Education, Training, and Practices of Neurorehabilitation in India During the COVID-19 Pandemic

Abstract

Background: Corona virus disease (COVID-19) was declared a pandemic by the World Health Organization in March 2020. This has affected service delivery among all medical disciplines in India including neurorehabilitation services.Aims and Objectives: The aims and objectives of the study were to assess the effect of COVID-19 pandemic on neurorehabilitation services across India.Methodology: A prospective nationwide survey study was undertaken by the Indian Federation of Neurorehabilitation during the pandemic. A questionnaire was prepared using Google forms software consisting of four sections: demography, neurorehabilitation practice before COVID-19 pandemic, neurorehabilitation practice during COVID-19 pandemic, and continuing medical education during COVID-19 pandemic.Results: Responses (872) were received from neurorehabilitation professionals across the country out of which 2.2% professionals did not give consent for participating in the survey. Participants (36.6%) were practicing traditional or independent referral basis rehabilitation, while 63.4% participants were practicing multidisciplinary rehabilitation. On an average, respective units were conducting 500–750 therapy sessions per month. Majority of the rehabilitation units in India lacked a physiatrist, rehabilitation nurse, music therapist, cognitive therapist, and urologist. Approximately 80% of the rehabilitation units have the basic rehabilitation modalities and advance technology was present in only 20% of the rehabilitation units. During COVID-19 pandemic, 19.5% centers were providing elective services, 50.3% emergency services, 15.6% new outpatient services, and 22.7% were providing follow-up outpatient services. Centers (51.5%) were providing telerehabilitation services for neurological conditions during the times of COVID-19 pandemic. Professionals (61.1%) providing telerehabilitation were working from home. Among the patients who needed neurorehabilitation, 28% were doing their exercises independently, 31% were supervised by caregivers, 17% were supervised by therapists, and 24% were not receiving any therapy. Participants (95.5%) wanted to receive more training in the field of neurorehabilitation. The participants utilized webinars (71%), online courses (22%), case discussion forums (19%), panel discussions (13%), and literature search (8%) during COVID-19 pandemic to continue education.Conclusion: The study reflects the situation of neurorehabilitation service delivery in India during the pandemic as the respondents were from all parts of the country and included most components of the neurorehabilitation team. Neurorehabilitation services were severely affected across India during the COVID-19 pandemic. Tele-neurorehabilitation has emerged as a new service delivery model during the pandemic. Online means of education has emerged as the primary source of continuing medical education during the pandemic.

Tele-Neurorehabilitation During the COVID-19 Pandemic: Implications for Practice in Low- and Middle-Income Countries

“…A review of home-based tele-rehabilitation services in Southeast Asian countries found that the completion rates of interventions accessed by people with disabilities have been ~80% in China and South Korea ( 15 ). A recent survey from the sub-continent (India) had showed close to 80% of the rehabilitation facilities with basic tele-rehabilitation infrastructure ( 16 ). However, tele-health and rehabilitation services are not available and are poorly utilized by the government primary care systems in many countries in the region of Sub-Saharan Africa ( 17 ).…”

“…For instance, close to 1/3 of the Brazilian population lack access to internet ( 27 ). Although the providers have access to basic tele-rehabilitation infrastructure like in India, the consumers need to have internet access to avail such services ( 16 ).…”

Assistive Technology Provider Experiences during the COVID-19 Pandemic

“…The literature exploring the impact of COVID-19 on people living with disabilities and older persons, those likely to require regular access to AT, is steadily increasing [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. The impact of COVID-19 on AT providers, however, has been less commonly investigated.…”

Access to Assistive Technology during the COVID-19 Global Pandemic: Voices of Users and Families

“…Critical discussions are occurring in the literature regarding how health services might be transformed given pandemic restrictions [ 50 , 51 ], and how health professions may respond [ 50 , 51 , 52 ]. Data from this study provided some perspectives from AT users and families as to the capability and responsiveness of AT personnel (see other studies in this series) as well as the impacts of the loss of other personnel (community-based rehabilitation workers, volunteers, school staff, community members) upon their health, development, and wellbeing.…”