Saudi Journal of Sports Medicine

: 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

Sohel Ahmed, Rahemun Akter 
 Mount Adora Physiotherapy and Neuro-Rehabilitation Center, Mount Adora Hospital, Akhalia, Sylhet, Bangladesh

Correspondence Address:
Sohel Ahmed
Mount Adora Physiotherapy and Neuro-Rehabilitation Center, Mount Adora Hospital, Akhalia - 3100, Sylhet


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.

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;21:35-38

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 2021 Dec 3 ];21:35-38
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Full Text



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

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}

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

Confirm the appointment by providing basic information regarding coronavirus before coming to the hospitalEnsure maintaining social distance while entering the hospital and rehabilitation centerDisinfect hands and feet thoroughly before entering the hospitalBefore 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-19For the safety of the patient and healthcare professionals, separate outdoor service such as: (a) flue corner (b) normal outpatient department and maintain good referral systemProviding service to the patients who have obtained clearance certificate in initial scanning from outpatient departmentTo 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-consumingTransfer the suspected patient or confirmed case of corona to the isolation center or corona unit.

 Prepare Yourself for the Service

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

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 removalGoggles: 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 itMask: 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 efficiencyHand gloves: Disposable hand gloves should be used for treating patientGown: 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

Ensure the availability of PPE for physiotherapist and staffEnsure vaccination for all staff of the clinical setup. Those who are not vaccinated yet should not allow treating the patientRe-organize the waiting room maintaining social distancingDisinfect patients sitting place, floor, and equipment's after completion of each sessionEnsure the use of surgical mask by both the therapist and patient is compulsory to limit the spread of virusEnsure the use of disposable hand gloves while treating patientEnsure the use of disposable bedcovers and pillow covers to prevent infectionEnsure disinfection of each equipment after useLimit the number of in-patient visits.

 Points to be Remembered

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

 Modify Manual Therapy Service Model

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.

Provide manual therapy only to patients with urgent medical issue and cancel nonurgent appointmentPPE should be used by the physiotherapist while handling patientsMasks should be mandatory for patients seeking treatmentBefore going to provide manual therapy treatment, ask the patient if they have symptoms of respiratory illnessManual therapy can be given to a patient without any hesitation if patient has already recovered from COVID-19 as they are immuneFor patients who have already been vaccinated, manual therapy can be easily provided.

 Plan Home Exercise Program for Less Severe Patient

Physiotherapists are encouraged to continue virtual consultation as preferred option where ever possibleAfter consultation, plan home-based exercise program and plan for virtual care to minimize the in person visitConsider which services should continue to be provided remotely and which services can safely resume in-patientImplement a system for virtual consultations to determine if virtual care is appropriate or an in-person appointment is necessaryModify services to reduce the need for and time spent in in-person visits.

 Take Cautions While Providing Home Care Services

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.

Ensure the availability of proper PPE at the service providing areaMaintain the safety precaution and personal hygiene while treating patientEnsure that the patient and therapist both are vaccinated to minimize the chance of infectionCarry out rehabilitation activities in the patients' room whether possibleAvoid unnecessary gathering while treating patient in home.


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.


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