Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212 Friedman Bldg, 2177 Wesbrook Mall, Vancouver, British Columbia, V6T 1Z3, Canada.
School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
Phys Ther. 2020 Aug 31;100(9):1458-1464. doi: 10.1093/ptj/pzaa115.
Coronavirus disease 2019 (COVID-19) has sounded alarm bells throughout global health systems. As of late May, 2020, over 100,000 COVID-19-related deaths were reported in the United States, which is the highest number of any country. This article describes COVID-19 as the next historical turning point in the physical therapy profession's growth and development. The profession has had over a 100-year tradition of responding to epidemics, including poliomyelitis; 2 world wars and geographical regions experiencing conflicts and natural disasters; and, the epidemic of noncommunicable diseases (NCDs). The evidence-based role of noninvasive interventions (nonpharmacological/nonsurgical) that hallmark physical therapist practice has emerged as being highly relevant today in addressing COVID-19 in 2 primary ways. First, despite some unique features, COVID-19 presents as acute respiratory distress syndrome in its severe acute stage. Acute respiratory distress syndrome is very familiar to physical therapists in intensive care units. Body positioning and mobilization, prescribed based on comprehensive assessments/examinations, counter the negative sequelae of recumbency and bedrest; augment gas exchange and reduce airway closure, deconditioning, and critical illness complications; and maximize long-term functional outcomes. Physical therapists have an indisputable role across the contiuum of COVID-19 care. Second, over 90% of individuals who die from COVID-19 have comorbidities, most notably cardiovascular disease, hypertension, chronic lung disease, type 2 diabetes mellitus, and obesity. Physical therapists need to redouble their efforts to address NCDs by assessing patients for risk factors and manifestations and institute evidence-based health education (smoking cessation, whole-food plant-based nutrition, weight control, physical activity/exercise), and/or support patients' efforts when these are managed by other professionals. Effective health education is a core competency for addressing risk of death by COVID-19 as well as NCDs. COVID-19 is a wake-up call to the profession, an opportunity to assert its role throughout the COVID-19 care continuum, and augment public health initiatives by reducing the impact of the current pandemic.
2019 年冠状病毒病（COVID-19）敲响了全球卫生系统的警钟。截至 2020 年 5 月底，美国报告的 COVID-19 相关死亡人数超过 10 万，这是任何国家中报告死亡人数最多的。本文将 COVID-19 描述为物理治疗专业发展的下一个历史转折点。该专业在应对包括脊髓灰质炎在内的传染病方面拥有 100 多年的历史，经历过两次世界大战以及在发生冲突和自然灾害的地理区域；以及非传染性疾病（NCD）的流行。非侵入性干预措施（非药物/非手术）的循证作用一直是物理治疗师实践的标志，在解决 COVID-19 方面具有重要意义，主要有以下两种方式。首先，尽管 COVID-19 具有某些独特的特征，但在其严重的急性阶段，它表现为急性呼吸窘迫综合征。急性呼吸窘迫综合征在重症监护病房的物理治疗师中非常熟悉。基于全面评估/检查的体位和运动治疗，可以防止卧床和卧床休息带来的负面后果；增强气体交换并减少气道关闭、去适应和重症并发症；并最大限度地提高长期功能结局。物理治疗师在 COVID-19 护理的整个过程中都具有不可争议的作用。其次，死于 COVID-19 的人中有 90%以上有合并症，最常见的是心血管疾病、高血压、慢性肺部疾病、2 型糖尿病和肥胖症。物理治疗师需要加倍努力，通过评估患者的危险因素和表现，并实施循证健康教育（戒烟、全植物性营养、体重控制、身体活动/锻炼）来解决 NCD 问题，或在这些问题由其他专业人员管理时为患者提供支持。有效的健康教育是降低 COVID-19 死亡风险和 NCD 风险的核心能力。COVID-19 是对该专业的警钟，是在 COVID-19 护理连续体中发挥其作用的机会，并通过减少当前大流行的影响来增强公共卫生倡议。
