2020 has been an exceptional year for the global physiotherapy community, who have risen to the challenges of the COVID-19 pandemic, demonstrating both resilience and adaptability. The American Psychological Society defines resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress”. According to the Cambridge Dictionary, adaptability is “an ability or willingness to change in order to suit different conditions”.

For World Physiotherapy Day the PEDro Team are featuring five innovative physiotherapists from around the world who have demonstrated leadership despite adversity. These physiotherapists have worked proactively across clinical care, education and research to overcome challenging circumstances. They have displayed tenacity, flexibility, collaboration, long-term vision and high calibre reasoning skills.

We interviewed Bishwas Shrestha, Consultant Neurophysiotherapist at Nepal Mediciti Hospital and Senior Vice President of the Nepal Physiotherapy Association. Bishwas ensured his team were following regulations for social distancing, hand hygiene and personal protective equipment, and developed triage protocols for patients that needed priority outpatient care. The Nepal Physiotherapy Association distributed personal protective equipment to front line physiotherapists, and contributed to online physiotherapy professional education during the pandemic. The Association also adapted guidance from the World Health Organization and World Physiotherapy to the Nepalese setting, producing the “Clinical Guidelines for Physiotherapy Management of Patient with COVID-19 in Acute Hospital Setting in Nepal”. Regarding adaptability and resilience, Bishwas reflects: “adaptability is an art to create a new normal, what we are up to now in this pandemic, and resilience creates more adaptive capability. We all know that physiotherapy is a part of medical science, which keeps on evolving and changing with time. So, adaptability and resilience in physiotherapy practice is a must-have quality”.

Renato José Soares, Professor at the University of Taubaté and Director of Grupo Equality physiotherapy practice in São Paulo (Brazil), shared his insights into adapting physiotherapy practice during the pandemic. His clinical work is focused on evidence-based conservative treatment of spinal pain, with the goal of reducing rates of spinal surgery. At the onset of the pandemic, he collaborated with colleagues to fast track a telerehabilitation startup called “Hi! Healthcare Intelligence”, which has trained 20 physiotherapists and performed over 3,150 consultations. Telerehabilitation technology has been a vital link in allowing patients to continue accessing care. His advice for clinicians regarding adaptability and resilience in physiotherapy practice is: “to support your decisions with high quality clinical research, be flexible to new professional challenges, and make choices that are in the best interests of public health”.

Benita Olivier is the Professor in Musculoskeletal Physiotherapy at the University of the Witwatersrand and the Research Director of Wits Sport and Health Research Group in Johannesburg, South Africa. In response to the pandemic, Benita has created online academic tools and resources to support both research and education. During this time she founded the “Research Masterminds” platform, which supports research productivity. A flagship biennial event which she organises with her team, the Wits Faculty of Health Sciences Research Day, is one of the many events which rapidly moved online and which required deep breathing, rational thinking and resilience to actualise. She acknowledges the dedicated work of her colleagues who converted hundreds of hours of undergraduate teaching to an online platform in a short time frame. Benita has supported postgraduate students experiencing data collection disruption due to the pandemic, helping them problem solve creatively. She recommends judicious use of online meetings to maintain productivity, and found Microsoft Teams and the Moodle learning management system to be helpful in her work. Regarding resilience, Benita advocates: “not being afraid to make and learn from your mistakes”.

Rachael Moses (Consultant Respiratory Physiotherapist and Associate Director of Rehabilitation at Royal Brompton and Harefield Foundation Trust and Chief Allied Health Professional Lead at National Health Service Nightingale Hospital London, United Kingdom) and Michelle Kho (Associate Professor in the School of Rehabilitation Science, McMaster University and clinician in the intensive care unit at St Joseph’s Healthcare Hamilton, Canada) were part of the inspiring team that rapidly produced the “Physiotherapy Management for COVID-19 in the Acute Hospital Setting: Clinical Practice Recommendations”.

Rachael Moses would like to honour the amazing adaptability of physiotherapists in the United Kingdom, who stepped out of their comfort zones to provide high-quality clinical care during the pandemic. At the Nightingale Hospital London she saw military and private sector physiotherapists with previous respiratory experience put themselves forward to assist in treating critically ill COVID-19 patients. Rachael highlights the importance of doing respiratory physiotherapy rotations early in one’s career as these can be incredibly useful skills to have in a public health crisis. Intensive care units in the United Kingdom had to increase their capacity by 2- to 4-fold, and physiotherapists with recent respiratory experience were rapidly upskilled in the management of critically ill patients. Physiotherapists with neurological or musculoskeletal expertise were redeployed to work on medical rehabilitation wards (dealing with issues such as breathlessness, fatigue and nerve palsy) and in “proning teams” (assisting patients to move into the prone position in critical care units). She comments on the important contribution made by ‘shielded workers’ (ie, those at high COVID-19 risk) to online teaching and writing policies and guidelines. She reflects that COVID-19 has changed how we share resources such as practice guidelines and infection control policies, and that there has been much more pooling of knowledge and resources than in the past.

Michelle Kho shared her thoughts on how physiotherapists have demonstrated flexibility and teamwork locally and internationally. As the Canada Research Chair in Critical Care Rehabilitation and Knowledge Translation, she led the development of multidisciplinary guidance entitled “Rehabilitation for Patients with COVID-19”. She is one of the site investigators for SPRINT-SARI study, an international, multi-centre, prospective, incidence observational study of patients with severe acute respiratory infection (SARI). She notes that physiotherapists have been involved in gathering epidemiological data for the SPRINT-SARI study to help inform the COVID-19 pandemic. Michelle commends the resilience of her physiotherapy colleagues at St Joseph’s Healthcare Hamilton, who, in addition to providing treatment during the pandemic, had to deal with the department flooding. She acknowledges the ability of physiotherapists and physiotherapy assistants to ‘pivot’ across clinical areas, collaborating to coordinate case loads with fellow physiotherapists when required.