KNOWLEDGE, CHARACTERISTICS, WORK SITES OF HEALTH PRACTITIONERS FOR CHEST PHYSIOTHERAPY IN PATIENTS WITH COVID-19, IN KHARTOUM, SUDAN

Mohammed Elfatih Elbadri1image, Marina Victor2image, Randa Ibrahem2image, Aya Azhari2image, 

Mariam Essam2image, Ali Awadallah Saeed3,4image

1National University- Sudan. 2Faculty of Physiotherapy, National University, Sudan.

3Department of Pharmacology and Therapeutics, Pharmacy Program, Napata College, Sudan.

4Department of Pharmacology, Faculty of Clinical and Industrial Pharmacy, National University, Sudan.

 

 

Background and objective: COVID-19 was first identified in December 2019. The outbreak of coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization Emergency Committee and originated in the Hubei Province of the People's Republic of China, and on March 11, 2020. This study aims to describe the characteristics and work locations of health practitioners who apply chest physiotherapy for coronavirus patients and the extent and types of complications for coronavirus patients in Jabra and universal isolation centers in Khartoum.

Methods: A total of 109 participants from Jabra and universal isolation centers in Khartoum completed a questionnaire based survey on the Knowledge and practices and outcome of Physiotherapy for COVID-19 patients. The questionnaire was self-administrated and distributed by personal contact. Convenient sampling method was used for data collection and the distributions of responses were presented as frequencies and percentages.

Results: Total 109 individuals participated in this study; females (56%) were more than males. 28.4 % worked in isolation center for 3 -6 months while 23.9 % were worked for 6-9 months. 33 % from physiotherapists received patients aged 40-50 years old, while 23.95 received patients aged more than 60 years old. The intensive care unit was the most common site for chest physiotherapy (41.3%). Complications to isolation center patients occur as stated by 59.6% and the most common complications mentioned were shortness of breath (37.6%), followed by repeated chest infections (22.9%). Chest physiotherapy is very important for COVID-19 patients in isolation center as stated by (53.2%).

Conclusion: As overall, COVID-19 presents challenges to inpatient care and participants know that physiotherapists play a fundamental role throughout help patients to prevent very serious complications and patient hospitalization. Physiotherapist in hospitals must be well-oriented regarding specific care to both provide the best patient care and reduce infection risk.

Keywords: Chest Physiotherapy, Health Practitioners, Khartoum, COVID-19, Knowledge.

 

INTRODUCTION

 

COVID-19 was first identified in December 2019. The outbreak of coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization Emergency Committee and originated in the Hubei Province of the People's Republic of China, and on March 11, 20201.  Investigations are ongoing as to how this virus spread2. COVID-19 symptoms include fever, cough, shortness of breath or difficulty breathing, nausea or vomiting and congestion or runny nose. COVID-19 can lead to death3. Prevention involves coughing into the bend of your elbow, frequent hand washing, wearing a cloth face covering if you can't practice physical distancing and staying home when you are sick4,5. Physiotherapists are professionals working in primary and tertiary care who play a fundamental role in multi-professional teams providing rehabilitation interventions and ventilatory support during the acute illness phase6,7,8. This research describes practices and the different actions adopted by the Rehabilitation Service in isolation centers in Khartoum to face the challenges in containing and treating the spread of COVID-199-12. So, this study was done to raise the awareness of the community regarding chest physiotherapy and exercises to reduce complications in young people and adults to improve daily activities and productivity. Most patients have no exudation during acute period of COVID-19, and as such, chest physiotherapy may not be recommended and procedures such as pursed-lip breathing, diaphragmatic breathing, and bronchial hygiene/lung re-expansion techniques are contra-indicated during this stage, and priority to use of a mechanical ventilator13-15. Chest physiotherapy used to relieve dyspnea and depression and anxiety for those with exudation and mild to moderate symptoms6-15. There are no studies reporting on the use of chest physiotherapy during the acute stage aside from a recommendation based on anecdotal evidence15. Patients may lose spontaneous breathing during chest physiotherapy under mechanical ventilation and predispose the patients to develop ventilator-associated pneumonia and lung collapse, so chest physiotherapy used to reduce the length of stay in ICU and mechanical ventilator and prevent ventilator-associated pneumonia15. In addition, high-frequency chest wall oscillation for incubated patients resulted in decreased lung collapse on days 2 and 3, increased dry sputum weight and PaO2 on day 3, and culture positivity on day 3 (16). Patient who received 11 sessions of physical therapy every 2h for 12h over his 48h stay in the ICU, arterial oxygen level improved, with radiographic resolution of infiltration16.  Techniques recommended in patients who are on a ventilator include airway clearance techniques, endotracheal suctioning, lung maneuver recruitment, and change in posture. The airway clearance techniques recommended include manual and/or ventilator hyperinflation, percussion and vibration, positioning, active cycle of breathing, positive expiratory pressure (PEP), and mechanical insuflation-ensufflation17.

This study aims to describe the characteristics and work locations of health practitioners who apply chest physiotherapy for coronavirus patients and the extent and types of complications for coronavirus patients in Jabra and universal isolation centers in Khartoum.

 

METHODS

 

A total of 109 participants from Jabra and universal isolation centers in Khartoum completed a questionnaire based survey on the Knowledge and practices and outcome of Physiotherapy for COVID-19 patients. The questionnaire was self-administrated and distributed by personal contact. Convenient sampling method was used for data collection and the distributions of responses were presented as frequen-cies and percentages.

Ethical consideration

It was sought from the research technical and ethical committee at the faculty of Medicine. The participants' privacy and confidentiality were maintained.

 

RESULTS

 

Total 109 individuals participated in this study; females were 56%.The commonest age group was found to be 30-35 (35.8%), followed by 25-30 (27.5%). Regarding the importance of chest physiotherapy, (53.2%) said it is very important, while (38.5%) said it is somewhat important (Table 1). Total 45% were doctors, followed by nurses (33%) regarding the occupation of participants. 

Total 33 % from patients presenting to isolation center aged 40-45 years old and 23.9 % aged more than 60 years old.  Total 49.5% from patients received chest physiotherapy were in ICU and 14.7% were in HDU (Table 2).

Total 67.9% patients suffered from complications after isolation period (Table 3).  Total 67.9% from patients suffer from complications after isolation period while 32.1% didn’t (Figure 1). The most common complications mentioned were shortness of breath (37.6%), followed by repeated chest infections (22.9%), low oxygen (14.7%), and 7.3 % COPD (Table 3).

Most common chest physiotherapy technique used was huffing or coughing stated by 30.3%, percussion (clapping) (23.9%), vibration (30.2%), and porn position type (15.6%) (Figure 2).

 

DISCUSSION

 

To the best of our knowledge, this is one of the few studies in the scientific literature that investigates the knowledge, Characteristics, Work Sites of Health Practitioners for Chest Physiotherapy in Patients with COVID-19, in Khartoum. Physiotherapists are playing an important role in functional and respiratory rehabilitation of patients affected with COVID-19 by providing tele-rehabilitation services and carrying out outpatient physiotherapy during the pandemic20. Total 109 individuals participated in this study; females (56%) were more than males. The commonest age group was found to be 30-35 (35.8%), followed by 25-30 (27.5%). Regarding the occupation, (45%) were doctors, followed by nurses (33%). When compared to the previous studies, the results of this study convenient with them17-20. The commonest age group presenting to the isolation centers, (33%) said 40-50 years, followed by more than 60 years (23.9%). This result can be logical, in which these age groups are the most affected age groups according to the latest studies.Obtained data were not in concordance with literature data, which emphasize the real effectiveness of physiotherapy in respiratory patients admitted to the ICU for reducing their oxygen need18. Current finding inconsistent Letícia Marcelino Sotelo Dias et al., finding21, percussion used only in 1% patients while in current study used for 23.9%. Prone positioning used in 15.6% patients in current study while 90% in Letícia study. Cough used by 30.3% in current study and 75% in Letícia study. The importance of chest physiotherapy, only 8.3 % stated that it is not important for COVID-19 patients, this is consistent to what found in previous studies “physiotherapists will be increasingly involved in the care of these patients, to improve pulmonary function, physical and psychological efficiency, and to restore a good patient quality of life”22.

It was considered that the implementation of physiotherapy in the treatment of this category of patients can be considered an interesting therapeutic tool, which can be implemented after a thorough assessment of the abilities, needs, and co-morbidities of each patient. Coronavirus disease 2019, is pandemic has a respiratory complication after months of the initial illness. So, this study was done to raise the awareness of the community regarding chest physiotherapy and exercises to reduce complications in young people and adults to improve daily activities and productivity, despite there remains a lack of evidence about rehabilitation programs in patients with COVID-1922. In a previous study Loyola discussed the impact of COVID-19 in Mexico and suggests the different ways to prepare for future pandemics23. Mohammed et al.,24 in their study discuss the different herbal formulation for COVID-19 treatment in Sudan. In an another study Islam et al.,25 discussed COVID 19 impact in Bangladesh.

Limitation of study 

Several limitations were found, the small number of participants, the impact on the quality of life (QOL) of patients with COVID-19 regardless of the time of discharge after hospitalization and recovery. The global assessment of the lung function during this study was not possible because this type of investigation was not allowed to be conducted on patients infected with SARS-CoV-219. 

 

CONCLUSION

 

As overall, COVID-19 is a new disease that presents challenges to inpatient care. Participants know that physiotherapy plays a fundamental role throughout patient hospitalization and can help patients prevent very serious complications. However, the hospital physiotherapy team must be well-oriented regarding specific care to both reduce infection risk and provide the best patient care.

 

RECOMMENDATION

 

More studies are needed to investigate not only the impact that physiotherapy has on the clinical manifestation of the disease but also on effort capacity, muscle strength, and lung capacity.

 

AUTHOR’S CONTRIBUTION

 

All authors contributed to write and review the manuscript.

 

ACKNOWLEDGEMENTS

 

The authors thank all participants who volunteered to take part in this study.

 

CONFLICT OF INTEREST 

 

No conflict of interest associated with this work. 

 

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