COVID-19 can have both short- and long-term effects on patients, including in the form of physical and psychological impairments. A significant number of COVID-19 patients experience prolonged symptoms in the form of long COVID, which may last up to months or years and is more likely to affect older individuals, women, and individuals with a high body mass index. Patients with long COVID report significant disability characterized by multisystem complaints, many of which benefit from physical therapy.
Common symptoms include a decreased heart and lung capacity, impaired muscle strength, balance, and endurance, and generalized pain. The most common long COVID symptom, however, is fatigue 1. As such, long COVID often results in significant disability and a loss of functional independence. A recent study showed that seven months following their COVID-19 infection, many patients have not yet recovered from their primarily systemic and neurological symptoms, remaining unable to return to previous levels of daily function and work 2.
To address this challenge, the World Health Organization has encouraged the development of healthcare policies prioritizing the deployment of rehabilitation services, including physical therapy, to individuals living with long COVID 3. Rehabilitation may indeed represent a core element of recovery for COVID-19 survivors – with physical therapists playing a crucial role, helping individuals regain a certain degree of functional independence and easing their reintegration into the workforce. Interventions may address both physical and respiratory impairments, such as a combination of exercise, education, home and behavior modifications, and psychosocial support 4, spanning acute care, outpatient, school-based, and at-home settings 5.
Physical therapy plays a key role in helping individuals recover from the symptoms of long COVID in order to regain normal levels of function. In this context, graded exercise may be prescribed to patients to regain musculoskeletal function in the form of muscle strength, balance, and general endurance. However, the National Institute for Health and Care Excellence has cautioned against aggressive graded exercise therapy in the management of post-viral fatigue given concerns of its potential harm – exacerbating post-exertion malaise – with respect to myalgic encephalomyelitis and chronic fatigue syndrome 6. Physiotherapists are to deliberately balance activity and rest to optimize recovery, while specifically tailoring interventions to each patient.
In parallel, respiratory therapy is key to helping individuals regain their respiratory function. Patients may be taught pursed-lip or diaphragmatic breathing techniques, which can help them breathe more normally, helping to eventually regain a certain level of functional independence 7. Furthermore, educating patients as regards a gradual progression of movement and breathing is key to ensuring healthy, sustainable progress 7.
A number of online tools have been developed to support individuals with long COVID in their recovery progress. The National Health Service provides free online self-management rehabilitation for people recovering from COVID-19, while Mount Sinai’s Long COVID Recovery program provides free online breath-work for long COVID.
Interestingly, ongoing research has developed models that can be used to identify individuals at risk of long COVID. Incorporating just three factors (number of symptoms within the first week of illness, age, and sex) into their model, researchers were able to predict short (under 10 days) and long (over 28 days) COVID-19. Such predictions can be used to preempt and prevent long COVID, as well as devise a patient-tailored treatment and rehabilitation plan 1. Meanwhile, the National Institute for Health Research recently funded a promising, large-scale Rehabilitation Exercise and Psychological Support After COVID-19 Infection (REGAIN) study.
Long COVID has severe impacts on quality of life and mortality. Rehabilitation professionals are key to helping patients recover their physical function and return to work as effectively and safely as possible 8. Given the heterogeneity of long COVID, multidisciplinary research is needed to understand the underlying pathophysiology of the disease and drive the development of effective treatments.
References
1. Sudre, C. H. et al. Attributes and predictors of long COVID. Nat. Med. (2021). doi:10.1038/s41591-021-01292-y
2. Davis, H. E. et al. Characterizing long COVID in an international cohort: 7 months of symptoms and their impact. EClinicalMedicine (2021). doi:10.1016/j.eclinm.2021.101019
3. Wise, J. Long covid: WHO calls on countries to offer patients more rehabilitation. The BMJ (2021). doi:10.1136/bmj.n405
4. Bolton, C. E. et al. British Thoracic Society guideline on pulmonary rehabilitation in adults. Thorax (2013). doi:10.1136/thoraxjnl-2013-203808
5. Physical Therapist Management of Patients With or Recovering From COVID-19 | APTA. Available at: https://www.apta.org/patient-care/public-health-population-care/coronavirus/management-of-patients.
6. NICE cautions against using graded exercise therapy for patients recovering from covid-19. BMJ (2020). doi:10.1136/bmj.m2933
7. A Respiratory Therapist’s Experience Working in Pulmonary Rehab with Long-COVID Patients – AARC. Available at: https://www.aarc.org/an21-a-respiratory-therapists-experience-working-in-pulmonary-rehab-with-long-covid-patients/.
8. Paz, L. E. S., da Silva Bezerra, B. J., de Melo Pereira, T. M. & da Silva, W. E. Covid-19: The importance of physical therapy in the recovery of workers’ health. Revista Brasileira de Medicina do Trabalho (2021). doi:10.47626/1679-4435-2021-709