Exum Emelia, Hull Brian L, Lee Alan Chong W, Gumieny Annie, Villarreal Christopher, Longnecker Diane
Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX 75246 (USA)
Department of Physical Medicine & Rehabilitation, Baylor University Medical Center, Dallas, Texas Baylor Scott & White Institute for Rehabilitation, Dallas, Texas.
J Acute Care Phys Ther. 2020 Jun 15;11(3). doi: 10.1097/JAT.0000000000000143. Epub 2020 May 14.
The COVID-19 pandemic continues to grow, with 19% of total confirmed patients classified as severe or critical experiencing complications such as dyspnea, hypoxia, acute respiratory distress syndrome, or multiorgan failure. These complications require rehabilitative care. Considering the contagious nature of COVID-19 and the necessity to decrease the volume of health care professionals entering confirmed COVID-19 patient rooms and becoming a potential disease vector, can audiovisual technologies employed by telehealth and telerehabilitation help?
This case discusses the Baylor Scott and White Institute for Rehab (BSWIR) Physical Medicine and Rehabilitation (PMR) department COVID-19 acute care therapy team's creation of a telehealth strategy to provide early rehabilitative intervention without increasing the odds of disease transmission.
The COVID-19 therapy team created a simple process for identifying and triaging care for patients with possible or confirmed COVID-19. These patients were evaluated and treated by the dedicated team using telehealth strategies. A structured risk-benefit analysis was used to determine when in-room care was indicated.
Acute care physical therapy, occupational therapy, and speech-language pathology telehealth strategies can add value by mitigating COVID-19-related harm and influencing recovery, while not unnecessarily becoming additional disease vectors consuming personal protective equipment. COVID-19 is not only an aggressive respiratory illness similar to acute respiratory distress syndrome but also highly contagious and a risk for health care providers. Telehealth strategies allow therapists to intervene early, opening the possibility to maximize recovery and prevent harm or decompensation. Telehealth strategies can be more prevention-focused while the patient is experiencing relatively good health with goals to maximize strength and endurance before the disease process evolves to critical illness. As COVID-19 progresses, therapy can help mitigate potential complications associated with prolonged intensive care unit stay and ventilator management.
新型冠状病毒肺炎（COVID-19）大流行仍在持续，19%的确诊患者被归类为重症或危重症，出现呼吸困难、缺氧、急性呼吸窘迫综合征或多器官功能衰竭等并发症。这些并发症需要康复治疗。考虑到COVID-19的传染性，以及减少进入确诊COVID-19患者病房并成为潜在疾病传播媒介的医护人员数量的必要性，远程医疗和远程康复所采用的视听技术是否能有所帮助？
本病例讨论了贝勒·斯科特与怀特康复研究所（BSWIR）物理医学与康复（PMR）科COVID-19急性护理治疗团队制定的远程医疗策略，以提供早期康复干预，同时不增加疾病传播几率。
COVID-19治疗团队创建了一个简单流程，用于识别和分类护理可能感染或确诊COVID-19的患者。这些患者由专门团队使用远程医疗策略进行评估和治疗。采用结构化风险效益分析来确定何时需要进行病房内护理。
急性护理物理治疗、职业治疗和言语语言病理学远程医疗策略可通过减轻与COVID-19相关的伤害并影响康复来增加价值，同时不会不必要地成为消耗个人防护装备的额外疾病传播媒介。COVID-19不仅是一种类似于急性呼吸窘迫综合征的侵袭性呼吸道疾病，而且具有高度传染性，对医护人员构成风险。远程医疗策略使治疗师能够早期干预，为最大限度地促进康复、预防伤害或失代偿创造了可能性。在患者健康状况相对良好时，远程医疗策略可以更注重预防，目标是在疾病进程发展为危重症之前最大限度地增强力量和耐力。随着COVID-19病情进展，治疗可有助于减轻与长时间入住重症监护病房和呼吸机管理相关的潜在并发症。
