Friday, May 01, 2020 COVID-19 Research Updates and Perspectives Recent publications address home- and community-based care, post-intensive care syndrome, cardiac rehab, performance screening, neurologic effects of the virus, and the potential role of exercise as protection against organ system damage. The COVID-19 pandemic may be far from over, but clinicians and researchers already are evaluating lessons learned, attempting to identify factors related to poor outcomes, and proposing potential models of care as patients return home — and into rehab. The resulting articles, often put on a fast-track for publication and made available for free by journals — including APTA's scientific journal, PTJ — provide both research findings and clinical perspectives. Here's a collection of recently published studies and opinion pieces relevant to COVID-19 and physical therapy. PTJ Advance Access COVID-19 and the Advancement of Digital Physical Therapist Practice and Telehealth "The global pandemic has thrust the physical therapy profession and our society into digital physical therapist practice and telehealth," writes Alan C. W. Lee, PT, DPT, PhD, but many clinicians may lack competencies in this area. The author provides recommendations on digital physical therapist practice and poses critical questions the profession must answer as it looks toward the future of digital PT practice. Lee writes on behalf of the Digital Physical Therapy Practice Task Force of the World Confederation for Physical Therapy and the International Network of Physiotherapy Regulatory Authorities. Home and Community-Based Physical Therapist Management of Adults With Post-Intensive Care Syndrome In a perspective article, authors discuss the prevalence and clinical presentation of PICS and offer recommendations for physical therapist examination, developing plans of care, and intervention. According to authors, many PTs may not be aware of the syndrome, which involves both physical impairments, such as decreased muscle strength and pulmonary function, and cognitive impairments. Authors note that around half of patients who have experienced ARDS (acute respiratory distress syndrome) also have cognitive impairments that persist long after their release from the hospital. As part of an interprofessional team, home health and outpatient physical therapists are "ideally positioned to address the reduced functioning and participation associated with PICS," authors write. In a related PTJ Podcast, co-authors Patricia Ohtake, PT, PhD, and James Smith, PT, DPT, discuss how PICS can affect return to work, as well as the individual's family. The Essential Role of Home- and Community-Based Physical Therapists During the COVID-19 Pandemic From the point-of-view article: "For many patients, participation in physical therapist interventions reduces risk of hospitalization and allows them to remain at home instead of requiring nursing home-level care — both essential public health goals during a viral pandemic that is currently overwhelming hospital and nursing home capacity. Abdicating these essential roles — and allowing our profession to be designated as nonessential and our urgently needed interventions to be viewed as optional in a time of crisis — may disproportionately harm the most vulnerable patients and send a troubling message to payers and the general public about our value as physical therapists." The article was funded in part through a Foundation for Physical Therapy Research grant made possible through a donation from APTA. In a related PTJ Podcast, co-author Jason Falvey, PT, DPT, PhD, lays out pressing challenges facing the physical therapy profession, research priorities, and key opportunities as a result of the COVID-19 pandemic. Impact of COVID-19 on Physical Therapist Practice in Portugal Physical therapists in Portugal write about the challenges they face in determining what qualifies as "urgent" care and suggest strategies for reducing risk of infection for the PT. Authors write, "If the COVID-19 crisis lingers for a long time, physical therapists may start shifting their practice toward therapeutic exercise and away from passive techniques that require close proximity." Italian Physical Therapists’ Response to the Novel COVID-19 Emergency Physical therapists in Italy describe how their colleagues have responded and adapted their practice in the wake of COVID-19, and share insights they have gained from their experience thus far. Physical therapists, they write, "are first and foremost health professionals and, before that, citizens who want to make their contribution to support the whole population and all the components of the health system responding to this emergency." From Around the Web Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff (Cochrane Database of Systematic Reviews) A new Cochrane systematic review found that "covering more parts of the body leads to better protection but usually comes at the cost of more difficult donning or doffing and less user comfort," and thus could increase the risk of contamination. To decrease the risk of contamination and reduce errors, authors suggest modifying PPE design to make it easier to use, following donning and doffing guidance from the Centers for Disease Control and Prevention, and providing face‐to‐face training in PPE use. Respiratory Muscle Performance Screening for Infectious Disease Management Following COVID-19: A Highly Pressurized Situation (American Journal of Medicine) Researchers hypothesize that impaired respiratory muscle performance, which is linked to poorer baseline health, is "an underappreciated factor contributing to poor outcomes" in COVID-19 patients. Authors offer a theoretical patient management model to screen for impaired respiratory muscle performance and potentially intervene with respiratory muscle training. The article was funded in part through a Foundation for Physical Therapy Research scholarship awarded to lead author Richard Severin, PT, DPT, board-certified clinical specialist in cardiovascular and pulmonary physical therapy, made possible through a donation from APTA. The role of physical and rehabilitation medicine in the COVID-19 pandemic: the clinician’s view (Annals of Physical Medicine & Rehabilitation) In a letter to the editor, authors describe the effects of COVID-19 on the respiratory system and central nervous system, as well as virus-related cognition, deconditioning, critical illness-related myopathy and neuropathy, dysphagia, joint stiffness and pain, and psychiatric problems. They also provide suggestions for how rehabilitation could be modified in light of social distancing and in consideration of a patient's condition. Extracellular superoxide dismutase, a molecular transducer of health benefits of exercise (Redox Biology) Authors review the literature on an antioxidant, extracellular superoxide dismutase (EcSOD), and the role it plays in protecting organ systems from oxidative stress and related disease conditions. Because studies have shown that exercise can increase the production of EcSOD, authors propose that endurance exercise could help protect against cardiovascular disease, pulmonary disease including ARDS, and multiple organ dysfunction syndrome. COVID-19: A Time for Alternate Models in Cardiac Rehabilitation To Take Center Stage (Canadian Journal of Cardiology) Authors of an editorial propose a care delivery model of "technology-driven cardiac rehabilitation" that includes a wide array of technologies, including smartphones, mobile apps, websites, and wearable sensors. Neurologic Features in Severe SARS-CoV-2 Infection (New England Journal of Medicine) In a correspondence, physicians in Strasbourg, France, share their observations on 58 patients admitted to the hospital who developed ARDS due to COVID-19. In these patients, authors found that ARDS was linked to encephalopathy, agitation and confusion, and corticospinal tract signs.