Personal protective equipment
4.1	Droplet precautions should be appropriate for the provision of mobilisation, exercise and rehabilitation in most circumstances. However, physiotherapists are likely to be in close contact with the patient (eg, for mobilisation, exercise or rehabilitation interventions that require assistance). In these cases, consider use of a high filtration mask (eg, P2/N95). Mobilisation and exercise may also result in the patient coughing or expectorating mucus, and there may be circuit disconnections with ventilated patients. Refer to local guidelines regarding ability to mobilise patients outside of their isolation room. If mobilising outside of the isolation room, ensure that the patient is wearing a surgical mask.
Screening
4.2	Physiotherapists will actively screen and/or accept referrals for mobilisation, exercise and rehabilitation. When screening, discussion with nursing staff, the patient (eg, via phone) or family is recommended before deciding to enter the patient’s isolation room. For example, to try to minimise staff who come in to contact with patients with COVID-19, physiotherapists may screen to determine an appropriate aid to trial. A trial of the aid may then be performed by the nursing staff already in an isolation room, with guidance provided, if needed, by the physiotherapist who is outside the room.
4.3	Direct physiotherapy interventions should only be considered when there are significant functional limitations, such as (risk of) ICU-acquired weakness, frailty, multiple comorbidities and advanced age.
Early mobilisation
4.4	Early mobilisation is encouraged. Actively mobilise the patient early in the course of illness when safe to do so.23
4.5	Patients should be encouraged to maintain function as able within their rooms: • Sit out of bed. • Perform simple exercises and activities of daily living.
Mobilisation and exercise prescription
4.6	Mobilisation and exercise prescription should involve careful consideration of the patient’s state (eg, stable clinical presentation with stable respiratory and haemodynamic function).26,27
Mobility and exercise equipment
4.7	The use of equipment should be carefully considered and discussed with local infection monitoring and prevention service staff before being used with patients with COVID-19 to ensure that it can be properly decontaminated.
4.8	Use equipment that can be single patient use. For example, use elastic resistance bands rather than distributing hand weights.
4.9	Larger equipment (eg, mobility aids, ergometers, chairs and tilt tables) must be easily decontaminated. Avoid use of specialised equipment, unless necessary, for basic functional tasks. For example, stretcher chairs or tilt tables may be deemed appropriate if they can be decontaminated with appropriate cleaning and are indicated for progression of sitting/standing.
4.10	When mobilisation, exercise or rehabilitation interventions are indicated: • Plan well. • Identify/use the minimum number of staff required to safely perform the activity.26 • Ensure that all equipment is available and working before entering rooms. • Ensure that all equipment is appropriately cleaned or decontaminated. • If equipment needs to be shared among patients, clean and disinfect between each patient use.23 • Specific staff training for cleaning of equipment within isolation rooms may be required. • Whenever possible, prevent the movement of equipment between infectious and non-infectious areas. • Whenever possible, keep dedicated equipment within the isolation zones, but avoid storing extraneous equipment within the patient’s room.
4.11	When performing activities with ventilated patients or patients with a tracheostomy, ensure that airway security is considered and maintained (eg, a dedicated airway person to prevent inadvertent disconnection of ventilator connections/tubing).

COVID-19 = coronavirus disease 2019, ICU = intensive care unit.