Taking Stock

Tamsin Starr talks to those on the frontline of the pandemic to find out how they reacted to such an extraordinary time

Taking stock
Covid Learning [Zoran Obradovic/Alamy Stock Photo]

Seismic impacts

This time last year, healthcare faced unprecedented pressure as the national lockdown was lifted, days before frontline workers received their first vaccine doses. With a constant fear of exposure to Covid, it was a tough time to work through.

Many also saw their rehab spaces closed, with a snapshot survey of CSP members this summer showing one in five services never restarted. CSP steward Kavitha Santhanurthy, who was infected while working in community rehab, recalls, ‘It was hard, dreading we might get it, not knowing how it would affect us. But we didn’t let our fears affect the service we offered. We followed all precautions, stepped up, crossed professional barriers, and kept going together as a team.’ 

Physiotherapists redeployed to combat the crisis embraced change with grace, switching protocols and fitting in seamlessly with new colleagues. Some created virtual services offering vital treatments to shielding patients or helped mobilise the national response, including a network of nightingale hospitals.

Rachel Dalton, whose organisation Barts Health hosted the Nightingale Hospital at the Excel Centre in East London during the first wave, says,

‘Physiotherapists from all backgrounds and specialities came forward to undergo intensive training in order to care for acute Covid patients in an unknown environment. I could not have been prouder of both the Nightingale physios and those at our four acute hospitals for their commitment to patient care, creativity, versatility and outright hard work.’ Community advanced practitioner Jeremy Gee, who helped design the outcome measure Covid-19 Yorkshire Rehabilitation Scale, adds, ‘Since the emergence of Covid-19 the strength, flexibility and resilience of physiotherapists has shone through to advance practice in all areas and helped find solutions in the most difficult of times.’

The CSP and its professional networks supported with guidance, education and learning resources, ensuring that members’ voices were heard and included in key guidelines. While physiotherapists such as Darren Brown filled emerging gaps, such as creating networks for members with Long Covid.

Brown says of the 267-member strong network Long Covid Physio, ‘Physiotherapists living with Long Covid recognised early in the pandemic the need to mobilise knowledge from lived experience, generate visibility of our disability and safe rehabilitation, and the power of organising to create change.’ 

Though the pandemic is far from over, eight members who contacted Frontline to share their experiences look back at that extraordinary time, and the new knowledge they gained, which is now enhancing their everyday practice.  

Jennifer Davison, clinical coordinator, set up Leeds Long Covid community rehab pathway, which is therapy led and supported by rehab consultants, with colleague Rachel Tarrant

‘We learned about patients’ symptoms and effective interventions in more detail over the course of the pandemic, sharing our findings on the impact that Long Covid has on patients’ quality of life as well as showcasing how rehab is essential and at the heart of supporting patients with Long Covid. 

‘This new condition required an MDT approach to ensure post-Covid conditions such as Postural Orthostatic Tachycardia Syndrome are diagnosed and medical management optimised. Alongside a personalised rehabilitation approach these have been the key to our success. 

It was a great learning curve using technology to facilitate virtual multidisciplinary team meetings and apps to track and support patients’ progress, but they proved invaluable. ‘The team has worked relentlessly to establish this ever-evolving service and are a credit to the NHS. To quote a patient, “The team really do care, they are so helpful, I’d be lost without them”.

Geoff Wu, senior paediatric physiotherapist, Birmingham Children’s Hospital, re-deployed to Covid ITU at the Queen Elizabeth Hospital, Birmingham 

‘Being redeployed to the frontline of the pandemic was an overwhelming, daunting and extremely humbling experience, which challenged me both clinically and mentally. The resilience of many of my colleagues on Covid ITU had already been pushed to the limit as a result of working through the previous two waves; they were suffering from compassion fatigue, burnout and illness across the multidisciplinary team. 

‘I had to quickly adapt my skills from the paediatric ITU setting in order to provide the support that my fellow physiotherapists needed to manage the huge surge in patients during the third wave. It was truly a baptism by fire; not only did I have to work within new teams with full PPE all day, but I also had to rapidly learn how to assess and treat patients suffering with Covid-19 in sub-optimal conditions.

‘Overall, the experience has increased my understanding and reinforced my appreciation of the massive role that physiotherapists play in the ITU; whether in the context of Covid, adult or paediatric care, we as a profession are versatile and innovative in our techniques. 

In this respect, my newly gained knowledge of lung-protective ventilation strategies, Covid rehab protocols and the use of ventilator-derived parameters to measure changes in respiratory mechanics are just some of the learnings that I have brought back to the team at the Children’s Hospital.’

Ryan Allen, director of independent practice Primary Care Physio, whose FCP team was redeployed to Covid-19 vaccine centres

‘Our first contact physiotherapy team was supporting primary care networks and their member GP practices with vaccinating the patient population – it was great to be able to support the cause in this way. Some team members even helped as car park attendants stood outside in the January snow! I would like to thank every single one of our amazing team who went out of their way to integrate into primary care and support or GP colleagues and patients in the most challenging of circumstances. You should all be very proud of the work you have done throughout the pandemic and continue to do so today.’

Joshila DeVile, head of exercise medicine at GenesisCare, launched an exercise app to continue her service

‘During the March 2020 lockdown, we restricted all but essential footfall to our cancer centres. The GenesisCare Exercise Medicine App, which we launched during the first lockdown, allowed us to prescribe our sessions, monitor compliance and troubleshoot if necessary during lockdown. 

We were still able to assess, prescribe, monitor and discharge our patients, with outcome measures showing improvement across all parameters.  I am now working on a virtual exercise medicine model so that our centres that do not have space for an exercise clinic can still offer effective exercise medicine to their patients.’

Priyanka Patel, Senior Physiotherapist, Kettering General Hospital, launched an acute rehab service 

‘Being able to implement a Rehab Team within an acute setting is one thing, but being able to sustain this innovation during a pandemic and expand our services into the community has been the highlight of my career so far. Watching patients improve continuously and following their journeys home has shown how important therapy and the profession is.’

Tom Modzelewski, CF Physiotherapy Technician, Bristol Royal Infirmary, redeployed to older person’s rehab and the acute resp ward 

‘I was blown away by the level of devotion and commitment from my physio friends and colleagues who took it all in their stride, initially wrestled with the challenges of the presentation of new disease, then developed structured and novel approaches to the management of patients suffering from Covid-19. 

‘During this time I had an opportunity to utilise my expertise in exercise prescription for the rehabilitation of the elderly and step-down ITU patients. I believe that my support contributed to maintaining patient flow and took some strain from other colleagues who could continue their gargantuan challenge posed by the pandemic. It just goes to show just how flexible technicians can be in adapting to more versatile roles within healthcare.’

Tina Haghighi, physiotherapy student, University of Brighton, MSc graduate, carried out a research study exploring the experiences of physiotherapy students

‘Despite the many challenges faced, the students summarised their experience as positive, encouraging prospective students to approach the learning curve. The physiotherapy students’ compassion, determination, bravery, and continuous passion for the profession is something that will stay with me forever.’

‘As a service we supported our Covid patients, regional Nightingale ICU, urgent and emergency care, Ramada step-down facility and our care homes.  Staff were flexible and adaptable, moving sometimes on multiple occasions as we worked through the different surges. The resilience of staff and the flexibility of the profession to be part of the solution was always evident and is a credit to all members of the team.’

Elaine McConnell, professional head of physiotherapy, Belfast Health and Social Care Trust, led the mobilisation of physiotherapists at her trust during the pandemic

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