Physiotherapist Awareness in the Community

COVID-19 is an infectious disease that affects the respiratory system caused by the new SARS-Cov-2 corona virus, which originated in Wuhan, China, in late 2019. On January 30, 2020, the World Health Organization (WHO) declared it is an epidemic, and on March 11, 2020, it was described as a COVID-19 pandemic.

Respiratory problems such as fever (89%), cough (68%), fatigue (38%), phlegm production (34%) and/or shortness of breath (19%) may be considered as the primary symptoms seen in individuals with COVID-19 . Other rare symptoms include hemoptiziness, loss of appetite, nausea, vomiting, diarrhea, abdominal pain, muscle pain, headache, odor or taste disorder, conjunctivitis, and confusion. Complications common due to COVID-19 include acute respiratory distress syndrome, acute kidney damage, anemia, heart failure and secondary infection. The most common cause of death was reported to be multiple organ dysfunction syndrome followed by cardiac arrest, respiratory failure, and acute respiratory distress syndrome.

Symptoms seen in COVID-19 fall within the scope of pulmonary rehabilitation. Pulmonary rehabilitation provides benefits for all patients who suffer from any chronic respiratory disease, have reduced lung function, are symptomatic and have exertion intolerance, despite an optimal pharmacological treatment. The importance of rehabilitation after COVID-19 is emphasized according to the International Classification of Functionality, Disability and Health.

Recent reports indicated that 80% of cases were asymptomatic or mild, 15% severe (oxygen required infection) and 5% were critical (respiratory and life support). Intensive care unit (ICU) admission rates are approximately 5%. Oxygen therapy is required in approximately 42% of hospitalized patients.

Hospitalized COVID-19 patients often have comorbidities such as cardiovascular disease and diabetes and have long hospital stays. Some COVID-19 patients have physical impairments that can be exacerbated by prolonged inactivity, including muscle weakness, neurological disorder and/or malnutrition. In-hospital rehabilitation is proposed to tackle these problems and solve them.

A series of cases from Wuhan, China, reported that 20% of hospitalized patients with approved COVID-19 required intensive care. Similar figures were reported in Italy-Lombardy, where 16% of COVID-19 patients require intensive care unit (ICU) care. Early rehabilitation intervention prevents the complications that may arise because of hospitalization in ICU related to COVID-19 and can reduce or even eliminate the negative effects on daily life of patients. Respiratory muscle atrophy and diaphragm dysfunction are quite common in patients requiring long-term bed rest and mechanical ventilation. It has been documented that the respiratory function during the admission has a negative correlation with mortality and the duration of treatment in ICU is shortened from an average of 20.4 days to 12.8 days after the improvement in respiratory function.

Multiple symptoms may occur approximately 3 months after the onset of symptoms in hospitalized or non-hospitalized patients due to COVID-19. This situation indicates its existence as "post-COVID-19 syndrome". It emphasizes the presence of insufficiently met healthcare services and the need for rehabilitation in patient groups who have experienced "mild" or "severe" COVID-19. Physiotherapy and rehabilitation have an important line in these health services. Liu et al. In their study, it was reported that there was a significant improvement in respiratory function, quality of life and anxiety levels in patients as a result of the rehabilitation program that included 6-week respiratory muscle training, secretion excretion, diaphragm training, stretching exercises and home exercises after COVID-19. In the light of this information, the importance of physiotherapists in treatment is inevitable in improving the functional disorders of individuals with COVID-19 in both acute and chronic periods.

Considering the studies that mention that lifestyle diseases such as obesity, insulin resistance, diabetes and hypertension are associated with increased risk of hospitalization and death, there are suggestions that the presence of high aerobic capacity may be protective in a severe COVID-19 picture. In line with the examinations made in the USA and Italy; The presence of at least one lifestyle-related comorbidity of individuals infected with COVID-19 is 94% in the USA, while this figure is 99% in Italy. Improving lifestyle behaviors, preventing, and controlling comorbidities; It has been proven to reduce the risk of premature death and the progression of chronic diseases, improve quality of life, and provide significant economic benefits. Physiotherapists, who play a major role in preventive measures, may not be able to prevent catching COVID-19 with exercise training, but they can provide a shorter recovery with less severe symptoms. Due to the risk of transmission during the COVID-19 period, it is recommended to use telerehabilitation-based approaches to implement exercise training and rehabilitation program. Studies on telerehabilitation have emphasized the importance of telerehabilitation-based approaches in the physiotherapy and rehabilitation practices of individuals with both COVID-19 positive and COVID-19 negative diseases.

According to the study conducted in post-COVID-19 patients in Hubei, China; when asked about the rehabilitation awareness and willingness information source, 68.9% of the patients stated that they were not aware of rehabilitation before, the rest were from medical personnel (22.1%), online media (22.1%), and family or friends (1.4%) reported that they received information about rehabilitation. This is evidence of insufficient awareness in patients. After obtaining the basic information about rehabilitation, 38.9% of the patients wanted to receive rehabilitation treatment while they were in the hospital, 45.4% agreed to receive rehabilitation after discharge, and only 15.7% are not currently seeking rehabilitation. Based on these data, it can be said that it is necessary to provide the society with access to rehabilitation information.

There are many studies and reviews on the role of physiotherapists during COVID-19. From the beginning of 2020, we know how important rehabilitation activities are in the care of COVID-19 patients, in recently published recommendations. Therefore, there is an urgent need to increase academic and public awareness of physiotherapy and its different fields of action, work environments. Special emphasis should also be placed on raising awareness of physiotherapy considering the current challenges faced.