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Year : 2021  |  Volume : 21  |  Issue : 2  |  Page : 35-38

Guideline for re-establishing of physiotherapy services in hospital and rehabilitation center for general patient during COVID-19 outbreak

Mount Adora Physiotherapy and Neuro-Rehabilitation Center, Mount Adora Hospital, Akhalia, Sylhet, Bangladesh

Date of Submission15-Jun-2021
Date of Acceptance22-Jul-2021
Date of Web Publication02-Oct-2021

Correspondence Address:
Sohel Ahmed
Mount Adora Physiotherapy and Neuro-Rehabilitation Center, Mount Adora Hospital, Akhalia - 3100, Sylhet
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjsm.sjsm_16_21

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Coronavirus disease 2019 pandemic has altered the physiotherapy clinical practice globally. Lockdown and social distancing have limited the scope of physiotherapy practice. Hence, our aim was to provide a guideline regarding re-establishing of physiotherapy services during the outbreak. Various recent literatures, searched in the following databases such as PubMed, Scopus, and CINAHL, recommendations from Centers for Disease Control and Prevention, and different physiotherapy association's guidelines were included. This overview can consider as a unique example of physiotherapy practice guideline for hospital and rehabilitation service center.

Keywords: Coronavirus disease 2019, pandemic, physiotherapy, rehabilitation service

How to cite this article:
Ahmed S, Akter R. Guideline for re-establishing of physiotherapy services in hospital and rehabilitation center for general patient during COVID-19 outbreak. Saudi J Sports Med 2021;21:35-8

How to cite this URL:
Ahmed S, Akter R. Guideline for re-establishing of physiotherapy services in hospital and rehabilitation center for general patient during COVID-19 outbreak. Saudi J Sports Med [serial online] 2021 [cited 2022 May 22];21:35-8. Available from: https://www.sjosm.org/text.asp?2021/21/2/35/327485

  Background Top

The coronavirus disease 2019 (COVID-19) is a highly contagious pandemic outbreak that continues to this day all over the world. The disease spreads through the direct or indirect contact with the droplet or aerosol of infectious individuals.[1] To break the transmission chain, most of the countries in the world are in lockdown of varying severity.[2] This pandemic disease has generated not only a public health issue but also poses a challenge to healthcare providers to treat patients, as a large number of healthcare workers have also been affected by this disease.[3] The services of many nonessential healthcare professionals have been shut down to maintain social distance. Routine healthcare facilities have been cruelly disrupted.[4]

Healthcare service is a finite resource and in the present pandemic circumstances providing healthcare services is at the risk for both patient and healthcare providers. It is very challenging to ensure healthcare services to the normal patient separating them from the confirmed and suspected corona-positive patient, as there is a higher possibility of being infected from one to another. Physiotherapists are much more likely to be infected with COVID-19 than other medical professionals during their clinical practice because they have close physical contact with their clients. COVID-19 has severally impacted physiotherapy and other rehabilitation services as physiotherapy services have been declared as optional or nonessential for general patients, but physiotherapists are committed to keep their patient on the track.

The big question is how to provide rehabilitation services to the community by means of social distancing during the outbreak. Telehealth at this time is the most popular and widely discussed option, but the feasibility of this service for providing treatment by physical means is not clear. It is important for physiotherapists to understand the current healthcare landscape as it applies to reimbursement and other consideration.

How long will the healthcare system continue to fear this unknown at its own expenses? Herein, we need a clear guideline to provide rehabilitation services to the rehabilitation service seeker in an organized way. We should transform the disaster into potential by using creativity, innovation, and strategy that requires a careful approach. Therefore, we need a clear guideline to provide rehabilitation services to the one in need of it in an organized way. In this article, we will try to give a guideline for the delivery of rehabilitation services based on the available literature and guidelines from various organizations.

  Know about Coronavirus Disease 2019; Transmission, Pathogenesis, and Prevention Top

Coronavirus disease was first identified in December 2019 in the city of Wuhan, China. The disease made history by being the world's largest pandemic up to date. The virus is primarily transmitted by close contact of infected people via droplets produced during talking, coughing, or sneezing. The droplet cannot travel long distance over the air and usually drops into the ground. The virus can less commonly enter into the body by touching contaminated surface and then touching the face. The virus enters into the body through mouth, nose, and eyes, first replicate in the upper respiratory tract, and further in the lower respiratory tract. The incubation period is about 14 day's onset, developing upon the health status of the individuals.[1]

The cause of this viral outbreak in human is unknown till date; however, the report says that the first patient was infected through an animal. The infected person transmitted the disease with a large number of people. The infection can be spread in several ways, direct contact or through droplets spread. Air-borne transmission may be possible in specific circumstances during aerosols procedure performed such as intubation, open suctioning, turning patient to prone position, manual ventilation, and tracheostomy.[5] The Centers for Disease Control and Prevention provides a scientific brief about transmission of SARS-CoV-2. Inhalation of the virus is the primary cause of COVID-19 transmission.[6]

The preventive measure to diminish the chances of infection for general population includes staying at home, keeping social distancing from others, avoiding crowded places, washing hands for at least 20 s after touching unrecognized objects, maintaining good respiratory hygiene, and avoiding touching the mouth, eyes, and nose with unwashed hands. The preventive measures for the healthcare professionals are different from normal individuals. Many are not well versed in the use of transmissionbased safeguard and the physiotherapy community is no difference.[7] The following should be followed [Table 1] while handling patient.
Table 1: Do's and don'ts while treating patients

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  Separate Rehabilitation Service Seeker From Suspected and Conformed Coronavirus Disease 2019 Patients Top

  1. Confirm the appointment by providing basic information regarding coronavirus before coming to the hospital
  2. Ensure maintaining social distance while entering the hospital and rehabilitation center
  3. Disinfect hands and feet thoroughly before entering the hospital
  4. Before entering the hospital set a triage station to check the primary symptoms of coronavirus such as fever, cold, cough, and breathlessness, to identify the subject possibly affected by COVID-19
  5. For the safety of the patient and healthcare professionals, separate outdoor service such as: (a) flue corner (b) normal outpatient department and maintain good referral system
  6. Providing service to the patients who have obtained clearance certificate in initial scanning from outpatient department
  7. To provide rehabilitation service to the patient who have passed the initial scan, rapid testing kit can be used as it is less cost-effective but not time-consuming
  8. Transfer the suspected patient or confirmed case of corona to the isolation center or corona unit.

  Prepare Yourself for the Service Top

The coronavirus disease is mainly transmitted between people by droplets in close contact with a COVID-19 patient. The people most at risk of infection are those who are in close contact with a COVID-19 patient or who care for COVID-19 patients. Precaution should be taken by the healthcare workers to safeguard themselves and prevent transmission in clinical setting. The World Health Organization suggested to use personal protective equipment (PPE) according to the standard precaution and risk assessment for the healthcare workers during physical examination and treatment of patients without respiratory symptoms.[8] Knowledge about the appropriate use of PPE is important; all physiotherapy staff must receive adequate education and training; this involves choosing proper PPE, being trained how to donning, doffing, and dispose it to minimize self-contamination.[9]

  Personal Protective Equipment to Ensure Your Safety Top

  1. Face shields: These are fog resistant, made up of transparent plastic material, and can be re-used. It shields from cough droplets and sneezes from the mouth while talking. Use without removing during the shift period and follow the safe procedure for removal
  2. Goggles: It protects the eyes from droplets from cough or sneezes. Since it is made up of plastic, it can also be re-used after disinfecting it
  3. Mask: It helps minimize the dispersal of respiratory droplets to transmission. The World Health Organization suggests to use surgical mask for healthcare professionals who are not directly involved with the management of COVID-19 patients. Three-layer surgical mask provides 94% of filtering efficiency
  4. Hand gloves: Disposable hand gloves should be used for treating patient
  5. Gown: Use without removing while taking care of the patient, follow the safe procedure for removal of gown to prevent contamination of environment. Decontamination and re-use of cotton gown can be possible by washing and disinfection methods.

  Prepare Your Clinical Setup for the Rehabilitation Seeker Top

  1. Ensure the availability of PPE for physiotherapist and staff
  2. Ensure vaccination for all staff of the clinical setup. Those who are not vaccinated yet should not allow treating the patient
  3. Re-organize the waiting room maintaining social distancing
  4. Disinfect patients sitting place, floor, and equipment's after completion of each session
  5. Ensure the use of surgical mask by both the therapist and patient is compulsory to limit the spread of virus
  6. Ensure the use of disposable hand gloves while treating patient
  7. Ensure the use of disposable bedcovers and pillow covers to prevent infection
  8. Ensure disinfection of each equipment after use
  9. Limit the number of in-patient visits.

  Points to be Remembered Top

  1. For the patients who have been vaccinated, proof of vaccination should be provided
  2. For the patients who have not yet been vaccinated, maintain the rule of good clinical practice; limit the access of patient whose treatment cannot be postponed
  3. For the safety of the patient and staff, limit the access of visitors to ensure safety
  4. Strictly maintain the usual hygiene rules to minimize the transmission of virus.

  Modify Manual Therapy Service Model Top

Physiotherapy is a profession that involves a lot of hands-on manual therapy skills for assessment and treatment of patient. Due to the COVID-19 crisis, we are faced with a dilemma on how to provide manual therapy to the patient. Certain guidelines can be maintained to have a safe session for both the physiotherapist and the patient.

  1. Provide manual therapy only to patients with urgent medical issue and cancel nonurgent appointment
  2. PPE should be used by the physiotherapist while handling patients
  3. Masks should be mandatory for patients seeking treatment
  4. Before going to provide manual therapy treatment, ask the patient if they have symptoms of respiratory illness
  5. Manual therapy can be given to a patient without any hesitation if patient has already recovered from COVID-19 as they are immune
  6. For patients who have already been vaccinated, manual therapy can be easily provided.

  Plan Home Exercise Program for Less Severe Patient Top

  1. Physiotherapists are encouraged to continue virtual consultation as preferred option where ever possible
  2. After consultation, plan home-based exercise program and plan for virtual care to minimize the in person visit
  3. Consider which services should continue to be provided remotely and which services can safely resume in-patient
  4. Implement a system for virtual consultations to determine if virtual care is appropriate or an in-person appointment is necessary
  5. Modify services to reduce the need for and time spent in in-person visits.

  Take Cautions While Providing Home Care Services Top

In certain conditions where domiciliary service is required, medical judgment should be applied depending on the necessity. The following should be maintained while carrying out home-based rehabilitation service.

  1. Ensure the availability of proper PPE at the service providing area
  2. Maintain the safety precaution and personal hygiene while treating patient
  3. Ensure that the patient and therapist both are vaccinated to minimize the chance of infection
  4. Carry out rehabilitation activities in the patients' room whether possible
  5. Avoid unnecessary gathering while treating patient in home.

  Conclusion Top

This overview can consider as a unique example of physiotherapy practice guideline for hospital and rehabilitation service center and will be helpful for the rehabilitation professionals for providing a better service during the pandemic.


We thank Dr. Amena Abdul Muthlib, BPT, Junior Physiotherapist, Mount Adora Hospital, Akhalia, Sylhet - 3100, Bangladesh, for her valuable support.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

World Health Organization. Modes of Transmission of Virus Causing COVID-19; 2020. p. 19-21.  Back to cited text no. 1
Ahmed S, Akter R, Islam MJ, Muthalib AA, Sadia AA. Impact of lockdown on musculoskeletal health due to COVID-19 outbreak in Bangladesh: A cross sectional survey study. Heliyon 2021;7:e07335.   Back to cited text no. 2
Wang J, Zhou M, Liu F. Reason for healthcare workers becoming infected with novel coronavirus disease 2019 (COVID-19) in China. J Hosp Infect 2020;105:100-1.  Back to cited text no. 3
Naqvi K, Mubeen SM, Ali Shah SM. Challenges in providing oral and dental health services in COVID-19 pandemic. J Pak Med Assoc 2020;70 Suppl 3:S113-7.  Back to cited text no. 4
Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020;109:102433.  Back to cited text no. 5
Prevention C for disease control and. Scientific Brief: SARSCoV2 Transmission; 2021. Available from: https://www.cdc.gov/coronavirus/2019ncov/science/sciencebriefs/sarscov2transmission.html. [Last accessed on 2021 May 20].  Back to cited text no. 6
Guan WJ, Chen RC, Zhong NS. Strategies for the prevention and management of coronavirus disease 2019. Eur Respir J 2020;55:2000597.  Back to cited text no. 7
WHO. Rational Use of Personal Protective Equipment for Coronavirus Disease 2019 (COVID19) and Considerations during Severe Shortages. World Health Organization; 2020. Available from: https://apps.who.int/ iris/handle/10665/331695. [Last accessed on 2021 May 20].   Back to cited text no. 8
Suen LK, Guo YP, Tong DW, Leung PH, Lung D, Ng MS, et al. Self-contamination during doffing of personal protective equipment by healthcare workers to prevent Ebola transmission. Antimicrob Resist Infect Control 2018;7:157.  Back to cited text no. 9


  [Table 1]


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  In this article
Know about Coron...
Separate Rehabil...
Prepare Yourself...
Personal Protect...
Prepare Your Cli...
Points to be Rem...
Modify Manual Th...
Plan Home Exerci...
Take Cautions Wh...
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