Interdisciplinary Postgraduate Program in Health Sciences, Universidade Federal de São Paulo - UNIFESP - Campus Baixada Santista. Rua Silva Jardim, 136, CEP 11015-020, Santos, SP, Brazil; Department of Sciences of Human Movement, Universidade Federal de São Paulo -UNIFESP - Campus Baixada Santista, Rua Silva Jardim, 136, CEP 11015-020, Santos, São Paulo, Brazil.
Interdisciplinary Postgraduate Program in Health Sciences, Universidade Federal de São Paulo - UNIFESP - Campus Baixada Santista. Rua Silva Jardim, 136, CEP 11015-020, Santos, SP, Brazil.
Heart Lung. 2023 Nov-Dec;62:87-94. doi: 10.1016/j.hrtlng.2023.06.005. Epub 2023 Jun 12.
Chest physiotherapy for hospitalized patients with COVID-19 has been poorly reported. Although recommendations were published to guide physiotherapists, practice might have differed depending on education and training.
To analyze the differences in chest physiotherapy applied for hospitalized patients with COVID-19 between certified specialists and non-certified specialists.
An online questionnaire survey was developed for physiotherapists involved in the management of hospitalized patients with COVID-19. The questionnaire inquired about professional information and characteristics of physiotherapy practice.
There were 485 respondents, yielding a completion rate of 76%. Of these, 61 were certified specialists and 424 non-certified specialists. The certified specialists were older, had more years of professional experience, were more qualified, and had better job conditions. For mechanically ventilated patients, the certified specialists used the ventilator hyperinflation maneuver more frequently (50.4% vs 35.1%, p = 0.005), and the hard/brief expiratory rib cage compression (ERCC) (26.9% vs 48.3%, p = 0.016), soft/long ERCC (25.2% vs 39.1%, p = 0.047), and manual chest compression-decompression (MCCD) maneuver (22.4% vs 35.6%, p = 0.001) less often. For spontaneously breathing patients, the certified specialists used the active cycle of breathing technique (30.8% vs 67.1%, p<0.001), autogenic drainage (7.7% vs 20.7%, p = 0.017), and MCCD maneuver (23.1% vs 41.4%, p = 0.018) less frequently.
Certified specialists with higher levels of expertise seem to prefer the use of chest physiotherapy techniques that are applied with the mechanical ventilator over manual techniques. Furthermore, they use techniques that could potentially increase the work of breathing less frequently, mitigating the risk of exacerbating respiratory conditions in patients with COVID-19.
针对 COVID-19 住院患者的胸部物理治疗报道甚少。尽管已经发布了建议来指导物理治疗师，但实践可能因教育和培训而异。
分析有证和无证专家为 COVID-19 住院患者应用的胸部物理治疗的差异。
为参与 COVID-19 住院患者管理的物理治疗师开发了在线问卷调查。问卷询问了专业信息和物理治疗实践特征。
共 485 名受访者，完成率为 76%。其中 61 名为有证专家，424 名为无证专家。有证专家年龄更大，专业经验更丰富，更合格，工作条件更好。对于机械通气患者，有证专家更频繁地使用呼吸机过度充气手法（50.4% vs 35.1%，p=0.005），以及硬/短呼气肋骨笼压迫（ERCC）（26.9% vs 48.3%，p=0.016）、软/长 ERCC（25.2% vs 39.1%，p=0.047）和手动胸部压缩-减压（MCCD）手法（22.4% vs 35.6%，p=0.001）较少。对于自主呼吸患者，有证专家较少使用主动呼吸循环技术（30.8% vs 67.1%，p<0.001）、自主引流（7.7% vs 20.7%，p=0.017）和 MCCD 手法（23.1% vs 41.4%，p=0.018）。
具有更高专业水平的有证专家似乎更倾向于使用与机械通气相关的胸部物理治疗技术，而非手动技术。此外，他们使用的可能增加呼吸做功的技术更少，从而降低了 COVID-19 患者呼吸状况恶化的风险。
