Rehabilitation in the wake of COVID-19 -- A phoenix from the ashes (2020) Phillips M, Turner-Stokes L, Wade D et al

[MSEsperanza]

Phillips M, Turner-Stokes L, Wade D, et al. Rehabilitation in the wake of COVID-19-A phoenix from the ashes. Br Soc Rehabil Med [Updated 2020 Apr 27; cited 2020 Dec 27]. Available from: https://www.bsrm.org.uk/downloads/covid-19bsrmissue1-published-27-4-2020.pdf.

https://www.bsrm.org.uk/publications/publications


The document has been reviewed by members of the following BSRM committees:
• The Executive Committee
• The Research and Clinical Standards sub-committee.

This is a working document that will be reviewed and revised if necessary, as further evidence and information becomes available and as the Covid-19 situation develops.


Executive Summary
Rehabilitation forms a critical component of the acute care pathway, helping to relieve pressure on the acute and frontline services. It is shown to be both effective and cost-effective, whether through improving independence and societal reintegration; or managing the impacts of long-term disability including neuro-palliative care.

The Covid-19 pandemic has already led to a marked increase in the burden of disease and disability and will continue to do so. It has produced many new challenges:

• A diminished workforce due to sickness, shielding and redeployment to frontline services.

• The many impacts of social distancing including
  o socio-economic and psychosocial effects
  o isolation of patients from their families
  o restrictions on interventions that involve hands-on treatment, group interventions or aerosol generating procedures.

• An as yet unquantifiable additional case-load of patients with post-Covid disability presenting with a wide range of problems due to cardio-pulmonary, musculoskeletal, neurological and psychological/psychiatric complications of the disease, compounded in many cases by deconditioning from prolonged stays in ITU.

As NHS services re-boot in the wake of the pandemic, there is an important opportunity to work collaboratively to rebuild services on a better, more co-operative model – a phoenix from the ashes.

This document sets out the BSRM’s recommendations for rehabilitation services for adults aged 16 years and over in the wake of the Covid-19 pandemic - in particular, the role of specialist rehabilitation to support patients with more complex rehabilitation needs.

Edited to add information on the paper (text in italics at the beginning).

 

[MSEsperanza]

(The original article dates back to April 2020 -- not sure if this deserves an own thread, but thought title and authors could be interesting.)

Continued from above:

The rehabilitation pathway and coordinated networks

Given the diversity of presentation and rehabilitation needs, different patients require different types of services. Moreover, the same patient will require different services at different stages in their recovery.

Key elements of the model are illustrated in Figure 1, but can be summarised as follows:

Recovery pathways

• Rehabilitation should start as early as possible, ideally while the patient is still in intensive care.

• On step-down from intensive care, a rapid access acute rehabilitation programme can provide very early intervention and the opportunity for further triage into post-acute pathways in the network.

• The majority of patients are on a fairly fast recovery track. Their needs may be met by the local (Level 3) rehabilitation services, but these require significant expansion to enable patients to access them in a timely manner.

• A small number of patients will have more complex rehabilitation needs or a slower trajectory towards recovery. These may require specialist rehabilitation in a Level 1 or 2 service, often for longer periods. Hyper-acute specialist rehabilitation units provide rehabilitation for patients who continue to be medically unstable with input from all the relevant medical and surgical specialties. There are currently 75 specialist rehabilitation units in England catering for around 2500 admissions per year.

[...]

 

[Trish]

That part just quoted sounds like it's specifically about post intensive care rehab. Is there a section on long covid in those who were not hospitalised? I don't have the energy to look.

 

[Jonathan Edwards]

I thought the phoenix was a fairy story.

 

[rvallee]

That part just quoted sounds like it's specifically about post intensive care rehab. Is there a section on long covid in those who were not hospitalised? I don't have the energy to look.

I didn't see anything related to LC, this is really all about severe Covid from the context of the ICU outward, what happens after. It's very generic.

Unwittingly nailing the metaphor, however, except it's the ashes part, not the phoenix.

 

[MSEsperanza]

That part just quoted sounds like it's specifically about post intensive care rehab. Is there a section on long covid in those who were not hospitalised?

Have not read the paper, but in the summary people not admitted to hospital are cursorily mentioned:

Community re-integration and rehabilitation (p. 3)

As soon as they are fit to leave hospital, patients require access to supported discharge to
enable them to get home, followed by community reintegration programmes once able to
engage, to support them back to work and other activities.

• Some will require on-going specialist rehabilitation or generalist outpatient rehabilitation
services in the community.

• This may also apply to patients who never get admitted to hospital, but who still have on-
going needs for rehabilitation support 1-2 months after recovering from Covid, or Covid-like symptoms.

 

[Sean]

As soon as they are fit to leave hospital, patients require access to supported discharge to enable them to get home, followed by community reintegration programmes once able to engage, to support them back to work and other activities.

Love the absolutism in play here: "patients require access to", instead of 'patients may require access to'.

Because apparently humans are so predictably incompetent they need retraining and reintegration after every experience of adversity. According to the people whose income depends on delivering such retraining programmes.

 

[MSEsperanza]

Love the absolutism in play here: "patients require access to", instead of 'patients may require access to'.

Or what about a sentence along these lines:

As soon as they are fit to leave hospital, it is mandatory to consult with the patient whether they require access to supported discharge to enable them to get home, followed by offering community reintegration programmes once able to engage and if wanted....