QUESTION

Do I need to wear a mask if maintaining a 2m distance in a treatment room while delivering face-to-face CBT in Primary Care?

Short answer

The National Public Health Emergency Team (NPHET) has recommended that healthcare workers use a surgical mask for all patient care activities when a safe distance (2m) cannot be maintained. This implies that when a 2m distance can be maintained a mask is not necessary. However, the NPHET guidance does not state this explicitly and does not address the issues of room size/occupancy or duration of contact. The European Centre for Disease Prevention and Control considers maintaining a 2m distance in a closed environment, such as a treatment room, as low-risk for exposure to COVID-19. The HSE Health Protection Surveillance Centre state that in low-risk circumstances, where wearing a mask may impact on patient care, a clear face visor is an acceptable alternative.

The content of this document is correct as of 30/09/2020.

These documents were used to answer this question:

1. Health Protection Surveillance Centre (2020). Interim Guidance on Infection Prevention and Control for the Health Service Executive 2020 v1.2. HSE: September 2020.
2. Health Protection Surveillance Centre (2020). Guiding principles for Infection Prevention and Control when returning to routine General Practice during pandemic COVID-19 v2.1. HSE: July 2020.
3. European Centre for Disease Prevention and Control (2020). Public health management of persons having had contact with cases of novel coronavirus in the European Union. ECDC: February 2020.

Dr Liz Kingston, member of the RapidInfo4U Panel of Experienced Clinicians and Lecturer at the University of Limerick, with a clinical speciality in infection prevention and control, was consulted to answer this question.

Is there sufficient evidence to warrant a change in the established position (i.e. NICE guidelines of June 2020) regarding vitamin D for the prevention or treatment of COVID-19?

Short answer: No

The content of this document is correct as of 17/09/2020.

Question

1.Can a Classroom Feeding Observation for Dysphagia take place within a Pod? 

2.When conducting a Classroom Feeding Observation for Dysphagia do parents of children in the same Pod as the patient need to be informed of, and consent to, the observation?

Short answer

1.Yes, assuming local and national COVID-19 guidelines are followed including PPE and social distancing, a Classroom Feeding Observation for Dysphagia can take place within a Pod.

2.Yes, assuming local and national COVID-19 guidelines are followed including PPE and social distancing, a Classroom Feeding Observation for Dysphagia can take place within a Pod.

The content of this document is correct as of 18/09/2020.

This response was based on the Department of Education COVID-19 Response Plan for Reopening our Primary and Special Schools, version 2, published in August 2020. Access this document here.

Question

Can the below tests be administered via telepractice?

• Beery-Buktenica Developmental Test of Visual-Motor Integration
• Detailed assessment of speed of handwriting (DASH)

Answer

Yes, both Beery and the DASH have publisher recommendations for administration via telepractice. Detailed instructions for the DASH can be found here and detailed instructions for the Beery can be found here.

Both tests are published by Pearson. The DASH telepractice information is available on the Pearson UK website but it does not appear on their US website. For the Beery, vice versa, the telepractice information is available on the Pearson US website and does not appear on their UK website.

Question

What is the impact on return to work for patients with COVID-19 who have been hospitalised?

Short Answer

In Ireland, 3,676 people have been hospitalised because of COVID-19. There is no information on the consequent work status of these individuals. This is also the case on the global stage. There are indications from small scale studies and research on similar diseases (SARS & MERS) that some individuals hospitalised with COVID-19 will experience delayed return to work. Fatigue and breathlessness are the most common post-discharge symptoms. Scientists and professional bodies are calling for occupational therapists and other allied health professionals to prepare for the surge in demand for services but more research is needed to determine the long-term consequences of a COVID-19 hospitalisation and its impact on return to work.

The content of this document is correct as of 08/10/2020.

Vitacca, M., Carone, M., Clini, E. M., Paneroni, M., Lazzeri, M., Lanza, A., … & Banfi, P. (2020). Joint statement on the role of respiratory rehabilitation in the COVID-19 crisis: the Italian position paper. Respiration, 1-7.

Joint statement on the role of respiratory rehabilitation in the COVID-19 crisis from the Italian Thoracic Society (ITS – AIPO), Association for the Rehabilitation of Respiratory Failure (ARIR) and the Italian Respiratory Society (SIP/IRS).

This joint statement is a Consensus Statement on Respiratory Rehabilitation in patients with COVID-19. It is based on the general experience so far in dealing with the disease and on the existing knowledge of the ITS – AIPO, ARIR and the SIP/IRS.

This joint statement represents an expert opinion of clinicians engaged in the field of RR, called – together with other specialities – to face with this emergency. It summarises the recommendations they consider most appropriate and urgent.

World Health Organization, 2020. Support for Rehabilitation Self-Management after COVID-19-Related Illness (No. WHO/EURO: 2020-855-40590-54571). World Health Organization. Regional Office for Europe.

This leaflet provides basic exercises and advice for adults who have been severely unwell and admitted to the hospital with COVID-19. It provides information on the following areas:

• Managing breathlessness
• Exercising after leaving hospital
• Managing problems with your voice
• Managing eating, drinking, and swallowing
• Managing problems with attention, memory, and thinking clearly
• Managing activities of daily living
• Managing stress, anxiety, or depression

Click here for document

The Chartered Society of Physiotherapy (CSP) is the professional, educational and trade union body for the UK’s 59,000 chartered physiotherapists, physiotherapy students and support workers.

The CSP have a range of resources and guides available here for the rapid implementation of remote physiotherapy delivery

This guide was developed by the Irish Society of Chartered Physiotherapists’ (ISCP) Clinical Interest Group in Neurology and Gerontology. It is a guide for treating older people post COVID-19 in hospital, post-acute care and the community.

The purpose of this document is to update the 1999 ATS
Consensus Statement on dyspnea.

Parshall, M. B., Schwartzstein, R. M., Adams, L., Banzett, R. B., Manning, H. L., Bourbeau, J., … & Mahler, D. A. (2012). An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. American journal of respiratory and critical care medicine, 185(4), 435-452.

This is an American Thoracic Society Statement from 2012 providing an update on the Mechanisms, Assessment, and Management of Dyspnea

Click here for statement

Vitacca, M., Carone, M., Clini, E. M., Paneroni, M., Lazzeri, M., Lanza, A., … & Banfi, P. (2020). Joint statement on the role of respiratory rehabilitation in the COVID-19 crisis: the Italian position paper. Respiration, 1-7.

Joint statement on the role of respiratory rehabilitation in the COVID-19 crisis from the Italian Thoracic Society (ITS – AIPO), Association for the Rehabilitation of Respiratory Failure (ARIR) and the Italian Respiratory Society (SIP/IRS).

This joint statement is a Consensus Statement on Respiratory Rehabilitation in patients with COVID-19. It is based on the general experience so far in dealing with the disease and on the existing knowledge of the ITS – AIPO, ARIR and the SIP/IRS.

This joint statement represents an expert opinion of clinicians engaged in the field of RR, called – together with other specialities – to face with this emergency. It summarises the recommendations they consider most appropriate and urgent.

Keeney, T. (2020). Physical Therapy in the COVID-19 Pandemic: Forging a Paradigm Shift for Rehabilitation in Acute Care. Physical therapy, 100(8), 1265-1267.

The COVID-19 pandemic is a crucible for health care systems across the country. Although rehabilitation utilization in hospitals varies enormously based on institution size, financial resources, and geographic location, it is clear that even in settings where acute care physical therapy is well staffed and well-funded, expansion of our roles is essential. Acute care physical therapists have long provided skilled evaluation and treatment in frenetic and fast-paced environments to patients struggling with serious illness. However, it is only by reacting to these new and difficult circumstances with growth and self-advocacy that we can forge a future characterized by intensive skilled rehabilitation services in the inpatient setting, simultaneously benefiting our health care systems and the patient populations we serve.

Click here for article

Stanhope, J., & Weinstein, P. (2020). Learning from COVID-19 to improve access to physiotherapy. Australian Journal of Primary Hehttps://www.publish.csiro.au/py/Fulltext/PY20141alth, 26(4), 271-272.

This letter states that funding for telehealth should continue post-COVID-19 and should include provision for tele-physiotherapy. The authors argue there are several instances where tele-physiotherapy may be an appropriate form of primary care, including the early management of acute pain, which may otherwise become chronic.

Click here for article

Polastri, M. (2020). Physiotherapy in hospitalised patients with COVID-19 disease: what we know so far. International Journal of Therapy and Rehabilitation, Vol. 27, No. 3.

This short editorial was published in April 2020.

Click here for article

Turolla, A., Rossettini, G., Viceconti, A., Palese, A., & Geri, T. (2020). Musculoskeletal Physical Therapy During the COVID-19 Pandemic: Is Telerehabilitation the Answer?. Physical therapy, 100(8), 1260-1264.

This article discuses the clinical evidence for telerehabilitation and examines the feasibility and acceptability of this approach. Both the opportunities and challenges of Telerehabilitation are addressed.

Click here for article

Polastri, M., Brini, S., Ghetti, A., & Lama, A. (2020). Recommendations from scientific/professional societies: an essential support for physiotherapy in patients with COVID-19.

The article emphasizes the need to develop a collective approach to how physiotherapy for COVID-19 patients should be implemented.

Topics discussed include:

-characteristics of treatment

-lessons learned from the COVID-19 outbreak

-recommendations provided by international scientific societies such as the World Confederation for Physical Therapy

-position papers released by the Italian Association of Respiratory Physiotherapists and other related organizations in Italy

Click here for article

Awan, M. M. A., Qureshi, S., & Khushnood, K. (2020). Cardiopulmonary Physical Therapist; A rescuer for the patients suffering from COVID-19. Pakistan Journal of Medical Sciences, 36(5).

The article discusses that according to World Health Organization (WHO), the ailments caused by viruses have always emerged in the past and exposed masses to life threatening medical conditions. It mentions the physiotherapists specialized in cardiopulmonary physical therapy are a life saver and rescuer for patients having COVID-19 and discusses the most common complications associated with COVID-19: acute respiratory distress syndrome (ARDS).

Click here for article

Özkeskin, M., Elibol, N., & Bakırhan, S. (2020). Risk of COVID-19 Disease in the Elderly Population and Physiotherapy. Physiotherapy.

In this letter to the editor, the authors conclude that elderly patients in ICU or hospital should have early physiotherapy treatment with medical treatment because early physiotherapy will be important for improvement of functional status and quality of life in the elderly in the early period after discharge.

Click here for letter

A Coping with Breathlessness poster courtesy of the Dept of Physiotherapy, Pulmonary Rehabilitation, University Hospital Limerick.

A Progressive Muscle Relaxation script for Pulmonary Rehabilitation courtesy of the Dept of Physiotherapy, University Hospital Limerick.

World Health Organization, 2020. Support for Rehabilitation Self-Management after COVID-19-Related Illness (No. WHO/EURO: 2020-855-40590-54571). World Health Organization. Regional Office for Europe.

This leaflet provides basic exercises and advice for adults who have been severely unwell and admitted to the hospital with COVID-19. It provides information on the following areas:

• Managing breathlessness
• Exercising after leaving hospital
• Managing problems with your voice
• Managing eating, drinking, and swallowing
• Managing problems with attention, memory, and thinking clearly
• Managing activities of daily living
• Managing stress, anxiety, or depression

Click here for document