Frühe Rehabilitation bei COVID-19 – Best Practice
                    Empfehlungen für die frühe Rehabilitation von
                    Patient/innen mit COVID-19

Max Emanuel Liebl; Christoph Gutenbrunner; Jean Jacques Glaesener; Susanne Schwarzkopf; Norman Best; Gabriele Lichti; Eduard Kraft; Gert Krischak; Anett Reißhauer

doi:10.1055/a-1162-4919

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, Table of Contents

Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 2020; 30(03): 129-134
DOI: 10.1055/a-1162-4919

Originalarbeit

Early Rehabilitation in COVID-19 – Best Practice Recommendations for the Early Rehabilitation of COVID-19 Patients

Article in several languages: deutsch | English

Max Emanuel Liebl

¹Arbeitsbereich Physikalische Medizin und Rehabilitation, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin

,

Christoph Gutenbrunner

²Klinik für Rehabilitationsmedizin, Medizinische Hochschule, Hannover

,

Jean Jacques Glaesener

³Rehabilitationsmedizin, ifi – Institut für Interdisziplinäre Medizin, Hamburg

,

Susanne Schwarzkopf

⁴Zentrum für ambulante Rehabilitation, ZAR Erding, Nuernberg

⁵Klinikum Nürnberg, Paracelsus Medizinische Privatuniversität, Nürnberg

,

Norman Best

⁶Institut für Physiotherapie, Universitätsklinikum Jena, Jena

⁷Posture and Motion Group, Universitätsklinikum Jena, Jena

,

Gabriele Lichti

⁸Zentrum für Physikalische und Rehabilitative Medizin, Klinikum Bad Salzungen, Bad Salzungen

,

Eduard Kraft

⁹Klinik für Orthopädie, Physikalische Medizin und Rehabilitation, Ludwig-Maximilians-Universität München, Munich

,

Gert Krischak

¹⁰Institut für Rehabilitationsmedizinische Forschung, Universität Ulm, Ulm

¹¹Abt. Orthopädie und Unfallchirurgie, Federseeklinik Bad Buchau, Bad Buchau

,

Anett Reißhauer

¹Arbeitsbereich Physikalische Medizin und Rehabilitation, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin

› Author Affiliations

Abstract

The COVID-19 pandemic poses new challenges to physical medicine, physiotherapy, and acute care rehabilitation in rehabilitation clinics as well as in hospitals. We have to assume that COVID-19 patients may need early mobilization and acute care rehabilitation, despite of a possible scarcity of suitable facilities or services. It is the aim of this article to provide conceptual suggestions for the early rehabilitation of COVID-19, combining the existing experience in the acute care rehabilitation of patients with respiratory infections with the currently available sources and experience. These recommendations comprise a checklist of logistical and organisational preparations, aspects of infectivity and personal protective equipment, adjustment of the patients’ surroundings, interprofessional team work and co-therapy, respiratory therapy, mobilisation, activating care, ADL training, training intensity, and psychosocial management.

Key words

rehabilitation - Physical and rehabilitation medicine - COVID-19 - SARS-CoV2 - physiotherapy

Full Text

References

Literatur
1 Thomas P, Baldwin C, Bissett B et al. Physiotherapy management for COVID-19 in the acute hospital setting. Recommendations to guide clinical practice. Version 1.0, published 23 March 2020
2 World Health Organisation (WHO): Clinical Management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected Interim Guidance V1.2. 13 Mar 2020. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected. WHO Reference number WHO/2019-nCoV/clinical/2020.4
3 Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM): Alhazzani, et al (2020): Surviving sepsis campaign: Guidelines of the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Critical Care Medicine, EPub Ahead of Print March 20, 2020
4 McNeary L, Maltser S, Verduzco-Gutierrez M. Navigating Coronavirus Disease 2019 (Covid-19) in Physiatry: A CAN report for Inpatient Rehabilitation Facilities. PM&R 2020; 1482-1934.
5 Drahnak D, Custer N. Prone Positioning of Patients With Acute Respiratory Distress Syndrome. Crit Care Nurse 2015; 35: 29-37
6 Grabowski DC. Maddox KEJ. Postacute care preparedness for COVID-19. Published March 25 2020, JAMA
7 Negrini S, Ferriero G, Kiekens C. et al. Facing in real time the challenges of the Covid-19 epidemic for rehabilitation. European Journal of Physical and Rehabilitation Medicine 2020;
8 Liang T. Handbook of COVID-19 Prevention and Treatment – Compiled According to Clinical Experience. The First Affiliated Hospital, Zhejiang University School of Medicine 2020
9 Boldrini P, Kiekens C, Bargellesi S et al. First impact on services and their preparation. “Instant paper from the field” on rehabilitation answers to the Covid-19 emergency. European Journal of Physical and Rehabilitation Medicine. 2020 Apr 08. doi:10.23736/S1973- 9087.20.06303-0
10 Beyer J, Berliner M, Glaesener JJ. et al. Positionspapier zur Fachübergreifenden Frührehabilitation – 2. aktualisierte Auflage (2015). Phys Med Rehab Kuror 2015; 25: 260-280.
11 Liebl ME, Elmer N, Schwedtke C. et al. Fachübergreifende Frührehabilitation nach Sepsis – Eine retrospektive Analyse. Rehabilitation 2018; 57: 372-380
12 Schweickert WD, Pohlman MC, Pohlman AS. et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009; 373: 1874-1882
13 Gosselink R, Clerckx B, Robbeets C. et al. Physiotherapy in the Intensive Care Unit. Netherlands. J Critical Care 2011; 15: 66-75
14 Bhatraju Bhatraju PK, Ghassemieh BJ, Nichols M. et al. Covid-19 in Critically Ill Patients in the Seattle Region – Case Series. N Engl J Med 2020;
15 https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Hygiene_Tab.html; Stand: 15.04.2020
16 Wölfel R, Corman VM, Guggemos W. et al. Virological assessment of hospitalized patients with COVID-2019. Nature 2020;
17 Liebl ME. Mobilität messen – Assessment: Charité Mobilitäts-Index CHARMI. physiopraxis 2019; 17: 34-36
18 Liebl M, Elmer N, Schroeder I. et al Introduction of the Charité Mobility Index (CHARMI) – A novel clinical mobility assessment for acute care rehabilitation. PLoS One 2016; 11: e0169010
19 Liebl ME, Schwedtke C, Schröder I. et al Der Einfluss des Body Mass Index auf die Mobilisation von Patienten in der Frührehabilitation. Phys Med Rehab Kuror 2018; 28: 114-119
20 Zonghua J, He H, Hu X. et al. Recommendations for Respiratory Rehabilitation of COVID-19 in Adult 2020: PMID: 32125127..
21 https://www.ag-atemphysiotherapie.de/tl_files/aga/bilder/Physiotherapie%20bei%20COVID-19_02_04_2020.pdf Stand: 15.04.2020
22 Reißhauer A, Baack A, Liebl ME. Physiotherapie bei erwachsenen Patienten mit Verdacht oder Nachweis von COVID-19 an der Charité Universitätsmedizin Berlin. Phys Med Rehab Kuror 2020; 30: 64-65.
23 Jaber S, Petrof BJ, Jung B. et al. Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans. American journal of respiratory and critical care medicine 2011; 183: 364-371.
24 Kim WY, Suh HJ, Hong S-B. et al. Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation. Critical care medicine 2011; 39: 2627-2630.
25 Magnussen H, Kirsten A-M, Köhler D. et al. Leitlinien zur Langzeit-Sauerstofftherapie. Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e.V.. Pneumologie 2008; 62: 748-756.
26 Koczulla AR, Schneeberger T, Jarosch I. et al. Langzeitsauerstofftherapie. Gegenwärtige Datenlage und alltagsrelevante, praktische Aspekte. Dtsch Arztebl Int 2018; 115: 871-877.
27 Deffner T, Hierundar A, Arndt D et al. Klinische psychosoziale Notfallversorgung im Rahmen von COVID19 – Handlungsempfehlungen. Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI) https://www.divi.de/empfehlungen/publikationen/covid-19/1532-covid19-psychosoziale-notfallversorgung/file; Stand: 15.04.2020