The future is bright and exciting, and it must involve research

The ongoing COVID-19 pandemic has thrown clinical research into the spotlight like never before. The processes for research project development, initiation, analysis and dissemination have been streamlined and rationalised. The timeframe from research conception to clinical implementation has been rapid, without compromising ethics or quality. It has been a privilege to observe, learn and see patients benefit from such work.

Key studies during the pandemic have included the RECOVERY trial, a randomised evaluation of COVID-19 therapy that, to date, has recruited over 40,000 participants worldwide (www.recoverytrial.net). Of particular note are the highly anticipated results from Recovery-RS Respiratory Support (Perkins et al., 2021), which compared three ventilation strategies including CPAP and HFNO. There has also been a plethora of vaccine trials (both into the U.K. and internationally), which people have benefited from globally.

Gaps in the research have also been highlighted, illustrating the vulnerability of respiratory physiotherapy. One of the most frequently asked questions of 2020 was, ‘is it an aerosol generating procedure (AGP)?’. There was uncertainty about whether physiotherapy respiratory techniques were classed as AGP, with significant associated implications regarding viral spread and staff and patient safety. There was a scarcity of data relating to physiotherapy-specific techniques. The use of broad terms such as ‘chest physiotherapy’, encompassing multiple techniques or with no supporting definition, further hindered interpretation of findings (Jackson et al., 2020).

This year (2021), substantial progress has been made through publications linked to the U.K. based AERATOR study (Hamilton et al., 2021). Authors examined aerosol generation during medical procedures, with additional focus on whether generated aerosols were infective. The study provided data that dispels earlier thoughts about respiratory oxygen delivery systems. Results demonstrated CPAP to produce less aerosol emission in comparison to breathing, speaking and coughing. There was no evidence of increased aerosol emission from the respiratory tract with HFNO. Going forwards, clinicians and researchers should continue to collaborate to ensure relevant AGP research related specifically to physiotherapy interventions is completed. Results could have huge implications regarding the logistics of patient management, cost of PPE equipment and clinic capacity.

It is hoped that the COVID-19 pandemic will continue to provide the impetus for more research into the wider respiratory physiotherapy field. There are exciting studies at early stages, with physiotherapists playing an integral role in the TEAM ICU trial (NCT03133377), CFHealthHub (Wildman et al., 2021) and the MARCH study (NIHR130454). The longer-term consequences of COVID-19 are still unknown, and research into long COVID-19 is vital if we are to continue to support our patients appropriately over the next months and years. We still have so much to learn, and we are faced with new challenges as the virus continues to mutate and present with different clinical features. This is a stark reminder that the services we put in place need to be adaptable to change to ensure we are providing the right care required at the right time. We must also work hard to identify and explore health inequalities across many areas of our work. Only then will we understand what interventions may work and how best to implement them to provide most benefit for all our patient populations. Collaborations continue to be key across the multi-professional team, the clinical setting, academia and research teams. The future is certainly bright and exciting with so many opportunities for physiotherapy, and it must involve research.