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With the original version now nearly two years old, authors of one of the first guidance resources for physical therapist services related to COVID-19 have revised and significantly expanded their recommendations. As it was when originally published, the Australia-based resource has been endorsed by APTA, the APTA Academy of Cardiovascular and Pulmonary Physical Therapy, and the APTA Academy of Acute Care Physical Therapy. The open-access guidelines were published in the Australian Physiotherapy Association's Journal of Physiotherapy.

The revised guidelines update 20 previous recommendations, add 30 new ones, and feature an entirely new area devoted to recovery after COVID-19. The new section offers insight on the PT's role in management of what authors call "post-COVID syndrome," aka long COVID, or PASC, but every previously existing section of the resource has been expanded.

Authors write that since the first publication of the recommendations, in March 2020, "the experience of health care providers and policymakers in dealing with the pandemic and research specific to the COVID-19 population has expanded rapidly."

Additions and Revisions Cover a Wide Range of Areas

Six major areas are addressed in the guidelines: physiotherapy workforce planning and preparation; personal protective equipment; populations appropriate for PT treatment; physical therapist respiratory interventions; recommendations for mobilization, exercise, and rehab interventions; and the new section on recovery after COVID-19.,

The section that saw the highest number of new recommendations was related to physical therapy workforce planning and preparation, where authors added guidance related to planning for shifts in workload management, maintaining readiness, and requiring vaccination. The section also includes a new subsection devoted to clinical education, with authors recommending that student placements should continue "where this is safe and possible," and if not possible, that alternative clinical training be offered, "ensuring accreditation standards are met."

The new recovery section contains three recommendations — that PTs should encourage physical activity and health lifestyles, that PTs should support multi-professional rehab programs that span the patient trajectory from acute illness to return to the community, and that PTs should anticipate increased need for their services.

Other notable additions in other sections emphasize the importance of staff training on the use of personal protective equipment, what to do in response to a breach of PPE, monitoring of patients during proning, and physical assessments of patients who have had severe disease and prolonged bed rest.

A Valuable Resource — With Limits for U.S. PTs

The original guidance arrived at a critical time, and the revisions are just as timely, according to Anita Bemis-Dougherty, PT, DPT, APTA's vice president of practice.

"Once again, the recommendations are on target and well-informed by all that we've learned as this pandemic has progressed," said Bemis-Dougherty. "It's important that PTs and PTAs have access to this resource, because it runs the gamut in terms of guidance, from workforce considerations to clinical interventions."

As valuable as the resource is, there may be limits for PTs and PTAs in the U.S., Bemis-Dougherty added.

"It's important to remember that these guidelines were developed in Australia, where physiotherapists can perform some activities we associate with respiratory therapists here in the U.S.," she said.

More Guidance: Outcome Measures From APTA

The Australian recommendations aren't the only resource for PTs and PTAs: APTA offers two sets of COVID-19 core outcome measures guidance, one for adults and another for pediatric patients. The documents, developed collaboratively by several APTA sections and academies, describe the trajectory of recovery from COVID-19 and help explain trends in functional recovery. Both include a clinical application algorithm to assist in performing the test and measures.

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