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RehabilitationDec 19, 2020

Physiotherapy is a key part of rehab services for people with long-term Covid-19, says Nice

Physiotherapy is likely to play a central part in long Covid rehabilitation teams based in ‘one stop’ clinics and other settings, according to a guideline released on 18 December by the National Institute for Care Excellence (Nice).

‘Healthcare professionals should have a range of specialist skills, with expertise in treating fatigue and respiratory symptoms (including breathlessness),’ the guideline suggests.

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Patients' progress should be recorded in rehabilitation prescriptions

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‘They should be led by a doctor with relevant skills and experience and appropriate specialist support, taking into account the variety of presenting symptoms. Additional expertise may be needed depending on the age and symptoms of the person.'

The core team could include, but not be limited to, the following specialist areas:

  •        physiotherapy    
  •        occupational therapy       
  •        clinical psychology and psychiatry
  •        rehabilitation medicine

Calling on NHS services to ‘share knowledge, skills and training’ to help community-based practitioners provide assessments and interventions, the guideline suggests using interventions such as one-minute sit?to?stand tests and breathlessness training.

Integrated referral pathways – linking primary and community care, multidisciplinary rehabilitation services and specialist services and multidisciplinary assessment clinics and specialist mental health services – should be set up locally.

Encourage people to keep a record of, or use a tracking app, to monitor, their goals, recovery and any changes in their symptoms

In a section on multidisciplinary rehabilitation, the guideline calls for patients to be given a management plan, with their progress recorded in rehabilitation prescriptions.

Goal setting 

Among other suggestions, the guideline says patients should be helped to set their own goals and to work towards achieving them. They should be given advice on managing symptoms such as breathlessness, fatigue and 'brain fog'.

‘Encourage people to keep a record of, or use a tracking app, to monitor, their goals, recovery and any changes in their symptoms,’ it notes.

Older people might need short?term care packages, advance care planning and support because of social isolation, loneliness and bereavement. Children with similar conditions, on the other hand, might need to be referred for specialist advice after a four-week period.

Six-week follow-up

Among the steps outlined in a section on monitoring and follow-up, practitioners should consider offering ‘supported self-monitoring’ options at home.

If agreed as part of the person's assessment, heart rate, blood pressure and pulse oximetry could take place at home. ‘Ensure that people have clear instructions and parameters for when to seek further help,' the guideline stresses.

The guideline also notes: ‘A healthcare professional in secondary care should offer a video or phone follow?up consultation at six weeks after discharge to people who have been in hospital with acute Covid?19 to check for new or ongoing symptoms or complications.’

A 'living document'

Waqaar Shah, chair of the independent expert advisory panel, said: ‘We know this novel condition can have a significant impact on people’s quality of life, and through this guideline, we are able to define the best standard of care. The guideline is a ‘living document' that will be updated in line with emerging evidence, Dr Shah said.

The guideline was co-produced by Nice counterpart the Scottish Intercollegiate Guidelines Network, and the Royal College of General Practitioners.

The recommendations in COVID-19 rapid guideline: managing the long-term effects of COVID-19 cover:

  • assessing people with new or ongoing symptoms after acute Covid-19
  • investigations and referral
  • planning care
  • management, including self-management, supported self-management, and rehabilitation
  • follow-up and monitoring
  • service organisation 




Author: Ian A McMillan
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