The COVID-19 Rehabilitation Pandemic

Sarah De Biase; Laura Cook; Dawn A. Skelton; Miles Witham; Ruth ten Hove

Disclosures

Age Ageing. 2020;49(5):696-700. 

In This Article

What Could Rehabilitation Post COVID19 Look Like?

The COVID-19 pandemic provides an opportunity for health and social care services to transform how they deliver rehabilitation. In countries where current rehabilitation services are fragmented or siloed, there is an opportunity to redesign pathways that better reflect the patient journey,[17,18] from home to hospital and back again. Where services are narrowly focussed on hospitals, there is an opportunity to put services in primary care and the community centre-stage, and to engineer better collaboration with agencies outside healthcare. These integrated systems of rehabilitation are more likely to prove resilient to future pandemic waves and are likely to be more responsive to the needs of those requiring both acute hospital admission and those requiring community rehabilitation without admission. It is likely that care will need to be delivered close to home, and to be effective, teams must work across organisational boundaries. These principles underpin the NHS Right Care Community rehabilitation toolkit (2020),[17] which sets out a vision for how community rehabilitation should be planned, commissioned and delivered in the UK.

The anticipated increase in demand for rehabilitation means that capacity to deliver rehabilitation must increase. This will not be achieved simply by training more specialist practitioners who will take several years to enter the workforce; a more diverse rehabilitation workforce will be required to meet the scale of this challenge, using capacity and skills from sectors outside healthcare organisations. By stratifying rehabilitation need and matching approaches to the right profession, the right mix of skills can be deployed to the right person. For example, older people at risk of falls would be able to access community-based specialist exercise instructor-led exercise programmes, with more complex cases managed by therapy services. This increase in capacity can also be achieved by developing rehabilitation capabilities across the wider non-registered health care staff, including specialist trained exercise and sports science professionals, to help meet both demand and effective dose and progression of exercise.[19] Professional leadership is needed to drive clinical expertise and system improvement across these multiple pathways.[8]

Where rehabilitation is delivered is likely to change, with less emphasis on clinic or hospital-based services, and more emphasis in services delivered in or near patients own homes. This will mean changes in how rehabilitation is delivered—approaches involving travel or group work are likely to be especially vulnerable to future pandemic waves or the imposition of movement restrictions. Early investment in digital connectivity to support rehabilitation must therefore continue, particularly in rural areas; such investments will also help not only to develop a system that is resilient to future pandemic waves, but also to permanent changes in how we live if the severe acute respiratory syndrome coronavirus 2 becomes endemic. The pandemic response has brought opportunities as well as challenges—for instance highlighting how physical activity and exercise can be integrated into daily life via remote communication. This must be now be scaled up to support older people, care home residents and others who are currently (or may in future be) confined to their own homes with limited social contact. Even where face-to-face delivery of rehabilitation is able to restart, it is likely that more of this activity will need to happen remotely to enable efficient delivery of rehabilitation at scale.

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