A Physiotherapy Framework to Managing Long COVID: A Clinical Approach

Purpose: Individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), can experience ongoing, often debilitating symptoms after the acute infection known as Long COVID (LC). LC has profound medical, social, and economic consequences worldwide. Prevalence estimates vary, but it is estimated that 10% to 35% of people infected with SARS-CoV-2 develop LC. The World Health Organization endorses physiotherapy as a vital component in LC symptom management and stabilization. Cardiorespiratory physiotherapists are often involved in the management of patients with LC phenotypes such as post-exertional malaise/post-exertional symptom exacerbation, post-COVID interstitial lung disease, dysautonomia, breathing pattern disorders, and chronic cough. However, specific guidance is lacking regarding physiotherapy assessment and safe intervention strategies. In this review, we describe the relevant pathophysiology of the condition, report common clinical phenotypes, and propose a clinical framework for physiotherapy assessment and safe intervention strategies.