Post Covid-19: Outpatient Assessment: Difference between revisions
No edit summary |
No edit summary |
||
Line 12: | Line 12: | ||
=== Rationale === | === Rationale === | ||
Currently, there are no guidelines on probability of reinfection. It seems the best evidence we currently have focuses on viral loads. The highest level of viral shedding seems to occur when asymptomatic or with mild symptoms. Viral RNA can be found in oral swabs, anal swabs and blood of individuals who are infected with COVID-19.<ref name=":0">Zhang W, Du RH, Li B, Zheng XS, Yang XL, Hu B, Wang YY, Xiao GF, Yan B, Shi ZL, Zhou P. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048229/ Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerging microbes & infections.] 2020 Jan 1;9(1):386-9.</ref> A patient discharged with a negative oral swab may continue to be shedding the virus. The change in shedding may change from predominantly oral to fecal.<ref name=":0" /> Prior to treating a patient with post-COVID-19, the physical therapist may need to apply the responses about the patient's timing of COVID- | Currently, there are no guidelines on probability of reinfection. It seems the best evidence we currently have focuses on viral loads. The highest level of viral shedding seems to occur when asymptomatic or with mild symptoms. Viral RNA can be found in oral swabs, anal swabs and blood of individuals who are infected with COVID-19.<ref name=":0">Zhang W, Du RH, Li B, Zheng XS, Yang XL, Hu B, Wang YY, Xiao GF, Yan B, Shi ZL, Zhou P. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048229/ Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerging microbes & infections.] 2020 Jan 1;9(1):386-9.</ref> A patient discharged with a negative oral swab may continue to be shedding the virus. The change in shedding may change from predominantly oral to fecal.<ref name=":0" /> Prior to treating a patient with post-COVID-19, the physical therapist may need to apply the responses about the patient's timing of COVID-19 in order to be adequately prepared to assist the patient. | ||
For 30% of the hospitalized patients, positive | For 30% of the hospitalized patients, positive oropharyngeal saliva samples occurred 20 days after onset.<ref>To KK, Tsang OT, Leung WS, Tam AR, Wu TC, Lung DC, Yip CC, Cai JP, Chan JM, Chik TS, Lau DP. [https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30196-1/fulltext#seccestitle80 Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study.] The Lancet Infectious Diseases. 2020 Mar 23.</ref> In another study using reverse transcription polymerase chain reaction (RT-PCR), positive tests were also found. Patients who had a high severity presentation (respiratory distress, resting oxygen saturation <93% or other significant complications) continued to test positive for 10 or more days post onset.<ref name=":1">Liu Y, Yan LM, Wan L, Xiang TX, Le A, Liu JM, Peiris M, Poon LL, Zhang W. [https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30232-2/fulltext Viral dynamics in mild and severe cases of COVID-19.] The Lancet Infectious Diseases. 2020 Mar 19.</ref> For 90% of patients who were viewed as having mild cases, negative RT-PCR results occurred by day 10 post onset.<ref name=":1" /> | ||
== Subjective | == Subjective Patient Intake == | ||
*Self‐report | *Self‐report |
Revision as of 03:33, 7 April 2020
Original Editor -Selena Horner
Top Contributors - Selena Horner and Kim Jackson
Prior to Scheduling[edit | edit source]
Was the patient hospitalized? If no, when was the onset of symptoms? When was the last day of symptoms? If patient not sure of last day of symptoms, when was the last day of the fever?
If the patient was hospitalized, when was the patient discharged? Where diagnostic tests done to determine if the patient was COVID-19 negative?
Rationale[edit | edit source]
Currently, there are no guidelines on probability of reinfection. It seems the best evidence we currently have focuses on viral loads. The highest level of viral shedding seems to occur when asymptomatic or with mild symptoms. Viral RNA can be found in oral swabs, anal swabs and blood of individuals who are infected with COVID-19.[1] A patient discharged with a negative oral swab may continue to be shedding the virus. The change in shedding may change from predominantly oral to fecal.[1] Prior to treating a patient with post-COVID-19, the physical therapist may need to apply the responses about the patient's timing of COVID-19 in order to be adequately prepared to assist the patient.
For 30% of the hospitalized patients, positive oropharyngeal saliva samples occurred 20 days after onset.[2] In another study using reverse transcription polymerase chain reaction (RT-PCR), positive tests were also found. Patients who had a high severity presentation (respiratory distress, resting oxygen saturation <93% or other significant complications) continued to test positive for 10 or more days post onset.[3] For 90% of patients who were viewed as having mild cases, negative RT-PCR results occurred by day 10 post onset.[3]
Subjective Patient Intake[edit | edit source]
- Self‐report
- Performance‐based outcome measures
- Region‐specific historical examination
Special Questions[edit | edit source]
- Red Flags
- Yellow Flags
Investigations[edit | edit source]
- Radiological Considerations
Objective[edit | edit source]
Observation[edit | edit source]
- Posture
- Movement Patterns
Functional Tests[edit | edit source]
Palpation[edit | edit source]
- supine
- prone
- seated
Neurologic Assessment[edit | edit source]
Movement Testing[edit | edit source]
- AROM, PROM, and Overpressure
- Passive Intervertebral Motion
- Muscle Strength
Special Tests[edit | edit source]
References[edit | edit source]
- ↑ 1.0 1.1 Zhang W, Du RH, Li B, Zheng XS, Yang XL, Hu B, Wang YY, Xiao GF, Yan B, Shi ZL, Zhou P. Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerging microbes & infections. 2020 Jan 1;9(1):386-9.
- ↑ To KK, Tsang OT, Leung WS, Tam AR, Wu TC, Lung DC, Yip CC, Cai JP, Chan JM, Chik TS, Lau DP. Temporal profiles of viral load in posterior oropharyngeal saliva samples and serum antibody responses during infection by SARS-CoV-2: an observational cohort study. The Lancet Infectious Diseases. 2020 Mar 23.
- ↑ 3.0 3.1 Liu Y, Yan LM, Wan L, Xiang TX, Le A, Liu JM, Peiris M, Poon LL, Zhang W. Viral dynamics in mild and severe cases of COVID-19. The Lancet Infectious Diseases. 2020 Mar 19.