COVID-19 Physiotherapy Rehabilitation Guide

Publication: 29/05/2020  
Next review: 09/12/2022  
Clinical Guideline
ID: 6429 
Approved By: Clinical Advisory Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2021  


This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

COVID-19 Physiotherapy Rehabilitation Guide


Record: 6429
Clinical condition:


Target patient group:
Target professional group(s): Allied Health Professionals
Adapted from:

Evidence base

Reference List

Ahmed, Patel K, Greenwood D, Halpin S, Lewthwaite P, Salawu A, et al. Long-term clinical outcomes in survivors of coronavirus outbreaks after hospitalisation or ICU admission: a systematic review and meta-analysis of follow-up studies. medRxiv. 2020: [Pre-print. Not peer reviewed] Available from:

Allied Health Professions (AHP) Outcome Measures UK Working Group (2019) Key questions to ask when selecting outcome measures: a checklist for allied health professionals. Available from:

Association of British Neurologists (2020) Guidance on COVID-19 for people with neurological conditions, their doctors and carers.

BMJ (2020) visual summary- COVID-19: remote consultations, 25th March, 2020.   

Busl,K & Greer,D (2010) Hypoxic-ischemic brain injury: Pathophysiology, neuropathology and mechanisms. Neuro Rehabilitation 26, 5-13.

CSP (2020) Rehabilitation during and after the COVID-19 pandemic.  Accessed from:

CSP (2020) CSP COVID-19 Rehabilitation Standards Rehabilitation of adults who are hospitalised due to Covid-19: physiotherapy service delivery. Accessed from:

Chelsea Critical Care Physical Assessment tool (CPAx) Copyright of Chelsea and Westminster NHS Foundation Trust (01/03/2010)

Chen, Nanshan & Zhou, Min & Dong, Xuan & Qu, Jieming & Gong, Fengyun & Han, Yang & Qiu, Yang & Wang, Jingli & Wei, Yuan & Xia, Jia'an & Yu, Ting & Zhang, Xinxin & Zhang, Li. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet. 395. 10.

Chest Heart & Stroke Scotland (2007-2020) Stroke core Comopetencies for Health and Social Care Staff.

Cumbler E (2015) In-Hospital Ischaemic Stroke. The Neurohospitalist 5(3)173-81  

Corner E J, Wood H, Englebretsen C, Thomas A, Grant R L, Nikoletou D & Soni N (2013) The Chelsea Critical Care Physical Assessment Tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study. Physiotherapy. Vol. 99, Issue 1, 33-41

Head.V & Wakerley.B, (2016) Guillain-Barre syndrome in general practice: clinical features suggestive of early diagnosis. British Journal of General Practice. 66(645) 218–219.​

Headway Brain injury association (2020). Hypoxic and anoxic brain injury.

Healthline Media (2005-2020). Encephalopathy

Hermans G, De Jonghe B, Bruyninckx F, & Van den Berghe G (2008) Clinical review: Critical illness polyneuropathy and myopathy. Critical Care, 12:238

Holdroyd Leduc J et al, (2020) COVID-19 in older adults Regional Program, University of Toronto, April 7th, 2020.

Keikens C, Boldrini P, Andreoli A, Avesani R, Gamna F, Grandi M, Lombardi F, Lusuardi M, Molteni F, Perboni A, Negrini S (2020). Rehabilitation and respiratory management in the acute and early post-acute phase. “Instant paper from the field” on rehabilitation answers to the Covid-19 emergency. European Journal of Physical and Rehabilitation Medicine. April. DOI:10.23736/S1973-9087.20.06305-4

Kosinski S, Mohammad R A, Pitcher M, Haezebrouck E, Coe A B, Costa D K, Prescott, H C, Iwashyna T J, & McSparron J I (2020) What Is Post–Intensive Care Syndrome (PICS)? Am J Respir Crit Care Med Vol. 201, 15-16.

Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, Ren R, Leung KSM, Lau EHY, Wong JY, Xing X, Xiang N, Wu Y, Li C, Chen Q, Li D, Liu T, Zhao J, Liu M, Tu W, Chen C, Jin L, Yang R, Wang Q, Zhou S, Wang R, Liu H, Luo Y, Liu Y, Shao G, Li H, Tao Z, Yang Y, Deng Z, Liu B, Ma Z, Zhang Y, Shi G, Lam TTY, Wu JTK, Gao GF, Cowling BJ, Yang B, Leung GM, Feng Z. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. New England Journal of Medicine 2020 Jan 29.

Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al (2020). Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol

McNamara, 2020. Neurologic Symptoms and COVID-19:What's Known, What Isn't - Medscape - Apr 05, 2020.

Nakano,Y & Kanda, T. (2016) Pathology of Guillain-Barre Syndrome, Clinical and Experimental Neuroimmunology. 7(4) 312-319

NHS (2019) Overview of Stroke.    

National Institute of Neurological Disorders and Stroke (NINDS) (2019) Guillain-Barre Syndrome Fact sheet,

National Institute of Neurological Disorders and Stroke (NINDS) (2020) Encephalopathy,

National Institute for Health and Care Excellence (2009) Rehabilitation after critical illness in adults (GC83)

National Institute for Health and Care Excellence (2017) Rehabilitation after critical illness in adults (QS158)

Parmar P (2018) Stroke: classification and diagnosis. The Pharmaceutical Journal  Vol 10, no 1.  

Rawal G, Yadav S, Kumar R. Post -intensive care syndrome: an overview. J Transl Int Med 2017; 5: 90–92.

Rockwood K, Song X, MacNight C, Bergman H, Hogan D B, McDowell I & Mitnitski A (2005) A global clinical measure of fitness and frailty in elderly people. CMAJ. 173(5):489-95

Sohrabi, C., Alsafi, Z., O'Neill, N., Khan, M., Kerwan, A., Al-Jabir, A., Iosifidis, C., & Agha, R. (2020). World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). International journal of surgery (London, England), 76, 71–76.

Solanki T (2020), Atypical COVID-19 presentations in older people- the need for continued vigilance, BMJ blog, 14th April, 2020. Accessible from:  

Stam H, Stucki G Bickenback J. (2020) COVID-19 and post intensive care syndrome: a call for action. J Rehabil Med; 52: jrm00044

Stokes M, & Stacks E 92012) Physical Management for Neurological Conditions. Churchill Livingstone: Elsevier.

Stroke Association (ND) Types of Stroke.  

Thomas P, Baldwin C, Bissett B, Boden I, Gosselink R, Granger CL, Hodgson C, Jones AYM, Kho ME, Moses R, Ntoumenopoulos G, Parry SM, Patman S, Van der Lee L, (2020) Physiotherapy management for COVID-19 in the Acute Hospital Setting: Recommendations to guide clinical practice. Available at:  (Accessed: 29/5/2020)

Toscano G, Palmerini F, Ravaglia S, Ruiz L, Invernizzi P, Cuzzoni G, Baldanti F, Postorino P, Cavallini A, & Micieli G (2020) Guillain–Barré Syndrome Associated with SARS-CoV-2 New England Journal of Medicine April 17.

Truelson T, Begg S, Mathers C (2000) The Global Burden of Cerebrovascular Disease.

Vitacca M, Carone M, Clini E, Paneroni M, Lazzeri M, Lanza A, Privitera E, Pasqua F, Gigliotti F, Castellana G, Banfi P, Guffanti E, Santus P, Ambrosino N, (2020) Joint Statement on the Role of Respiratory Rehabilitation in the COVID-19 Crisis: The Italian Position Paper. Available at:  (Accessed 19/5/2020)

Wenzhang L & Hualan L. (2020). COVID-19: Attacks the 1-Beta Chain of Hemoglobin and Captures the Porphyrin to Inhibit Human Heme Metabolism.  

WHO (2020) Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected.Interim guidance 13th March.

Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, et al. (2020) Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020 Feb 24.

Zhao, Dahai & Yao, Feifei & Wang, Lijie & Zheng, Ling & Gao, Yongjun & Ye, Jun & Guo, Feng & Zhao, Hui & Gao, Rong-bao. (2020). A comparative study on the clinical features of COVID-19 pneumonia to other pneumonias. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America. 10.

Zheng S et al (2020) Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study. BMJ 369.

Zhou, M., Zhang, X., & Qu, J. (2020). Coronavirus disease 2019 (COVID-19): a clinical update. Frontiers of Medicine, 1–10. Advance online publication.

Approved By

Clinical Advisory Group

Document history

LHP version 3.0

Related information

Not supplied

Equity and Diversity

The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.