The month of May is celebrated as National Physiotherapy Month in Canada, highlighting the efforts and contributions of this profession to enable and support healthy living. While most people think about physiotherapists treating individuals with shoulder and back pain, physiotherapists working in both critical and acute care have a role unique unto itself; this role has evolved greatly when treating individuals with COVID-19.
The pandemic has made it more challenging for physiotherapists to provide support, as the nature of the therapy requires close proximity to the patient during treatment. Even with full PPE on, it can still be quite stressful treating COVID patients, especially when performing difficult maneuvers. Regardless of the challenges, the professionals have kept up their spirit in providing their support to the fullest. In honour of that, today Kingstonist is highlighting the contributions of the team in the Physiotherapy Department of Kingston Health Sciences (KHSC) at the Kingston General Hospital (KGH) Site.
For a patient with COVID-19, the patient’s interactions with physiotherapy often begins in the Intensive Care Department (ICU). Once these patients become medically stable, a Critical Care Physiotherapist initiates treatment, which might start with bed exercises or assistance with repositioning or proning, a method used with COVID-19 patients whereby they are placed on their stomachs to help with their medical recovery. As things improve, patients are assessed for more functional activity and mobility, such as sitting up at the edge of the bed with support, even if the patient was still intubated. At this time, the physiotherapist might need to titrate a patient’s oxygen level before and during treatment and provide suctioning (a process used to remove secretions from a patient’s airway). This is a vital component of weaning a patient off a ventilator so that they can eventually breathe with less support or even on their own.
A common characteristic of COVID patients is extreme weakness and deconditioning. With regular visits, eventually these patients may progress from using a mechanical lift to get to a chair to being able to transfer with the assistance of one to two people. Some patients can even start walking before they are transferred out of the ICU, the physiotherapy team at KGH shared.
“The goal here is to ramp them up physically as much as possible to enable them to maximize their rehab potential for the future. Generally speaking, the physiotherapist is laying the foundation of physical recovery for the long journey that lies ahead of them,” said Al MacVicar, one of the physiotherapists working in the local ICU.
MacVicar is proud to be a member of an interdisciplinary team that has had important contributions from all of the Critical Care staff during these unprecedented times. “It is so rewarding to see a patient be weaned off a ventilator and support their own weight for the first time — and to be a part of that process is truly gratifying.”
MacVicar continued, speaking of the experience treating COVID-19 patients on a more personal level.
“It is heartbreaking to see how sick the COVID patients are. They are often far from home without loved ones at their side. You see large posters and cards made by sons and daughters and grandchildren placed prominently in the room — with words of love and encouragement urging them on. As a physiotherapist, you want to do everything you can to help with the healing process and reunite them with their families,” he expressed.
Once patients are stable enough to be discharged to other floors, the physiotherapist and physiotherapy assistants continue with specific interventions in order to make discharge home possible. Before discharge, the physio team makes appropriate recommendations to the medical teams on what supports, services, and equipment one may need. There is also a significant education component included, as patients are taught how to self-monitor their breathing patterns, and given individualized protocols. These protocols will help patients manage the increased work of breathing and shortness of breath that is often associated with COVID-19 patients. The physiotherapist may also teach strategies for energy conservation, especially if they are going home on supplemental oxygen. Some patients continue to require physiotherapy after discharge and appropriate referrals are made to the team’s colleagues working for homecare, or at a rehabilitation hospital.
When asked about other challenges the physiotherapy team has faced, MacVicar mentioned that managing a work/life balance has been difficult for all frontline health workers during the pandemic, including the physiotherapy department. “We strive to be the best we can be for our patients, but we also have tremendous responsibility to our own families, as well. We are striving to provide time, patience, and guidance to our loved ones, with the ultimate goal of keeping well and staying healthy. It’s been tough at times.”
To help offset this challenge, the department supports its team through regular team huddles, virtual meetings, and small workshops so that no one becomes overwhelmed with their caseloads. The team also discusses strategies to cope with both the highs and lows on the job and personally.
Overall, the Physiotherapy Department has demonstrated perseverance and resilience over the past 14 months. Ashley Woodroffe-McClintock, one of the acute care physiotherapists working in the ER summed it up nicely by stating that it was the department’s “finest hour” from both an individual and collective sense.
“Teamwork, collaboration, and cooperation have been the guiding principles of the Physiotherapy Department, which have only made the delivery of care stronger. This group takes pride in its work and appreciates the opportunity to share its experience with the public,” she added.