Innovative Approaches in Providing Rehabilitation during the COVID-19 Pandemic
Introduction[edit | edit source]
COVID-19 is currently placing significant pressure on health services around the world. While the majority (81%) of individuals who get COVID-19 have mild illness, including fever, cough and dyspnoea (REF SIMPSON), a significant minority face serious complications, particularly those who have comorbidities or who are older than 65 years.[1] It has been reported that, thus far, of those requiring hospital level of care, 20.3% need ICU management, most commonly because of Acute Respiratory Distress Syndrome ARDS (32.8%).[1]
There is currently no treatment for COVID-19. The management provided in hospital settings is supportive and it is likely that there will be a large number of COVID-19 survivors who require significant rehabilitation support after they recover.[1] Common sequelae of critical illness are:
- Persistent changes in carbon monoxide diffusion capacity
- Intensive-care acquired weakness
- Critical illness polyneuropathy/critical illness myopathy
- Cardiorespiratory deconditioning
- Impairment of cognitive function (delirium)
- Mental health impairment[1]
Commonly recorded complications of COVID-19 are:
- Neurological complications such as stroke
- Critical care neuropathy
- Complications associated with prolonged bed rest (such as venous thromboembolism, disseminated intravascular coagulation, acute kidney injury, delirium anxiety, post‐traumatic stress disorder)[2]
In general, patients who experience critical illness and who are ventilated for more than seven days will usually require quite significant rehabilitation input - for instance, sixty percent of these patients will initially be unable to walk.[2] If patients experience stroke or cardiac complications following COVID-19, they will require rehabilitation for an extended period - in some cases, they will require lifelong support.[2]
Rehabilitation services are, therefore, essential if patients are to optimise their physical and cognitive functioning and reduce disability.[3] However, during a pandemic when social distancing is required, healthcare providers need to explore innovative approaches to rehabilitation to ensure that both COVID-19 and non-COVID-19 patients receive adequate care and support.[1]
Telehealth[edit | edit source]
Any reduction in rehabilitation services has a significant impact on patients, families and healthcare workers.[3] One way in which rehabilitation providers can prevent disruptions to services during the COVID-19 pandemic is to adopt telehealth or virtual rehabilitation.[4]
The practicalities of telehealth are discussed in detail here, but a key benefit of virtual rehabilitation is that it enables personalised consultations and treatments to continue via electronic media (phone and/or video) during the pandemic, thus eliminating the risk of transmission of the virus.[1][4] This is significant as it protects both patients and the healthcare team - during the last major viral outbreak prior to COVID-19 in 2002, a fifth of all cases were health workers.[4]
Other benefits of virtual rehabilitation include:
- Innovative technology is often appealing to users, which can increase adherence and decrease the potential for patients to give up on treatment
- Direct contact between patients with providers and the ability for constant feedback enhances trust/peace of mind[4]
There are certain challenges associated with telehealth, which has limited its uptake prior to COVID-19.[5] These are discussed in more detail here and here, but key difficulties include the need for both providers/patients having access to stable internet and the appropriate technology to engage in this mode of communication. Similarly, both the health provider and the patient must have the knowledge to be able to use the technology and be able to access support for any troubleshooting.[3]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Simpson R, Robinson L. Rehabilitation after critical illness in people with COVID-19 infection. Am J Phys Med Rehabil. 2020;99(6):470-474.
- ↑ 2.0 2.1 2.2 Faux SG, Eager K, Cameron ID, Poulos CJ. COVID ‐19: planning for the aftermath to manage the aftershocks. MJA. 2020 Jun 29.
- ↑ 3.0 3.1 3.2 Bettger JP, Thoumi A, Marquevich V, De Groote W, Battistella LR, Imamura M, Ramos VD, Wang N, Dreinhoefer KE, Mangar A, Ghandi DB. COVID-19: maintaining essential rehabilitation services across the care continuum. BMJ Global Health. 2020 May 1;5(5):e002670
- ↑ 4.0 4.1 4.2 4.3 Dy Care. Rehabilitation and physiotherapy in times of pandemic. Available from https://www.dycare.com/products/rehabilitation-and-physiotherapy-in-times-of-pandemic/ (accessed 10 July 2020).
- ↑ Dinesen B, Nonnecke B, Lindeman D, Toft E, Kidholm K, Jethwani K. Personalised telehealth in the future: a global research agenda. J Med Internet Res. 2016; 18(3): e53.
