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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 6  |  Issue : 1  |  Page : 23-26

A survey conducted among physiotherapists to assess awareness on COVID-19 during the first and second waves in India


NIMHANS, Bengaluru, India

Date of Submission25-Nov-2021
Date of Acceptance19-Feb-2022
Date of Web Publication04-Mar-2022

Correspondence Address:
Mr. Tittu Thomas James
Physiotherapy Center, DPNR Building, NIMHANS Hospital Campus, Hosur Road, Bengaluru 560029.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jsip.jsip_16_21

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  Abstract 

Background: COVID-19 is an infectious disease caused by novel coronavirus (SARS CoV-2). The mode of spread of the infection is through droplets and also through direct contact of contaminated surfaces. Measures such as social distancing and use of protective equipment are required to prevent the spread of infection. This study was designed to assess the awareness about COVID-19 among physiotherapists, during the two phases of lockdown. Materials and Methods: An online survey was conducted in two phases among 110 physiotherapists to assess their awareness and knowledge about the disease. The first phase of the study was done during the first COVID-19 wave in India between 25th and 30th of March 2020, and the second phase was conducted between 7th and 12th of May 2021 when the second wave of COVID-19 in India was at its peak. Results: It is essential for physiotherapists to understand COVID-19 as a disease and to know its mode of spread in order to take necessary precautions and measures within their working environment to prevent the spread of the disease. With the first phase of the study, we identified a need for educational and awareness programs in therapists and need of guidelines in order to implement effective and safe strategies in dealing with the patients during this pandemic. The second phase identified that better understanding existed in physiotherapists about the disease, with precautions taken at their workplace to prevent the spread of COVID-19. Conclusion: A better knowledge about COVID-19 was reflected among physiotherapists at the second lockdown phase than during the first lockdown.

Keywords: Awareness about COVID-19, COVID-19, lockdown, physiotherapist


How to cite this article:
Menaria S, James TT, Nayak JS, Saxena S, Dhargave P. A survey conducted among physiotherapists to assess awareness on COVID-19 during the first and second waves in India. J Soc Indian Physiother 2022;6:23-6

How to cite this URL:
Menaria S, James TT, Nayak JS, Saxena S, Dhargave P. A survey conducted among physiotherapists to assess awareness on COVID-19 during the first and second waves in India. J Soc Indian Physiother [serial online] 2022 [cited 2022 May 23];6:23-6. Available from: http://www.jsip.ac.in/text.asp?2022/6/1/23/339143




  Introduction Top


COVID-19 is caused by novel coronavirus, which is named as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1] At the time this article was written, this disease had been reported by more than 210 countries and territories, with more than 11 million confirmed cases and 5 lakh deaths.[2] The virus was first detected at Wuhan province of China, on December 31, 2019, and it was declared as public health emergency of international concern on January 30, 2020 by the WHO. According to a recent study, the most common symptoms of COVID-19 are fever (88.7%) and dry cough (67.8%).[3] Loss of smell and taste (59%), fatigue (38%), sputum production (34%), shortness of breath (19%), muscle pain (15%), sore throat (14%), headache (14%), and diarrhea (3%) are the other symptoms.[4],[5],[6]

The first case of COVID-19 in India was reported on January 30, 2020 in Kerala. Although they had traveled from China and was confirmed by testing, the outbreak was well contained and no contact cases reported from them. The spread of COVID-19 in India started on 4th March, from an Italian tourist group, and the first death on 12th March in Karnataka.[7] India is currently the second most affected country in the world.

The incubation period of the virus is estimated to be within a range of 1–12.5 days (median 5–6 days).[8] The mode of transmission is found to be droplets sprayed by affected individuals during coughing or sneezing and also through contact with patient respiratory secretions, contaminated surfaces, and equipment. Therefore to prevent the spread of infection and protect oneself from the disease, it is necessary to maintain social distancing and to use personal protective equipment (PPE) as advised. As physiotherapists are exposed directly to the population without knowing whether someone is a carrier of the disease or not, it is mandatory for therapists to understand the disease to take adequate measures to prevent its spread. We conducted an online survey among physiotherapists to identify the level of awareness and knowledge about the disease. The first phase of the study was during the first lockdown phase enforced by the Government of India, where the educational and awareness programs regarding COVID-19 were just launched.


  Materials and Methods Top


We conducted an online survey among 110 working physiotherapists to analyze their knowledge about COVID-19. The study was conducted in two phases. The first phase was between March 25, 2020 and March 30, 2020, during which the first lockdown was imposed in India by the government officials as a measure to control the spread of COVID-19. This was after 55 days of the first reported case of COVID-19 in India, which was on January 30, 2020, in Kerala. Even though the wide spread of the infection was predicted initially, adequate awareness measures were not in action, even when the first lockdown was initiated. The second phase of the study was conducted between May 7, 2021 and May 12, 2021 when the second wave of COVID-19 was at its peak in India. The second phase was conducted to identify the effectiveness of awareness programs as well as the precautions taken by physiotherapists at their workplace to prevent the spread of the disease.

To analyze the effectiveness of awareness activities and level of knowledge, we formulated multiple answers and open-ended questions which were sent online to physiotherapists using Google Forms. The responses were collected within a time frame of 5 days. Descriptive statistics were used to analyze the responses and to derive conclusions.


  Results Top


Phase I

About 39.1% of the participants knew that the term “corona” is derived from the Latin word for crown, and the virus which causes COVID-19 is SARS CoV-2. Among the participants, 32.7% thought that coronavirus is found only in humans, whereas 12 of them selected that camels and civet cats are the sources of coronavirus. About 62.7% of them did not know that asymptomatic carriers of the virus may be present within the community. About 88.18% of them were confident with regard to the signs and symptoms of COVID-19, which included fever, cough, and shortness of breath; 10.91% of them considered nausea as a symptom of COVID-19 which was false. Around 44.5% of the physiotherapists correctly identified that symptoms such as persistent chest pain and fever required emergency medical attention.

Approximately 50.90% knew that individuals above 70 years of age and those with severe chronic illness were at a higher risk for developing COVID-19. Around 78.2% of them mentioned that the incubation period of COVID-19 is of 2–14 days, whereas 17.3% mentioned 14–20 days and 4.5% mentioned as less than 7 days. Out of all the participants, 75.45% of them selected that regular handwashing and coughing into a tissue or bent elbow will help in preventing the rapid spread of the infection; 78.18% of them answered that everyone with cough may not be tested.

The testing of the upper respiratory tract for COVID-19 is through nasopharyngeal swab, which was answered correctly by 45.5%, whereas 31.8% answered sputum analysis, 11.8% answered broncho-alveolar lavage, and 10.9% answered buccal swab. About 45.45% of them answered that the differential diagnosis of COVID-19 was influenza, pneumonia, and adenovirus infections; 81.8% selected that those who test positive for COVID-19 are called confirmed cases and 52.7% selected that those who have symptoms with a travel history within 3 weeks were called suspect cases.

Only 64.54% considered that strict infection control protocols should be implemented at all points of entry to a hospital, and 25.50% mentioned that early supplemental oxygen therapy was indicated for patients with respiratory distress. Around 69.10% answered that mechanical ventilation was required for patients with COVID-19 who had ARDS or respiratory failure, whereas 7.10% answered incorrectly that it was required immediately upon diagnosis. Ninety-four (85.5%) of the participants suggested that the use medical mask was indicated for healthcare workers, symptomatic individuals and those who were taking care of patients.

Phase II

Out of 110 participants, 58.6% were expecting a second wave of COVID-19 during the first lockdown period. Around 41.1% of them never thought a second wave would happen. Eleven of them had been affected with COVID-19 in the last 1 year making an incidence rate of 10% in this study population.

Around 23% of them still considered that coronavirus was found in humans only; 59.50% of them knew that the word corona meant “crown” in Latin. About 74% of them correctly expressed that all those who were infected would not develop severe respiratory symptoms. Regarding the symptoms of the disease, 98% of them correctly identified fever as one of the symptoms of COVID-19 along with cough and shortness of breath. Approximately 4.3% of them still thought ulcers and rashes as common symptoms in COVID-19; 87.1% of them said that persistent chest pain and bluish discoloration of lips and face were signs requiring emergency medical attention, whereas 22.4% of them wrongly identified fatigue as one of the emergency symptoms. Of them, 93.1% correctly identified that people with comorbidities and those above 70 years of age were considered as at being high risk for developing severe symptoms, whereas 22.4% said that it can be seen in those staying in densely populated areas which may not be true. About 64.7% of the respondents correctly identified the incubation period of COVID-19 as 2–7 days, whereas 9.5% still thought that the incubation period was 14–20 days. Majority of them (96%) said that washing hands and sanitizing with alcohol rub helped in preventing the rapid spread of COVID-19, and 68.1% correctly replied that everyone with cough does not have to be tested for COVID-19, whereas the others stated the opposite. Around 87.1% of the participants answered nasopharyngeal swab as the test of choice of upper respiratory tract for identifying COVID-19, whereas others considered broncho-alveolar lavage, buccal swab, and even sputum sample for testing. About 96.6% of them correctly identified bacterial pneumonia and influenza as the differential diagnosis for COVID-19, whereas almost 12% answered as measles, shingles, and mumps; 85.3% correctly answered that if someone has tested positive for COVID-19, they were considered to be confirmed cases, whereas others answered wrongly as suspected case. A person with a 3-week-old history of travel to known location of COVID-19 and currently having symptoms of fever and cough was correctly identified by 56% of the respondents as a suspected case. Majority of them answered that strict infection control practices must be implemented in hospitals to prevent the spread of COVID-19, whereas 1.7% of them wrongly answered that all those who are diagnosed with COVID-19 must be hospitalized. All participants agreed that mechanical ventilation is indicated only during respiratory failure even with supplemental oxygen therapy. Around 47.4% of them considered N95 mask to be used by medical professionals to avoid infection by COVID-19, whereas 42.2% of them thought that PPE gown was a must.


  Discussion Top


Coronavirus disease (COVID-19) is a new pandemic in the world. The virus was found to originate from the wet markets of Wuhan province in China and is currently causing large-scale devastation throughout the world. Knowledge about the spread and course of infection is of utmost importance as there is no cure found for the same till now. Lack of knowledge and improper measures may lead to widespread of this disease, which may cause its spread from patients to therapists or vice versa. Physiotherapy profession deals with rehabilitation of individuals, in both acute and chronic stages. Physiotherapists come in direct contact with patients throughout the treatment period and generally spend more time with the patients than any other medical professionals. Physiotherapists also played a major role in this pandemic situation owing to the needs of pulmonary rehabilitation of patients affected with COVID-19 and also in reducing the hospital stay and preventing bed rest complications. We performed an online survey to identify the awareness and knowledge of physiotherapists about COVID-19. The first phase of the study identified that majority of the population under study knew exactly about the disease and its spread, but there was a need of awareness and educational programs to reach out to those who required help. The second phase of the study found significantly better awareness among physiotherapists and found them to be knowledgeable about adequate precautionary measures in preventing the spread of COVID-19.

During the lockdown period in India, we saw a number of awareness programs and educational sessions conducted by various bodies including governmental and non-governmental organizations. These programs were conducted by organizations such as WHO, MOHFW of Govt. of India, as well as universities such as Stanford, Harvard, Medvarsity, RGUHS Karnataka, etc. These programs were conducted through social media and online platforms in the form of quiz, webinars, and surveys. The first standard guideline for physiotherapists was released on March 30, 2020 for acute hospital setting by Thomas et al.[9] Guidelines were also released by the Indian Association of Physiotherapists, the advisory body in India, regarding recommendations for hospital and clinical settings. The guidelines clearly stated the need for adequate safety measures such as screening, sanitization, disinfection of equipment and treatment premises, as well as self-protection measures using PPE, N95 masks, etc.

We conclude that effective awareness and educational programs are the need of the hour, both for therapists as well as for the general public in view of prevention of spread of the infection and to establish a safe working environment for all. Authorities must make sure that the programs are effective in terms of reach and the guidelines are strictly followed. We also suggest the medical professionals to regularly update themselves with new regulations in effectively managing this pandemic situation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20.  Back to cited text no. 1
    
2.
Countries Where COVID-19 Has Spread [Worldometer Website]. Available from: https://worldmeters.info/coronavirus/countries-where-coronavirus-has-spread/. [Last accessed on June 4, 2021].  Back to cited text no. 2
    
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Lima CMAO. Information about the new coronavirus disease (COVID-19). Radiol Bras 2020;53:V-VI.  Back to cited text no. 3
    
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Prakash J, James TT. Effects of wearing face mask on physical activity in morning walkers during the period of COVID-19 pandemic—A preliminary study. Int J Sci Res 2020;9:8-9.  Back to cited text no. 4
    
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Jiang F, Deng L, Zhang L, Cai Y, Cheung CW, Xia Z. Review of the clinical characteristics of coronavirus disease 2019 (Covid-19). J Gen Intern Med 2020;35:1545-9.  Back to cited text no. 5
    
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Menni C, Valdes AM, Freidin MB, Sudre CH, Nguyen LH, Drew DA, et al. Real-time tracking of self-reported symptoms to predict potential Covid-19. Nat Med 2020;26:1037-40.  Back to cited text no. 6
    
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Mishra V, Burma AD, Das SK, Parivallal MB, Amudhan S, Rao GN. Covid-19-hospitalized patients in Karnataka: Survival and stay characteristics. Indian J Public Health 2020;64:221-4.  Back to cited text no. 7
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8.
Backer JA, Klinkenberg D, Wallinga J. Incubation period of 2019 novel coronavirus (2019-nCoV) infections among travellers from Wuhan, China, 20–28 January 2020. Eurosurveillance 2020;25:200062.  Back to cited text no. 8
    
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Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, et al. Physiotherapy management for Covid-19 in the acute hospital setting: Clinical practice recommendations. J Physiother 2020;66:73-82.  Back to cited text no. 9
    




 

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