key: cord-0921854-lv2mo7d7
authors: Alpalhão, Vanessa; Alpalhão, Miguel
title: Impact of COVID-19 on Physical Therapist Practice in Portugal
date: 2020-04-17
journal: Phys Ther
DOI: 10.1093/ptj/pzaa071
sha: dd70781d2df83f1c9c338cb8d2e878ef8a75ba62
doc_id: 921854
cord_uid: lv2mo7d7

nan

The physical therapy profession has been severely affected by the crisis. In Portugal, regulatory rules have determined that only -urgent‖ care should be provided for the duration of the pandemic-leaving each physical therapist with the discretionary power to determine which cases could benefit the most from their intervention. Although many may recognize the benefit of physical therapy in the face of this infection, 1 many cases may fall into a gray area, resulting in asymmetrical accessibility to care.

Long-term care and convalescence units are particularly sensitive areas. It is hard to define -urgent‖ interventions in such settings, where the main goal is to reinstitute function and quality of life to patients in the mid to long term. We must also consider that much of the income and social value of these units derive from the rehabilitation care developed and provided by physical therapists. The sudden loss of income may represent a risk for the viability of these institutions.

Taking this into consideration, physical therapists continue to intervene in all settings, facing an increased risk for COVID-19 infection due to the physical proximity involved in our usual practice as well as due to the high number of patients treated each day. Furthermore, given that asymptomatic individuals have been shown to spread the infection, 2 the exposed physical therapist might represent a risk to other patients, many of whom may be older and have significant comorbidities.

Some practices may be adopted to reduce these risks. First, wearing disposable personal protection equipment, which should be changed between patients, can reduce transmission of the infection; second, decreasing the number of patients and therapists in the same physical space may facilitate social distancing; and third, digital physical therapist practice, making use of technology for communicating with and guiding patients, is proposed by some international agencies. 3 These methods, however, have a steep learning curve not suited for an immediate-need context, and many older patients may have limitations using new technologies. Involving family and caregivers in the treatment session may reduce this hindrance and promote participation, particularly in patients with neuropsychiatric conditions and in pediatric patients. This strategy would require legal regulation to prevent uncertified individuals from offering health care services, even if in a virtual setting, without the appropriate accreditation and certification of expertise.

If the COVID-19 crisis lingers for a long time, physical therapists may start shifting their practice toward therapeutic exercise and away from passive techniques that require close proximity. This is far from ideal, as many benefits from an integrative approach could be lost.

Physical therapist interventions remain fundamental for the health of our communities and should not be avoided as a general rule. All available precautions should be taken to reduce the likelihood of infection for both practitioner and patient, and every patient should have an individual examination for risks and benefits of the planned intervention. Therapeutic strategies may be adapted to reduce physical contact to a minimum while providing therapeutic benefit, and new digital strategies may become more widespread, but caution should be taken to ensure the quality of the intervention provided. 

There is no funding to report.

Physiotherapy management for COVID-19 in the acute hospital setting: Clinical practice recommendations

Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany

Information and resources about COVID-19. World Confederation for Physical Therapy website

The authors declare no conflicts of interest.