COVID-19 was a huge challenge for rehab specialists.
Early in the year there were more questions than answers on how to protect ourselves and our patients, when to start rehabilitation, and what we could expect for outcomes. As this year moves along we receive more clarity and approaches to this patient population improve.
Recently a new guide was developed by a group of clinicians with early experience in managing patients with COVID-19. The guide not only stresses the importance of early rehabilitation for those hospitalized with the disease, but also provides basic recommendations on how to approach that rehab, as well as options after discharge.
As per it’s abstract: “Recognizing a need for more guidance on the SARS-CoV-2 (COVID-19) pandemic, members of the Archives of Physical Medicine and Rehabilitation Editorial Board invited several clinicians with early experience managing the disease to collaborate on a document to help guide rehabilitation clinicians in the community. This consensus document is written in a “question and answer” format and contains information on the following items: common manifestations of the disease; rehabilitation recommendations in the acute hospital setting, recommendations for inpatient rehabilitation and special considerations. These suggestions are intended for use by rehabilitation clinicians in the inpatient setting caring for patients with confirmed or suspected COVID-19. The text represents the authors’ best judgment at the time it was written. However, our knowledge of COVID-19 is growing rapidly. The reader should take advantage of the most up to date information when making clinical decisions.”1
Titled “What Now for Rehabilitation Specialists,” the guide was published as a free-access document in the Archives of Physical Medicine and Rehabilitation, and is targeted at “rehabilitation clinicians working in the inpatient setting with patients with confirmed or suspected COIVID-19.” The resource gathers recommendations from clinicians who were on the frontlines of hospitals that faced large numbers of COVID-19 patients earlier this year, primarily in New York, Boston, Baltimore, and the Washington, D.C. area.
The guide uses a question-and-answer format to cover topics. They categorized the questions under 4 major topics: 1) pathophysiology and clinical manifestations of COVID-19, 2) rehabilitation in the acute hospital setting, 3) rehabilitation in an inpatient rehabilitation facility (IRF) setting, and 4) special considerations.
The American Physical Therapy Association points out that the resource puts an emphasis on early rehabilitation, beginning as soon as possible in the acute care hospital using a “transdisciplinary approach” that brings all rehab and medical team members together in ways that support both the overall recovery goal and efforts of team members to contribute to that goal; for example, the authors write, the participation of PTs in supporting respiratory therapy during this phase.
At this time the authors of the study weren’t able to make a confident prediction about the percentage of patients hospitalized for COVID-19 who will require inpatient rehabilitation services, writing that “a number of factors,” including whether a community has been forced to convert IRF beds into acute care beds, could have an effect on the length and level of rehab services required in the hospital. “It is important to remain maximally flexible, recognizing that one solution may not suit all situations,” they write, adding that “at this time, the optimal riming or rehabilitation is unknown and influenced by delivery care factors.”
To care for patients recovering from CVID-19, the article recommends following lessons learned from geriatric rehab, especially around the concepts of frailty and resilience. Authors write that similar to care for older persons with multiple morbidities, patients recovering from COVID-19 may benefit from a “6M” approach to care that focuses on mind, mobility, medications, multicomplexity (medical/social issues), “matters most,” and motivation.
The document states that the overall intent of the resource is to demonstrate “the clear need for rehabilitation intervention in both the acute and postacute phases of the disease.” While there are substantial challenges to performing rehabilitation in this new environment, with appropriate safeguards high quality rehabilitation can still be delivered.”
The article concludes with stating that the COVID-19 pandemic represents the biggest health care challenge of our lifetime. This document, produced by content experts with early experience managing patients with COVID-19, outlines the clear need for rehab intervention in both the acute and post-acute phases of the disease. While there are substantial challenges to performing rehabilitation in this new environment, with appropriate safeguards, high quality rehabilitation can still be delivered. It is important to note that the information provided in this document is not designed to replace local policies and should not replace clinical reasoning for individual patient management. The text represents the authors’ best judgment at the time it was written. However, our knowledge of COVID-19 is growing rapidly. The reader should take advantage of the most up to date information when making clinical decisions.2