- On World Physiotherapy Day, the importance of this discipline during the pandemic is highlighted for the musculoskeletal and cardiorespiratory recovery of patients who have passed the infection or have prolonged sequelae
- Physiotherapists care for Covid patients both in the ICU and in hospitalization and, after discharge, in outpatient care.
Fragility syndrome, pain, scars, fatigue, encephalopathy, lack of concentration, fibrosis, dyspnea, muscle weakness, sarcopenia, contractures, retractions, osteonecrosis, myopathies, polyneuropathies, insomnia, loss of quality of life... These are some of the sequelae that present patients who have suffered from Covid19 and who continue to show, weeks or months after the initial infection, in what has become known as persistent Covid or long covid. "Symptoms are extremely numerous and varied, which adds complexity to the syndrome, in terms of its diagnosis and its need for multidisciplinary health care," explains the head of the Preventive Medicine Service of the University Hospitals of Vinalopo y Torrevieja, managed by the Ribera health group, Vicente García Román.
The hospitals of the bank group They have developed specific programs for the rehabilitation of patients with persistent Covid, as well as to help recover those who reveal musculoskeletal sequelae after suffering the infection, which are coordinated from the Physiotherapy services or in the post-Covid Units. It is in this context of multidisciplinary care that Physiotherapy plays a prominent role. This is revealed on World Physiotherapy Day, which is celebrated tomorrow, September 8, and which this year has persistent Covid and rehabilitation as its axis.
The person in charge of the Physiotherapy Service of Ribera Hospital of Molina, managed by the Ribera health group, Ana Mª Dasí Espinosa, explains that "physiotherapy acts on physical, cardiorespiratory and osteomuscular alterations, taking into account the sequelae and deficits suffered by each patient". He assures that it is unknown exactly why these sequelae appear and which patients are most affected, "although we can say that older people, with pathologies prior to the infection, those hospitalized and those who have been in the UCIS, with long periods of mechanical ventilation, are the most prone to suffer them”.
The Physiotherapy Supervisor Torrejón University Hospital, Enrique Gonzalvo, adds as some of the most common side effects in Covid patients "loss of muscle flexibility, fibrosis and adhesive capsulitis and loss of balance and difficulty walking or standing". Like the person in charge of the Ribera Hospital de Molina Service, she explains that the longer the period of immobilization, the more serious the affectation of the musculoskeletal system. "After a while, muscle atrophy occurs, when the muscles lose size."
Physiotherapy is included in all phases of the disease in the hospitals of the Ribera health group, and work is done with the patient, whenever the professionals so determine, in the Intensive Care Unit, hospitalization, and after discharge, in a manner outpatient or telematically, to help you overcome the consequences of the disease, as well as persistent Covid. Laura Rubio, physical therapist at Ribera Povisa Hospital, explains that in the case of patients who suffer from myopathy after a Covid infection or as a consequence of persistent Covid, the approach by a professional from this Service is key. "The patient presents loss of strength in the most proximal musculature, in the shoulders and scapulae, in the trunk, the pelvis and in the hip, generating a very disabling muscular weakness, since it hinders basic functions."
Dr. Adrián Gallego, traumatologist at the Ribera Polusa Hospital, advises a specific rehabilitation program, based on individualized exercise and adapted to each patient, under the supervision of the doctor and the physiotherapist. "Electrostimulation and neuromodulation can be used, which help to overcome the physical sequelae and reduce pain." The person in charge of Physiotherapy at Ribera Hospital de Molina spoke along the same lines. “It is essential for these patients to carry out a structured and constant physical exercise program, realistic and with achievable objectives, along with a respiratory physiotherapy program, which allows them to recover mass, flexibility and general muscle strength; reduce myopathies, arthropathies and polyneuropathies associated with the degeneration of muscle fibers; improve respiratory functionality, re-educate respiratory patterns and cardiac efficiency; reduce dyspnea, fatigue and asthenia; recover the physiological reserves of the organism; improve proprioception, coordination and balance; and restore tolerance to effort in the performance of activities of daily living.
Doctor García Román explains that different studies point to "pathogenic mechanisms such as cell damage, a robust innate immune response with production of inflammatory cytokines or a procoagulant state induced by infection as the cause of this persistent Covid". Other authors, he adds, point out as a hypothesis the persistence of the virus or viral particles and immunopathological pictures mediated by autoantibodies”.
