Adapting Physical Therapy Management of Patients With COVID-19 in the Acute Care Setting: A Clinical Perspective

Purpose: Using emerging evidence and information pertaining to the SARS-CoV-2 virus, a team of physical therapists (PTs) and occupational therapists (OTs) at the Duke University Hospital (DUH) created a screening algorithm to guide PT/OT evaluation readiness and treatment decisions. This article aims to discuss factors that were considered in the initial development of therapy guidelines and, in so doing, emphasizes the need for ongoing analysis of such screening algorithms and treatment guidelines as evidence continues to emerge. Summary of Key Points: The interdisciplinary team, leveraging their collective experience combined with the updated literature, changed the initial medical management for patients diagnosed with coronavirus disease 2019 (COVID-19). As a result, the screening algorithm was adapted to reflect evolving evidence-based practices. This facilitated earlier and more skillful PT intervention as well as continued PT involvement in the treatment process throughout the course of the patients' stay in the hospital. Conclusions: To guide clinical decisions regarding medical stability of patients and appropriate timing for PT intervention, the therapists at DUH considered factors including defining and identifying stages of disease severity, assessment of laboratory values, and monitoring oxygen stability. Beyond medical complexity, mobility was limited by several additional isolation barriers which presented challenges for PTs, nursing staff, and the patient.