Physiotherapists during COVID-19: usual business, in unusual times

Informing the Development of Telehealth Education in Physiotherapy Programs. Assessments and Interventions for Individuals Accessing Physiotherapy Care via Synchronous Telehealth. A Scoping Review

BACKGROUND

In order to develop contemporary telehealth curricula for entry-to-practice physiotherapy programs that develop the capabilities required to practice telehealth, it is important to evaluate the delivery of telehealth practices within the physiotherapy profession.

OBJECTIVE

To assess the current literature to (i) determine what types of assessments and interventions have been delivered via synchronous forms of telehealth (videoconferencing and telephone) by physiotherapists (ii) determine which platforms were used for service delivery and which practice areas have delivered synchronous telehealth physiotherapy assessments and interventions.

DESIGN

Scoping review adhering to Joanna Briggs Institute guidelines. Three electronic databases (Medline, Embase, and CINAHL) were searched for articles involving physiotherapists using synchronous forms of telehealth (videoconferencing/telephone) to deliver assessments and/or interventions.

STUDY SELECTION

Articles were included if they related to physiotherapists using synchronous forms of telehealth (videoconferencing and/or telephone) to deliver assessments and/or interventions.

DATA SYNTHESIS

A narrative synthesis was conducted.

RESULTS

From 2748 records, 134 studies were included. Standardised assessments (e.g. subjective assessments, range of motion, functional assessment) were the most commonly (82%) delivered. Most interventions delivered were exercise (82%), followed by education (27%). Freely available synchronous videoconferencing platforms including Zoom (n = 30, 34%), WhatsApp (n = 10, 11%), and Skype (n = 9, 10%) were commonly used. Telehealth-delivered physiotherapy assessment and interventions were primarily utilised in musculoskeletal (33%), neurological (23%) and respiratory (14%) practice areas.

CONCLUSION

The diverse use of physiotherapy telehealth-delivered assessments and interventions across varied clinical practice settings and patient populations highlights the importance of preparing future physiotherapists with telehealth skills fit for contemporary practice.

Impact of the Covid-19 pandemic and lockdowns on the education and mental health of physiotherapy students in France: a descriptive cross-sectional study with national online survey

OBJECTIVE

To determine the impact of the SARS-CoV-2 (COVID-19) pandemic and lockdowns on the mental health status, training, perceptions of the physiotherapy profession, and career plans of French physiotherapy students.

DESIGN

A descriptive cross-sectional study was conducted, representing the first and only survey of its kind, using a national online survey.

SUBJECTS

A total of 2678 French physiotherapy students participated in the study.

METHODS

Mental health status was assessed using the validated French versions of established depression, anxiety, and insomnia scales.

RESULTS

The survey revealed that female sex, age below 21 years, living alone, and having a psychiatric history or COVID-19 risk factors were associated with more severe symptoms of depression, anxiety, and insomnia in the surveyed students. In addition, stress, anxiety, and depression induced by the COVID-19 crisis were linked to apprehension about continuing practical training in physiotherapy. These factors also affected students' perceptions of the profession and the initially envisioned mode of practice, particularly among fifth-year students (odds ratio (OR) = 2.25, 95% confidence interval (95% CI) = (1.69, 2.99), p < 0.001). Notably, the pandemic significantly reduced the desire of these students to pursue a career as physiotherapists (adjusted OR (aOR) 1.41 (1.06, 1.86)).

CONCLUSION

French physiotherapy students, especially those in their fifth year, have experienced significant impacts from the COVID-19 pandemic, affecting their mental health, education, perceptions of the physiotherapy profession, and career plans.

Physiotherapist-led, exercise-based telerehabilitation for older adults improves patient and health service outcomes: a systematic review and meta-analysis

BACKGROUND

Telerehabilitation can be an appropriate alternative to face-to-face rehabilitation for adults; however, it is uncertain whether it is safe and effective for older adults.

OBJECTIVE

This review aimed to determine the effect of physiotherapist-led, exercise-based telerehabilitation for older adults on patient outcomes (health-related quality of life, activity limitation, functional impairment) and health service costs.

METHODS

Randomised or non-randomised controlled trials including community-dwelling older adults (mean age ≥ 65 years) who received exercise-based telerehabilitation led by a physiotherapist were eligible. Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, PubMed and Cochrane Library were searched from the earliest available date to August 2022. Methodological quality was assessed using the Physiotherapy Evidence Database scale. Data were synthesised with inverse variance, random-effects meta-analyses to determine standardised mean differences and 95% confidence intervals. Certainty of evidence was determined by applying Grading of Recommendations, Assessment, Development and Evaluation criteria.

RESULTS

Eleven studies (10 randomised) with 1,400 participants (mean age 65-74 years) experiencing musculoskeletal and cardiopulmonary conditions were included. Telerehabilitation was safe, effective and well adhered to. Telerehabilitation was non-inferior to face-to-face physiotherapy in relation to range of movement, strength, 6-min walk distance (6MWD), timed up and go test (TUGT) and quality of life and had lower health-care costs compared with face-to-face physiotherapy. Compared with no intervention, telerehabilitation participants had significantly better range of motion, strength, quality of life, 6MWD and TUGT speed.

CONCLUSION

Physiotherapist-led, exercise-based telerehabilitation is non-inferior to face-to-face rehabilitation and better than no intervention for older adults with musculoskeletal and cardiopulmonary conditions.

Canadian Physiotherapists Integrate Virtual Care during the COVID-19 Pandemic

Purpose

To examine Canadian physiotherapists' experiences in adapting their delivery of patient care during the COVID-19 pandemic. We examine the level of strain on the profession and barriers and enablers to virtual care and provide strategies to support future virtual care implementation.

Methods

From May to October 2020, a series of eight cross-sectional survey cycles were distributed every 2-4 weeks through branches and divisions of the Canadian Physiotherapy Association, social media, and personal networks. Descriptive statistics summarized the main findings. Open ended questions were first analyzed inductively using thematic analysis, then deductively mapped to the Capability-Opportunity-Motivation Behavioural (COM-B) Model.

Results

Between 1,820 (cycle 1) and 334 (cycle 7) physiotherapists responded. Median strain level was 5/5 (cycle 1) and dropped to median 3/5 (cycles 5-8). In cycle 1, 55% of physiotherapists had ceased in-person care, while 41% were providing modified in-person care. Of these physiotherapists, 79% were offering virtual care. As modified in-person care increased, virtual care continued as a substantial aspect of practice. Physiotherapists identified barriers (e.g., lack of hands-on care) and enabling factors (e.g., greater accessibility to patients) for virtual care. In-depth examination of the barriers and enablers through the COM-B lens identified potential interventions to support future virtual care implementation, including education and training resources for physiotherapists and communication and advocacy to patients and the public on the value of virtual care.

Conclusions

Canadian physiotherapists exhibited high adaptability in response to COVID-19 through the rapid and widespread use of virtual care. By creating an in-depth understanding of the barriers and enablers to virtual care, along with potential interventions, this work will facilitate future opportunities to support and enhance physiotherapists' delivery of virtual care.

Are Telerehabilitation Exercise Practices Effective in Patients Diagnosed with Benign Paroxysmal Positional Vertigo?

The aim of this study was to investigate the effectiveness of classical Vestibular Rehabilitation Exercises (Control Group-CG) given as home exercise program and VR + balance exercises (Experimental Group-EG) applied with telerehabilitation method on patients with Benign Paroxysmal Positional Vertigo (BPPV). Material and Methods: The patients were randomly divided into 2 therapy groups in the ALKU Hospital (CG; 21 patients, and EG;22 patients). Pre- and post-test experimental design was adopted and a six-week training was offered. The participants' balance ability (Romberg, tandem and semi-tandem tests), vertigo severity (Vertigo Symptom Scale-VSS, VAS), vertigo-related disability level (Dizziness Handicap Inventory-DHI), anxiety (Beck Anxiety Inventory-BAI) and quality of life (Vertigo Dizziness Imbalance Questionnaire-VDI) were assessed. Regarding the balance ability, findings in tandem and semi-tandem tests were significantly increased in the EG compared to CG (p < 0.05). According to VAS, the severity of dizziness decreased significantly compared to the CG (p < 0.05). Regarding the DHI score, symptoms of vertigo were reduced considerably after the treatment compared to the CG (p < 0.05). A significant improvement was observed in the quality of life of the EG group according to VDI scoring (p < 0.05). Although gains were observed in both groups, it was observed that the EG group obtained more effective improvement in the severity of vertigo, disability level due to vertigo, and quality of life compared to the home exercise group.These results confirmed the hypothesis that EG applications are effective and clinically applicable in patients with BPPV.

"Burnout felt inevitable": Experiences of university staff in educating the nursing and allied health workforce during the first COVID-19 waves

Introduction

Maintaining progress in the face of looming burnout during the first 2 years of the COVID-19 pandemic was crucial for the health workforce, including those educating the next generation of health professionals. The experiences of students and healthcare practitioners have been explored to a greater degree than the experiences of university-based health professional educators.

Methods

This qualitative study examined the experiences of nursing and allied health academics at an Australian University during COVID-19 disruptions in 2020 and 2021 and describes the strategies that academics and/or teams implemented to ensure course continuity. Academic staff from nursing, occupational therapy, physiotherapy, and dietetics courses at Swinburne University of Technology, Australia provided narratives regarding the key challenges and opportunities they faced.

Results

The narratives highlighted the strategies generated and tested by participants amidst rapidly changing health orders and five common themes were identified: disruption; stress; stepping up, strategy and unexpected positives, lessons, and legacy impacts. Participants noted challenges related to student engagement in online learning and ensuring the acquisition of discipline-specific practical skills during periods of lock-down. Staff across all disciplines reported increased workload associated with converting teaching to on-line delivery, sourcing alternative fieldwork arrangements, and dealing with high levels of student distress. Many reflected on their own expertise in using digital tools in teaching and their beliefs about the effectiveness of distance teaching for health professional training. Ensuring students were able to complete required fieldwork hours was particularly challenging due to constantly changing public health orders and conditions and staffing shortages at health services. This was in addition to illness and isolation requirements further impacting the availability of teaching associates for specialist skills classes.

Discussion

Solutions such as remote and blended learning telehealth, and simulated placements were rapidly implemented in some courses especially where fieldwork could not be rescheduled or amended at the health settings. The implications and recommendations for educating and ensuring competence development in the health workforce during times when usual teaching methods are disrupted are discussed.

Telehealth For Individuals with Parkinson's Disease During Covid-19 In Brazil: A Prospective Case Series

Objective

To implement a telerehabilitation prevention, treatment, and follow-up physical therapy protocol for monitoring individuals with Parkinson's disease (PD) and to verify its effectiveness in minimizing the deleterious effects of the COVID-19 pandemic.

Design

Prospective case series, involving 40 participants with mild to moderate PD recruited from a specialized neurorehabilitation group. The study was divided into four parts: (1) Phone calls to assess the feasibility of participating in remote physical therapy. (2) Social media training. (3) Baseline and post-intervention assessment for functional lower extremity strength, fear of falling, quality of life, depression, anxiety, activities of daily living, verbal fluency. (4) Intervention protocol consisting of 20 remote weekly physical therapy sessions, graphic material for physical and cognitive training, social activities, and education.

Conclusion

The telerehabilitation protocol was viable and effective for patients with PD as an alternative to in-person treatment during the COVID-19 pandemic.

[Recommendations for outpatient respiratory rehabilitation of long COVID patients]

The appearance of COVID-19 has been a problem for public health on a global scale, putting pressure on health care systems. The after-effects of this illness have highlighted the importance of rehabilitation in long COVID patients involv-ing different health professionals. The treatment of the respiratory after-effects of this disease in an outpatient setting is a specialized field. It is appropriate to offer a series of practical recommendations of cardio-respiratory rehabilitation that are helpful to the professionals involved in the after-effects when ending hospitalisation. This review of the literature includes ten key aspects of respiratory physiotherapy that range from assessment, parameters to monitor, signs of alarm and respiratory rehabilitation techniques and other exercises for this population.

The role of information quality, trust and anxiety on intention to buy food supplements at the time of COVID-19 outbreak

Purpose

The purpose of this study is to analyze the factors affecting consumer`s intention to buy food supplements during COVID-19 pandemic using the expanding theory of planned behavior model. The variables of perceived information quality, trust and anxiety are integrated in the model of this study.

Design/methodology/approach

A total of 553 valid questionnaire responses were collected via an online survey in the epicenter of the pandemic in Indonesia, such as Jakarta and surrounding cities. To evaluate the causal links between latent variables, structural equation modeling was adopted using LISREL software. Before the research hypothesis had been tested, validity and reliability analysis was carried out to make sure the measurement can be used.

Findings

The findings indicate that perceived information quality influences trust and anxiety, and then both of them influence attitude toward food supplements. Moreover, the intentions to buy food supplements are determined by the consumer`s attitude.

Research limitations/implications

This study assumes all consumers have similar access to information because they are living in the greater Jakarta. Nevertheless, in fact, the access of information is not similar between age groups and locations. Future research may wish to differentiate evaluations of a full-information group from those of the limited-information groups.

Originality/value

This study provides a model of consumers` buying intentions toward food supplement products in the time of a health crisis such as the COVID-19 pandemic as a novelty. The implications of this study provide meaningful direction for marketing decisions and policy interventions in developing food supplement industries.

Tele-Neurorehabilitation During the COVID-19 Pandemic: Implications for Practice in Low- and Middle-Income Countries

The importance of neurorehabilitation services for people with disabilities is getting well-recognized in low- and middle-income countries (LMICs) recently. However, accessibility to the same has remained the most significant challenge, in these contexts. This is especially because of the non-availability of trained specialists and the availability of neurorehabilitation centers only in urban cities owned predominantly by private healthcare organizations. In the current COVID-19 pandemic, the members of the Task Force for research at the Indian Federation of Neurorehabilitation (IFNR) reviewed the context for tele-neurorehabilitation (TNR) and have provided the contemporary implications for practicing TNR during COVID-19 for people with neurological disabilities (PWNDs) in LMICs. Neurorehabilitation is a science that is driven by rigorous research-based evidence. The current pandemic implies the need for systematically developed TNR interventions that is evaluated for its feasibility and acceptability and that is informed by available evidence from LMICs. Given the lack of organized systems in place for the provision of neurorehabilitation services in general, there needs to be sufficient budgetary allocations and a sector-wide approach to developing policies and systems for the provision of TNR services for PWNDs. The pandemic situation provides an opportunity to optimize the technological innovations in health and scale up these innovations to meet the growing burden of neurological disability in LMICs. Thus, this immense opportunity must be tapped to build capacity for safe and effective TNR services provision for PWNDs in these settings.

Modèles alternatifs dans la pratique de la rééducation à l’ère de la pandémie de Covid-19

La pandémie de Covid-19 a imposé un changement soudain et forcé dans le spectre des soins de santé qui s’est produit avec une rapidité sans précédent. La nécessité d’accommoder le changement à une grande échelle a exigé de l’ingéniosité et une réflexion décisive. Ces changements affectent les acteurs du domaine de la médecine physique et de la réadaptation (MPR) personnellement et professionnellement. Les experts réfléchissent maintenant à la manière d’améliorer la pratique médicale en utilisant de nouvelles approches en réadaptation. Les modèles et les expériences rapportés dans la littérature, tels que la téléréadaptation, la préadaptation et l’activité physique adaptée sont basés sur la stratégie de l’auto-rééducation collaborative qui est proposée comme un élément-clé de ces voies alternatives. Ces approches innovantes aideront à restructurer les processus d’exercice de la réadaptation, non seulement dans ces moments inhabituels, mais aussi dans l’avenir de la MPR.

Niveau de preuve

NA.

Podiatry as a career in the UK - what attracts Generation Z? A qualitative exploration with university and college students

Background

Training for a career in podiatry is reported to provide graduates with excellent employability, alongside professional autonomy and suitable renumeration. Yet, there has been an ongoing decline in the number of those applying to study the subject. There is limited literature associated with this topic and we sought to explore the factors that attract ‘generation Z’ (those born 1995–2010) to a potential career in podiatry.

Method

A qualitative design framework underpinned by phenomenological principles used four focus groups over a two-year period to generate data from participants at University and in Further Education. Focus group conversations were led by external facilitator, recorded, independently transcribed verbatim and anonymised prior to thematic analysis. This was followed by external, independent verification of themes.

Results

Four main themes were determined from the analysis i) a lack of awareness of podiatry; ii) podiatry: accessible course, accessible career; iii) career status; iv) breadth/opportunity of the scope of practice. Both positive and negative experiences were reported and highlighted key gaps in how the attractiveness of a career in podiatry is portrayed.

Conclusion

The chronic lack of awareness of podiatry as a career clearly needs to be addressed, ideally with more positive role modelling in mainstream and popular media. The career status offered together with the breadth of, and opportunity associated with, the scope of practice should continue to be celebrated.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13047-021-00470-y.

Beyond COVID-19 Pandemic: An Integrative Review of Global Health Crisis Influencing the Evolution and Practice of Corporate Social Responsibility

Background: Global health crisis continues to drive the dynamics of corporate social responsibility (CSR) across industries with self-perpetuating momentum. From a historical point of view, more than a century of immense corporate fecundity has formed the ecological conditions and shaped current understanding of the effect of public health on CSR. This study sought to examine the extent to which companies are able to balance their business interest with social interest through health-related CSR and how knowledge of them can help explain the potential impact of COVID-19. Method: This study employs a narrative review of current literature; however, the integrative strategy was combined with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist to rigorously select the necessary articles for proper integrative synthesis. Results: We note that in the pursuit of their social responsibility, corporate enterprises struggle to balance the interest of society and their own interest. Genuine CSR activities such as donations are often undermined by unbridled and excessive desire to draw society on themselves to reap economic benefits are largely dominated by the need to advance. There are signals that enterprises might see COVID-19-related CSR as an entry door to increase corporate influence thereby commercializing the pandemic. Conclusions: The impact of COVID-19 on CSR is epochal. There is a moral obligation for enterprises to reform current risk assessments and collaborate more deeply with state agencies to invest in the health and safety inspections at the world place. CSR strategies must be proactive to endure other unknown pandemics with equal capacity to disrupt business operations. Companies must create innovative and regular activities to educate its stakeholders to become more committed to safeguarding future enterprise-based defense mechanism needed to diagnose, protect, treat, and rehabilitate victims and those threatened by pandemics and other emergencies that affect the stability of an organization to reduce its cost and protect revenue.

Experiences of Australian podiatrists working through the 2020 coronavirus (COVID-19) pandemic: an online survey

BACKGROUND

On the 19th of January, 2020, the Chief Medical Officer of Australia issued a statement about a novel coronavirus, or SARS-CoV-2. Since this date, there have been variable jurisdictional responses, including lockdowns, and restrictions on podiatry practice. This study aimed to describe impacts of the SARS-CoV-2 pandemic on the podiatry profession in Australia.

METHODS

This was a cross sectional study of Australian podiatrists using demographic data collected between 2017 and 2020, and pandemic-related question responses collected between 30th March and 31st August, 2020. Data were collected online and participants described their work settings, patient funding types, business decisions and impacts, and information sources used to guide practice decisions during this time-period. Inductive thematic analysis was used to analyse open-ended questions about their practice impact of SARS-CoV-2.

RESULTS

There were 732 survey responses, with 465 Australian podiatrists or podiatric surgeons providing responses describing pandemic impact. From these responses, 223 (49% of 453) podiatrists reported no supply issues, or having adequate supplies for the foreseeable future with personal protective equipment (PPE) or consumables to support effective infection prevention and control. The most frequent responses about employment, or hours of work, impact were reported in the various categories of "business as usual" (n = 312, 67%). Participants described most frequently using the local state and territory Department of Health websites (n = 347, 75%), and the Australian Podiatry Association (n = 334, 72%) to make decisions about their business. Overarching themes which resounded through open-ended comments was that working through the pandemic was likened to a marathon, and not a sprint. Themes were: (i) commitment to do this, (ii) it's all in the plan, but not everything goes to plan, (iii) my support team must be part of getting through it, (iv) road blocks happen, and (v) nothing is easy, what's next?

CONCLUSION

Podiatrists in Australia reported variable pandemic impact on their business decisions, PPE stores, and their valued sources of information. Podiatrists also described their "marathon" journey through the pandemic to date, with quotes describing their challenges and highlights. Describing these experiences should provide key learnings for future workforce challenges, should further restrictions come into place.

Factors associated with Brazilian physical therapists' perception of stress during the COVID-19 pandemic: a cross-sectional survey

This study aimed to evaluate the stress perception among Brazilian physical therapists (PTs) during COVID-19 pandemic and to identify which psychosocial demands, sociodemographic, professional and clinical factors do associate with the PTs' stress perception. This cross-sectional survey was based on a convenience sample of PTs, who answered a questionnaire about: 1) sociodemographic and professional characteristics, 2) clinical characteristics and information related to COVID-19, 3) psychosocial demands, and 4) 10-item Perceived Stress Scale (PSS-10). Full responses were obtained from 417 PTs. The average PSS-10 score was 19.2 (95% CI 18.5 to 19.9), which was higher than in other Brazilians before COVID-19 and figured among the highest one observed in healthcare workers from different countries during COVID-19 pandemic. After multivariate analysis, PTs' perceived stress remained associated with female sex, younger age, previous diagnosis of depressive or anxiety disorder, worsening in sleep patterns, large reduction in family income, housework, relationship with the partner, concern about close people/family members being infected by SARS-CoV-2, and loneliness.

Impact of COVID-19 on Mental Dimension of Health: A Sensitive Issue to be Addressed at the Earliest

Background:

The novel coronavirus disease outbreak of 2019 was declared as a public health emergency by the World Health Organization. At present, the virus has spread throughout the world, leading to millions of cases and is further increasing.

Objective:

The main objective of this study is to review the impact of Corona Virus Disease 2019 (COVID-19) on the mental health of frontline workers, isolated and quarantined people and the general population.

Methods:

The relevant articles were extracted from PubMed, Web of Science and ScienceDirect database by using the keywords “Mental health”, “COVID-19”, “Impact of COVID-19”, “Frontline workers”, “Quarantine”, “Isolation”, “Immunity” and “Economy”. The retrieved articles were included in the study based on inclusion criteria to perform the review. All the selected scientific articles were critically reviewed and the information is summarized in this narrative review.

Results:

The majority of the studies stated that frontline health workers were at an increased risk of depression. The infected, suspects and quarantined people were reported with high stress, posttraumatic stress disorder, and suicidal thoughts. The pandemic has devastated the world’s economy, which has severely impacted global mental health.

Conclusion:

Mental health should be taken into account, and necessary interventional initiatives need to be considered both by the health authorities and the government to minimize the adversity of the consequences. The pandemic may disappear with the discovery of new vaccines or medications, but its negative impact on mental health may persist, particularly among vulnerable populations. Thus, mental health must be a matter of concern in the present scenario.

Lockdown During COVID-19 and the Increase of Frailty in People With Neurological Conditions

Governments around the globe have introduced quarantine, lockdown, and mandatory isolation to slow the transmission of COVID-19. These public health and policy measures aim to protect the public and vulnerable people. This perspective paper argues that the impacts of lockdown (such as social disconnection, reduced exercise, and fewer physiotherapy treatments) may be amplified for people with neurological conditions with subsequent increases in frailty. The paper outlines why this may occur, and explores how adverse impacts for these vulnerable populations may be minimized through strategies such as telehealth, exercise programs, and health policies.

Pulmonary rehabilitation and exercise therapy in a patient with COVID-19: A Case report

Dyspnea, shortness of breath, and inability to perform activities of daily living are the main complaints in patients with COVID-19 and physiotherapy has a vital role in managing such symptoms. We present a case treated with pulmonary and neurological physiotherapy, which improved symptoms and quality of life. In this case report, the importance and potential effect of concise physiotherapy on patients with COVID-19 is presented.

Systematic rapid living review on rehabilitation needs due to COVID-19: update to May 31st, 2020

INTRODUCTION

This paper adds to the series of systematic rapid living reviews, started in April 2020, to provide the rehabilitation community with updates on the latest scientific literature on rehabilitation needs due to the COVID-19 pandemic. The aim of this study was to present the results of a systematic search performed on papers published from May 1st to May 31st, 2020.

EVIDENCE ACQUISITION

An extensive search on the main medical literature databases for articles published (including Epub), in English, from May 1st to May 31st, 2020 was performed, according to the methodology already described in the previous 2 rapid reviews, with 2 important improvements: first, we made the search string more comprehensive; second, we relied on accredited terminologies to describe the study designs and report the rehabilitation settings.

EVIDENCE SYNTHESIS

Fifty-eight out of 618 articles were finally included for qualitative analysis. The number of primary studies has increased, with respect to the previous months, although still around 60% papers are just expert opinions. Six papers report on the prevalence and /or characteristics of emerging disability after COVID-19, 12 on rehabilitation approaches to COVID-19 patients, up to 25 on the organization of rehabilitation services after COVID-19, 13 papers on the impact of COVID-19 on health conditions of rehabilitative interest and only 2 on late complications due to COVID-19 that may be of rehabilitative interest.

CONCLUSIONS

Nowadays, all patients with disability, regardless of COVID-19 infection, are suffering because of restrictions imposed to rehabilitation service delivery. Neurological involvement is often present during acute and postacute stage, conveying the risk of a long-lasting disability. Accordingly, careful neurological monitoring should be granted. Although new therapies are under development, the main gap in the available scientific literature is the lack of high-quality primary studies, so experimental studies on the effects of rehabilitation are still warranted.

COVID 19 and manual therapy: international lessons and perspectives on current and future clinical practice and education

BACKGROUND

The COVID-19 pandemic has altered clinical practice and education in manual therapy globally. Social distancing has limited in-person care and changed health-care provision. Education in manual therapy has moved to online platforms with in-person instruction restricted. The global impact on the clinical practice of manual therapy and education has to date not been explored.

METHODS

a questionnaire survey methodology was used. A sample of convenience of global leaders in manual therapy practice and education received an electronic link to two surveys: one on clinical practice and one on education. Contributors could complete one or both surveys.

RESULTS

Twenty-five surveys were received on clinical practice and 23 on education in manual therapy, representing the six major continents. Global themes in clinical practice demonstrated a sudden and dramatic shift away from patient contact, with limited modifications to manual therapy in patient care currently adopted. Themes in education were of a major shift to online learning, development of new modes of student instruction including video-based assessment and virtual case-based instruction.

CONCLUSION

The international perspectives provided demonstrate a major change in manual therapy practice and education globally. Various approaches have been taken in practice and education without a uniform approach being demonstrated.