That is according to the British Society of Rehabilitation Medicine, which has set out how the rehab field moves forward after current events.
Its paper, Rehabilitation in the wake of Covid-19: A phoenix from the ashes, focuses on the anticipated increased demand for rehab post Covid-19.
It explains: “Covid-19 has led to a pandemic that is increasing the burden of disease and disability throughout the world. It has brought many challenges and has caused major disruption to services. But we have also learned some new ways of doing things. As the NHS re-boots, there is an opportunity to rebuild services on a better, more collaborative, model.
“In the aftermath of major illness injury, many patients require rehabilitation to help them back to normal function or to adapt to living with disability.
“Patients who have required intensive care for more than a few days often have wider physical, cognitive and mental health support needs following discharge from acute settings. In addition, as Covid-19 is a multi-system disease, we are increasingly recognising more subtle deficits in patients less severely affected, even in those who did not require hospital admission.”
Given the diverse range of impairments, pathologies and environmental situations, the range of disabilities and their impact on societal participation will also be wide, the BSRM says.
It believes that the rehabilitation response will need to consider both the needs of individual the patient and those of the population.
“Analogous to rehabilitation following head injury, the much larger cohort of people rehabilitating from moderate disease may have a greater impact at a population level, but will have very different needs from those recovering from severe disease,” it says.
“In addition, these needs will be against a background of a population that is struggling with huge societal changes and it is likely that many different organisations may be separately trying to address the issue. In order to cater appropriately for the various different needs it will be critical to coordinate these efforts.”
Using technology to deliver rehab and assist in self-management will be important, it explains, as will coordinating the many organisations that can assist in delivery.
Crucially, however, the individualised aspect of rehab delivery must “run alongside this in order to be effective, especially for those survivors who are more dependent”. The numbers involved mean that an increase in staffing will be needed.
Managing the threat of coronavirus infection, meanwhile, could require “Covid-positive and Covid-negative streams”.
Regular and repeated testing for the virus will be necessary to support segregation and it is essential that staff have access to the all the necessary personal protective equipment (PPE) to be able to treat patients safely.
The BSRM also sets out some of the complications of the virus for individuals which rehab professionals must be aware of. They include:
- Cardiovascular, pulmonary and musculoskeletal deconditioning
- Restrictive lung disease
- Affective disorders: depression, anxiety, post-traumatic stress disorder
- Post intensive care syndrome, including critical illness polyneuropathy, critical illness myopathy and a combination of these
- Other neurological consequences of the virus and critical care, such as encephalopathy, cerebrovascular events and cerebral hypoxia
- Acute confusional state, at least in the early stages of rehabilitation
- Fatigue
- Cognitive impairment
Less common complications include:
- Thromboembolic disease ( myocardialinfarction, stroke, pulmonaryembolism)
- Musculoskeletal pain and discomfort
- Posterior reversible encephalopathy syndrome
The BSRM makes the following organisational-level recommendations:
- Critical care, acute medical and specialist rehabilitation teams should work closely together to develop rehabilitation pathways for patients who are recovering following treatment in intensive care and high dependency care (whether for Covid-related illness or other critical conditions). Within each network an identified rehab medicine consultant (or consultants) should be an integral part of the acute care pathway team.
- There should be integrated planning and close networking links between Level 1, 2 and 3 services, with adequate capacity at all levels.
- There should be close integration of hospital and community services with collaborative commissioning arrangements. Patients who require long-term support should have joined up provision of health and social care.
- There should be networking with general practice so that patients who present with late rehabilitation needs are identified and referred for a Rehabilitation Prescription.
- During the Covid-19 pandemic there should be Covid-positive and Covid-negative streams for rehabilitation. Regular and repeated testing for Covid should be undertaken to support segregation and staff should have access to all the necessary PPE to be able to treat patients safely.
On an individual level it recommends that:
- Patients with severe disabling illness/injury should have access to appropriate rehabilitation to optimise their recovery, including early rehabilitation while still in hospital and longer-term community-based support.
- Patients stepping down from ITU or HDU should have immediate access to an acute rehabilitation programme that provides very early intervention and the opportunity for further triage into post- acute pathways in the network.
- Patients with on-going rehabilitation needs after the immediate early rehabilitation phase should have a Rehabilitation Prescription (RP) outlining their physical, cognitive, neuro-behavioural and musculoskeletal rehabilitation needs and how/where they will be met.
- RM consultants should be involved from an early stage in the patient’s acute care pathway to assess patients with complex rehabilitation needs and participate in the planning and execution of their interim care and rehabilitation.
- Patients who have (or are likely to have) on-going complex needs for requiring specialist rehabilitation should have a complex needs checklist completed and should be assessed by an RM Consultant prior to discharge from the acute unit. The RM consultant (or their designated deputy) is responsible for confirming category A or B needs (using the PCAT Tool), and for expediting referral and transfer for on-going specialist rehabilitation as soon as they are fit enough.
- Patients who are ready to go home should have supported discharge and early community-based rehabilitation, with access to a range of services according to their individual needs, including but not limited to primary care, cardiopulmonary rehabilitation, sports and exercise medicine, neurorehabilitation and neurological disability services.
- Patients who are ready to leave hospital but require long-term care should be discharged to an appropriate care setting under the “Discharge to Assess” programme, where their on-going requirements for health and social care can be planned in close integration.
Read the full report here.
