine is produced and mass distributed. If the APTA were to make a blanket recommended for outpatient clinics to close based on a certain level of coronavirus risk across the USA may result in year long closures and prolonged lack of access to crucial physical therapy care. You also can't apply the same clinical judgement for New York City physical therapists as you do for a therapist working in West Virginia, the virus will run a different course at various geographical locations. This is what it means to use professional judgement. If you are a licensed PT you are obligated to discuss risk and benefit with your patients. Decide based on evidence, experience and patient preference how you want to proceed case by case. Physical therapists work in ambiguity all the time, decisions are made that impact patients lives. Stand up and face the decisions that you have to make and live with them. We may make mistakes but this is our calling as medical providers. Use your best clinical judgement my colleagues!

      Posted by Brandon, DPT on 4/9/2020 7:37 AM

    • The APTA is recommending that as therapists we should be following CDC guidelines. The CDC guidelines now state: "facilities should delay elective ambulatory provider visits...provider visits related to prevention services should be postponed unless the risks of postponement are believed to outweigh the benefits.". How does this statement/guideline apply to outpatient physical therapy services? APTA WE NEED GUIDANCE! We need to come together as a profession and develop a strategic plan. I understand the need for those who are post-op to continue receiving in-person services, but what about those patients who are coming in for "prevention of further pain" or "exercises to improve x,y,z". We are pleading for guidance as a profession.

      Posted by n/a on 4/9/2020 8:54 AM

    • If PPE is a requirement in any case to treat, even if both the client and the provider are asymptomatic, is this the best use of PPE today? When providers in ERs and ICUs do not have adequate PPE in a highly infectious environment and PTs are using this resource in a low risk environment, is that an appropriate and ethical allocation of resources? I don't think so. At a minimum, for PTs to practice in OP, there needs to be an adequate quantity of PPE. Unless you can justify see patients without adequate protection that puts the provider and their family/social network and the patient and their family/social network, at risk. Today, (hopefully not tomorrow), I would posit it is not an option to use PPE in a non critical environment until that resource is more available.

      Posted by Herbert Silver -> >JX^D on 4/9/2020 3:58 PM

    • Are there any recommendations for physical therapy evaluation and treatment of home health patients that are positive for COVID-19?

      Posted by Jessica Parton -> BHQ]AH on 4/10/2020 4:04 PM

    • I am a 61 yo outpatient oncology rehab and lymphedema specialist. I work in extremely close contact with my immunocompromised patients, some with weeping skin conditions. In early March, I was wearing a mask and gloves, using an air purifier in my tiny treatment room, carefully changing all bedding in between patients, lengthy handwashing, afraid to take a sip of water in between because that would mean mask removal, repeat 8 times per day. Then learned (from nurses, not APTA) I should also be wearing goggles, have my hair covered, be wearing a cover-up gown. Sitting in a small charting room with my colleagues, eating lunch and using a shared computer station - - did I just rub my eyes? Had I contaminated these orthopedic PTs who are able to socially distance? Had I inadvertently shared contaminants between my at-risk patients? Had I brought home Covid to my husband who has COPD and heart failure? And despite my robust health, what about my own congenital cardiac WPW and asthma? By mid-March I could no longer find PPEs so I was reusing my mask. That is when I stepped down. I felt defeated, that I had failed. And a day later CA issued shelter-at-home. And during this entire time I had been searching for advice and support on specific physical and emotional strategies. Going forward, I suggest APTA and other leaders in our field develop detailed, step-by-step protocols for outpatient practices that don't have the knowledge and benefits of working in a hospital.

      Posted by Teri Burk on 4/13/2020 1:52 PM

    • Agree with many prior comments: it is blatantly irresponsible not to provide outpatient PT guidelines. Manual therapy and proximity to patients is an ongoing problem with only silence from APTA after 3 weeks+. CDC does not understand the dynamic in a physical therapy office. APTA must lead.

      Posted by wayne macmasters -> DNUc>F on 4/13/2020 10:11 PM

    • I’m a homecare therapist being asked to see patients discharged from hospital after ICU admit and intubation, still with positive COVID tests at time of discharge. Furthermore, many of these patients live in homes where others have had symptoms but have not been tested. The only guidance I find from WHO, CDC and APTA references at home care for patients with mild symptoms/no acute hospitalization. Patients are being sent home prior to testing negative. I feel as if my health and safety is being ignored.

      Posted by NA on 4/14/2020 3:19 AM

    • @Jessica, Wayne, and others regarding home health: Please see: http://www.apta.org/PatientCare/COVID-19/PatientManagementAdult/. See also: https://aptahhs.memberclicks.net/coronavirus--information-for-providers

      Posted by APTA staff on 4/14/2020 8:25 AM

    • I'll share what our clinic has done during the COVID-19 out break. Once the governor of California declared a stay at home order, our clinic shut our doors and began cancelling patients as of 3/20/20. All staff were essentially furloughed and 1-2 office each day were in the clinic to answer phone calls and perform clerical duties. We remained closed for two weeks, seeing no patients. Management made arrangements to obtain surgical masks and gloves and arranged our clinic to allow for maximum distancing between patients. Staff returned to work on a limited basis and functioning at only 40% of our normal volume. Patient's that had recently undergone surgery received priority appointments and then decisions were made on a case by case basis for all other patient's. Therapists called patient's at home to either encourage a follow-up visit or to remain home and perform prescribed home exercises. Many patient's have chosen to stay at home but slowly, more patient's are returning to the clinic. Patient's are screened at the door, before entry and their temperature is taken and asked several questions regarding their health status. All patient's are issued a mask if they don't already have one and also given gloves. All patient's have been encourage to be faithful in their HEP to avoid having to go out in the community to attend PT visits. All staff also have to have their temperature at the beginning of the day and also a second time in the afternoon. All equipment and treatment tables are wiped down after each use. This has allowed us to continue to provide care for our patient's and not be accused of abandonment of care. Staff and patient's have acknowledged that they feel safe and are at minimal risk for exposure given the precautions and steps we have taken.

      Posted by DK on 4/14/2020 8:03 PM

    • I'm an OP Manual PT working for a private PT company renting space inside of a Primary Care Physician office on Long island. I'm currently not working in the clinic after being partially laid off ( only telehealth visits from home) who is not willing to return to the clinic until I know that these issues about STRONG revised PPE guidlelines for manual therapist are cleared up by our professional authority the APTA . All the topics brought up in most of these posts have been on my mind all week. I feel the CDC and other political authorities who make the hard decision about who an " Essential Worker " is , are not fully educated about our specialty . We need to know that the APTA will not forget about us, especially since the this virus has SILENT/SYMPTOM FEE CARRIERS. These people will be the hardest , if not impossible to distinguish from other covid-19 free clients. We dont know how many Typoid Mary's are out there , they dont even know who they are. This scares me the most .... A new Standard of Precautions is needed now because the Novel Corona Virus is here and not going anywhere any time soon . For all those that are on Furlow or currently working now are going to start getting pressure to return to the clinic ( or increase their work load) and need to know the private business owners know what the new standards are so we, the Staff PTs have protection from lack of resources which is the biggest topic/crisis for physicians and nurses throughout our countries acute settings . We are below tertiary on the PPE list at these hospitals /SNF/LTC facilities. So what does that mean for OP facilities ?? Is it possible to even get the PPE that is needed for use to function as a MANUAL THERAPIST?? Please APTA help protect us!!!

      Posted by Phil C NY DPT on 4/14/2020 10:34 PM

    • Outpatient private practice PT guidance please...for all potential employees. APTA understands the setting...manual therapy, less than 6 feet for almost all that we do, exposure to office staff, etc. Are we setting the stage for being one of THE primary reasons for spread of COVD-19?

      Posted by CD on 4/15/2020 7:24 PM

    • APTA STAFF HAVE BEEN REPLYING TO HOME HEALTH QUESTIONS, BUT NOT TO OUTPATIENT PT. ****THE APTA NEEDS TO ISSUE A STATEMENT RE: OUTPATIENT ORTHO/SPORTS MED PT. **** IT IS THE RESPONSIBILITY OF OUR PROFESSIONAL ORGANIZATION, TO WHOM WE ALL PAY ANNUAL DUES, TO OFFER THIS TYPE OF GUIDANCE. PLEASE SUPPORT AND PROTECT YOUR LOYAL MEMBERS. AND PLEASE DON'T WAIT ANOTHER MONTH (IT'S ALREADY TAKEN TOO LONG) AND THEN OFFER GUIDELINES AFTER THE DUST HAS SETTLED. ****PLEASE PROVIDE GUIDELINES FOR OUTPATIENT ORTHO/SPORTS MED PT*****

      Posted by NA on 4/16/2020 8:27 AM

    • Suggestions for working in outpatient facilities as we understand CDC guidelines: 1. All staff and patients screened before entering the building (fever >99.4, development of cough, development of new upper respiratory issues, exposure to know person with COVID-19 in the past 14 days, recent travel outside of county - not country). Staff are required to text or email temps prior to coming to work. Patients are asked to take temps prior to coming to physical therapy and are then again screened once entering the building. 2. Clinic set up modified to allow for social distancing to be maintained between patients at all times (arrangement of tables, equipment and use of treatment rooms). Limit how many patients / staff in the building at any given time. 3. Patients required to wear some type of cloth mask at least. 4. Clinicians to wear at least a cloth mask when social distancing CAN be maintained. If social distancing can't be maintained, clinical staff wears appropriate PPE as determined by the CDC. Our clinical staff now wear scrubs which are washed and changed into on-site. Clinicians no longer wearing jewelry on wrists and / or hands. 5. Physical Barriers set up for office staff in addition to wearing at least a cloth mask. Patient pens are 1 time use between being disinfected. Create a situation where social distancing can be maintained if possible. 6. Waiting area is no longer available. Patients are to wait in car until their appointment time and family members waiting for patients are asked to wait in their vehicles. If patients arrive early, we have them wait in the car and call the patient once we are ready for them. 6. Everyone must wash hands upon entering the building (>20 seconds). Clinical staff must wash hands between working with patients. 7. Patients issued gloves to wear if making contact with equipment. 8. Equipment / Machines / Tables that comes in contact with patients need to be disinfected after use. In addition, door handles, light switches, etc. were contact is made must be disinfected after contact (we have changed bathroom lights to be motion sensitive since everyone is asked to wash hands there) 9. HVAC system filters changed with higher level filters (MERV 14-20) and fans to HVAC system are turned on all the time to constantly replace the air in the building. These are many of the key steps our organization has taken to continue to treat in an outpatient setting. THIS LIST SHOULD NOT BE CONSIDERED A GUIDELINE. Please refer to the CDC or APTA for guidelines. This is just some of the specific steps our organization is taking. The list has changed as new information becomes available...which seems almost daily. Hope that helps someone.

      Posted by Chris Z on 4/16/2020 3:29 PM

    • We need guidance for outpatient settings. We do not have proper PPEs. We cannot practice social distancing from our patients. How many more people need to post the same questions before we get an answer?

      Posted by KD on 4/16/2020 11:33 PM

    • There have been a lot of conflicting information and confusion about Outpatient Physical Therapy being an ESSENTIAL SERVICE during the COVID-19 pandemic. They are not an essential service should be closed during the COVID-19 Pandemic. My “reasonable” opinion along with many, many others, is that Outpatient Physical Therapy offices should be closed during COVID-19 Pandemic, unless they use Telemedicine. It is impossible for a Physical Therapist that works in an Outpatient Physical Therapy Office, to be 6 feet away from a patient while treating a patient. It is impossible for them not to touch you while providing treatment. Therefore, they are not able to follow the Social Distancing Mandated Order to be 6 feet away from a patient, because they have to be very close to the patient to provide treatment. Below are examples of up close and personal treatments from Out Patient Physical Therapists: Outpatient Physical Therapists treat a patient with physical modalities including massage, heat, cold, Iontophoresis – electrical stimulation, laser light therapy, Kinesion Taping, lumbar traction, joint mobilization, to decrease pain, inflammation, and treat muscle strains and sprains USING TOUCH. (Up close and with touch). Physical Therapists do not save lives, they see patients for non-threatening injuries. They teach patients how to properly use therapeutic exercise techniques to alleviate pain. They are experts in movement. A lot of people live with pain every day. If pain is very bad, their physician can prescribe a prescription for pain. Therefore, Outpatient Physical Therapy offices are a NON-ESSENTIAL SERVICE. These outpatient offices are putting patients and their staff at risk for the COVID-19 VIRUS. This is reckless and negligent! They have a duty of care to protect people from harm. The front line health care providers ARE ESSENTIAL BECAUSE THEY SAVE LIVES. A physical therapist that works in a hospital is part of a PHYSICIAN TEAM of healthcare professionals that works in acute care. (Surgery) They are VERY educated about cross contamination –they always wear PPE and constantly disinfect everything. A hospital team’s goal is to ensure that the surgical patient will be moving around safely while in the hospital and when the patient leaves the hospital. This physical therapist’s job in a hospital would be considered as an ESSENTIAL SERVICE. A lot of outpatient physical therapy offices are not very diligent about constant wiping everything down. Most do not wear gloves while treating a patient. They do not wash their hands after treating a patient. Most offices will have 5-10 people in the room at the same time. Money is being valued over lives. Jeff

      Posted by J on 4/18/2020 3:54 PM

    • Practice guidance for the outpatient setting: please see http://www.apta.org/PatientCare/COVID-19/PatientManagementAdult/ and http://www.apta.org/PTinMotion/News/2020/03/31/WhereThingsStandPracticeGuidance/ these resources are regularly updated. APTA also continues to update our general coronavirus page at http://www.apta.org/Coronavirus/

      Posted by APTA staff on 4/21/2020 8:45 AM

    • APTA, PLEASE advocate for your physical therapists and set guidelines on OUTPATIENT PHYSICAL therapy in NJ. Governor is considering outpatient PT as “ essential” however we are experts in movement , we are dealing with non life threatening issues in an outpatient setting. There is no way to maintain the cdc guideline of 6 ft social distancing when you are providing manual therapy interventions or tactile cues for improper technique or body mechanics with an exercise. We are exposing patients and staff everyday and could be continuing the spread of the virus due to the inability to maintain 6 ft distancing and not having proper PPE for being in close contact with patients, at what point does the cost outweigh the benefit!? APTA stand firm and give us PT’s a set of clear guidelines and restrictions that need to be in place if offices remain open.

      Posted by Courtney on 4/22/2020 7:54 AM

    • OP PTs are being asked to choose between their livelihood or risk contracting a deadly disease. I have called OSHA for guidance and have been told that existing regulations should be followed but no specific regulations are in place for OP clinics. Just follow CDC guidelines. There are clinics operating that do not have PPE and do not follow social distancing guidelines and are not trained in disinfecting a workplace. The only answer IMO is for OP clinics to close until these issues can be fixed. Staff should be collecting unemployment benefits under CARES Act provisions. Patients that need post op or sub acute care should go to OP clinics in hospitals that have experience in infection control.

      Posted by Fred Nesvet on 4/28/2020 5:14 PM

    • • @Courtney: Practice guidance for the outpatient setting: please see http://www.apta.org/PatientCare/COVID-19/PatientManagementAdult/ and http://www.apta.org/PTinMotion/News/2020/03/31/WhereThingsStandPracticeGuidance/. These resources are regularly updated. APTA also continues to update our general coronavirus page at http://www.apta.org/Coronavirus/

      Posted by APTA staff on 4/29/2020 8:25 AM

    • @Fred: OSHA’s primary resource is the OSHA COVID-19 Official Webpage. This page is being updated routinely and we encourage you to review it frequently. Enforcement Memorandums: Seven (7) memorandums related to COVID-19 are in effect and intended to be time-limited to the current public health crisis: • 04/16/2020 - Discretion in Enforcement when Considering an Employer's Good Faith Efforts During the Coronavirus Disease 2019 (COVID-19) Pandemic • 04/13/2020 - Interim Enforcement Response Plan for Coronavirus Disease 2019 (COVID-19) for handling COVID-19-related complaints, referrals, and severe illness reports • 04/10/2020 - Enforcement Guidance for Recording Cases of Coronavirus Disease 2019 (COVID-19) • 04/08/2020 - Expanded Temporary Enforcement Guidance on Respiratory Protection Fit-Testing for N95 Filtering Facepieces in All Industries During the Coronavirus Disease 2019 (COVID-19) Pandemic • 04/03/2020 - Enforcement Guidance for Use of Respiratory Protection Equipment Certified under Standards of Other Countries or Jurisdictions During the Coronavirus Disease 2019 (COVID-19) Pandemic • 04/03/2020 - Enforcement Guidance for Respiratory Protection and the N95 Shortage Due to the Coronavirus Disease 2019 (COVID-19) Pandemic - [1910.134 App B-1] • 03/14/2020 - Temporary Enforcement Guidance - Healthcare Respiratory Protection Annual Fit-Testing for N95 Filtering Facepieces During the COVID-19 Outbreak Healthcare Industry Resources: OSHA: • Healthcare Workers and Employers • Emergency Response Workers and Employers

      Posted by APTA staff on 4/29/2020 8:26 AM

    • The patient population of my outpatient clinic is infants/toddlers. My work is face-to-face hands-on.My clinic has been closed since our state announced shelter-in-place. I intent to re-open June 1. I have had difficulty with kids knocking off my glasses during interventions. I suspect that this will also occur with facemasks. I need guidance on appropriate PPE.

      Posted by J Mast on 5/6/2020 10:42 AM

    • As a physician mom with a PT daughter, please speak up APTA. OP PT is not essential except postop care. If you think it is then YOU need to supply PPE now. My daughter needs protection. Where are you people? There is NO social distancing in OP PT. Protect your own.

      Posted by Kathryn Schutt Kinnear on 5/11/2020 9:37 AM

    • I was a patient before and I need to continue with my therapy. When will I be able to go back to the PT business, with the work out machines and massages? In a lot of pain. I am happy to wear full PPE.

      Posted by Paula Miller on 5/14/2020 11:35 AM

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