On September 8, World Physiotherapy Day is observed to generate awareness about the crucial role of physiotherapists who enable people to be mobile, well, and independent.

On this day, members of World Confederation for Physical Therapy (WCPT) association take the lead in their respective countries to raise awareness about the contribution physiotherapists make to society.

This year’s theme focused on rehabilitation and long COVID (long-term problems after recovering from the original infection of Covid-19), and the role of physical therapists in the treatment of people affected by coronavirus.

In Rwanda, according to physiotherapists, the day means that physiotherapy can serve the population, especially Covid-19 patients, in need of the services.

Covid-19 is believed to affect patients’ breathing and exercise capacity. Patients normally have decreased ability to perform activities of daily living (ADLs), also called self-help or self-care activities, which include everyday tasks such as dressing, self-feeding, bathing, laundry, and/or meal preparation.

In this regard, physiotherapists have been involved in the management of Covid-19, to help patients get back to their daily lives as ordinarily as possible.

When he was diagnosed with Covid-19, 54-year-old Emmanuel Clement Byiringiro, says he was in critical condition which left him in the Intensive Care Unit (ICU) for some days.

The resident of Nyamirambo explains that to him, physiotherapy treatment came in handy as he had an issue with his lungs, which compromised his breathing.

"Through physiotherapy, experts were able to help me out through a kind of treatment known as chest physiotherapy (postural drainage), for easier breathing which worked well and I was able to recover easily,” he says.

The role of physiotherapists in managing Covid-19 

Through the Department of Physiotherapy, College of Medicine and Health Sciences-University of Rwanda, and the Rwanda Physical Therapy Organisation (RPTO), Rwanda Biomedical Centre and the Ministry of Health have included physiotherapy in the management of Covid-19.

Currently, physiotherapists are taking care of patients in the two major treatment centres (Nyarugenge and Kanyinya), with expectations of expanding to other centres in the future.

RPTO is working towards leveraging the physiotherapy rehabilitation in long Covid management as well as raising awareness on the importance of physiotherapy, together with other healthcare professionals.

According to Dr Nuhu Assuman (PhD), the vice president of RPTO and lecturer in the Physiotherapy Department at the University of Rwanda, physiotherapy has been one of the key professions in the management of Covid-19 worldwide.

And this, he says, is from the time of initial infection, in isolation through critical illness, in intensive care and in hospital admission as well as discharge.

Meanwhile, it has been reported that 1 out 10 Covid-19 survivors will exhibit symptoms for a period of 12 weeks or longer, described as long Covid.

Dr Assuman says long Covid is different for everyone, and rehabilitation must be tailored to the individual.

"Physiotherapy plays a key role in delivering safe and effective rehabilitation that is fundamental to recovery after Covid-19. Therefore, patients displaying symptoms like shortness of breath or chest pain, extreme fatigue and other symptoms like memory and concentration problems should seek physiotherapy,” he says.

Jacques Nshimiyimana, a physiotherapist at Deus Est Neuro-Rehabilitation Center and Clinics in Kigali, says inclusion of physiotherapy in the management of Covid-19 implies a comprehensive/holistic management of the patients and ensuring a better quality of life for patients affected by Covid-19.

More importantly, Nshimiyimana says, this is a great step in the physiotherapy profession as it is considered a cornerstone in patient care in Rwanda.

Lately, 18 physiotherapists have volunteered to provide physiotherapy service for Covid-19 patients at two treatment centres (Nyarugenge District Hospital and Kanyinya Health Center), for a period of one month.

Within this period, a minimum of 25-30 patients per day were seen by the physiotherapist present in the treatment centre, where the patients were offered 1-2 sessions per day for a duration of 45-60 minutes per session.

Nshimiyimana says that it is recommended that all hospitalised patients with Covid-19 should be assessed regularly by a physiotherapist and offered this service as needed.

"Physiotherapists should be involved in the discharge process of the patients in order to follow up discharged patients for long term need,” he advises.

Sylvia Mbabazi, a physiotherapist at King Faisal Hospital, says she has also played a role in helping patients with long Covid and those in critical condition (ICU patients) where some of them needed mechanical ventilation or oxygen support.

Nshimiyimana says for such patients, it means their lungs are not working properly and when this happens, it makes more secretion which fills up the lungs, thus making it hard to breathe.

"We come in as physiotherapists to help such patients be able to breathe better, whereby we use techniques such as chest physiotherapy (postural drainage, percussion, chest vibration and cough stimulation),” Nshimiyimana says. 

Through physiotherapy, he adds, strengthening and stretching exercises as well as endurance training, such as walking or cycling on a stationary bike, are also forms of treatment used on Covid-19 patients.

In addition to this, there are also patients who have been taken off the machines. "They have been in the hospital for so long, sometimes they get muscle weaknesses and joint stiffness. They are helped get out of the bed to move around and do some simple exercises in order to build their strength again, and endurance.

"We can also assist in bed mobility like turning the patients (those who are unconscious in ICU), where we do passive movements to prevent contractures, joint stiffness and deformities that might arise from prolonged hospitalisation,” says Nshimiyimana.

Physiotherapy in general

Mbabazi says physiotherapy does not only work for the physical perspective, but also mentally and psychologically.

"For instance, in my daily routine, we help patients by taking ample time to listen to their complaints and also assess the possible associates that can, in one way or another, relate to their physical difficulties.

"We prescribe and show exercises to patients where necessary, depending on their needs after our assessment. We also treat injuries and deformities and take time to educate patients on healthy behaviour,”

According to Mbabazi, people should understand physiotherapy and what it does before they get sick and find themselves in a position where they have to see a physiotherapist, because physiotherapy works much better on the preventive side.

"In our therapy, we use just physical treatment, no medications, because we believe that for long-term effects, exercises work better than painkillers and will not cause any harm or side effects to your health,” she adds.