Many physiotherapists are preparing to return to working alongside sports teams, players and athletes over the coming weeks, whether that be on the field, courtside or within clubrooms. It is important to remember that while many sports have been allowed to resume at Alert Level 2, physiotherapists working with these athletes are still required to take the same care and precautions to protect themselves and the public, as they would working in any other environments.
Sports physiotherapists will begin working within their usual environments again. Some tasks however, may require adaptation to ensure they comply with the Ministry of Health guidance released for community allied health, scientific and technical providers. While much of the Ministry’s guidance refers to face-to-face consultations, any assessment, treatment, strapping or massage of an athlete or player is deemed to be a consultation.
Ministry of Health’s guidance for face-to-face consultations during Alert Level 2:
As a reminder under Alert Level 2 the Ministry of Health has stated for community allied health, scientific and technical providers:
When the country does move into Alert Level 2 the following changes can occur:
Please note telehealth and virtual appointments are still the preferred option in Alert Level 2.
Please exercise extra caution when treating vulnerable groups.
Practitioners will be able to see patients face-to-face if the following processes are in place:
Screening for COVID-19 symptoms prior to in person appointment
Physical distancing measures
Infection prevention control measures including PPE where required
Practitioners will be able to travel within and to the neighbouring regions to provide care to patients and receive training.
Group treatment (e.g. exercise classes) can occur so long as physical distancing is in place’.
While physiotherapy services can reopen for routine face-to-face consultations under Alert Level 2, protocols must be implemented by physiotherapists and clinics to maximise patient and staff safety, including ongoing risk assessment and appropriate infection prevention control procedures.
Despite the easing for face-to-face consultations under Alert Level 2, telehealth should still be considered especially for vulnerable patient groups.
Overarching Requirements at Alert Level 2
- be aware that under Alert Level 2, there may still be some community transmission of Covid-19. An extremely high level of vigilance is required. Physiotherapists must use a high level of clinical judgement at all times when assessing and treating patients in order to keep themselves and the public safe
- have knowledge of and understand the most current Health and Safety procedures, and the latest advice from Ministry of Health
- consider their own safety and that of the patient and wider public
- screen patients for COVID-19 signs or symptoms when making the appointment and again on arrival. If they are deemed to be a risk, do not allow them into the clinic or see them in the community until they have medical clearance. Consider using telehealth services
- carry out a risk assessment and have a plan in place for the premises they are working in whether that be in a clinic or the community. Risk assessment during Alert Level 2 should be ongoing and continuous
- maintain a log of all patient and staff contacts in case contact tracing is required
- adapt their working practises to allow enough time between appointments to carry out necessary duties including cleaning equipment, surfaces and their own hands before another patient is brought into the treatment room
- carefully assess the risks and benefits of a face-to-face consultation if patients are 70 years of age or over or have significant co-morbidities or vulnerabilities. Consider using telehealth services.
This guidance from the Ministry of Health, PNZ and the Physiotherapy Board should be adapted by practitioners to suit their own working environment. For sports physiotherapists planning for this is especially important as the environment and setting may change quickly and not all environments are ideally suited for easy infection control.
Planning, preparation, and continuous risk assessment are vital components of keeping physiotherapists and the public safe. Clubs, sports teams, athletes and players need to be made aware that while sporting activities have resumed, the provision of health services has not returned to business as usual. They may need to work alongside physiotherapists and adapt club practices to ensure physiotherapy services can be delivered safely.
You must remain aware that physiotherapists are often exposing themselves to multiple patients over multiple locations e.g. sports field or courts, clinic, regional travel.
Considerations for sports physiotherapists in addition to the existing Alert level 2 Guidance released by the Physiotherapy Board should include the following:
- a risk assessment and plan for providing services needs to be in place prior to commencing work with athletes
- communicate to clubs, sports teams, athletes and players early about how physiotherapy services may differ from usual
- approach the club to see if there is a more suitable place to see athletes or players during training, which can be cleaned and controlled as necessary including limiting entry to the treatment area
- confirm and be comfortable with the tracing and screening systems the club currently has in place
- physiotherapists still need to screen athletes and players themselves and keep their own record of contacts, including contact details, whether they are assessing, treating, strapping, or performing other techniques such as soft tissue massage, manual therapy or stretching
- if working with a club with multiple teams training consider limiting this to one or two teams during this period if possible
- discussions with and professional supervision of less experienced physiotherapists by more experienced physiotherapists may be required or need to increase during this time
- physical distancing should still be maintained where possible
- keep the physical contact to the least number of players as necessary during practice and matches
- use signs to discourage casual ‘walk ins’ by players. They must have been screened before entering the treatment area, even if that is side-line
- try to encourage players to do as much for themselves as possible. If they can get another player who they have already been in contact with, to help them stretch, it may be a better option than having another patient ‘contact’
- if you feel uncomfortable with the set up the club has provided then discuss it with them. If it feels unsafe, remove yourself from the situation
- try to control the environment as much as possible. That may mean isolating an area where athletes and players can see you for treatment or come to get strapped, but setting it up in a way that ‘walk ins’ are discouraged
- discourage athletes and players from attending physio with their teammates
- ensure you have enough cleaning supplies for practice and game day. Have a cleaning plan for the area you are working in, equipment being used on set up and during sessions, post session cleaning and packing up
- maintain control of your team kit as appropriate and ensure players sanitise hands before taking tape from the team kit
- while physiotherapists may sometimes be asked to cover for opposing teams this should only be used if there is no other option, and you have the ability to screen, contact trace and minimise interactions
- visiting teams should be made aware of the above point prior to matches. If you do agree to see them for treatment, screening prior to the match and collection of contact information of those seen will be required
- familiarise yourself with the latest updates from the New Zealand Resuscitation Council of on CPR during the COVID-19 situation
- the following are high risk behaviours and if you feel unsafe remove yourself. As preparation for providing services to sports teams you should seek assurance from the team manager/club officials that players have been asked to cease:
- the use of shared water bottles
- using shared towels for body fluid clean up
And encourage good hygiene practices