Perspectives on Research and Health Practice in Physical and Occupational Therapy in Geriatrics during and Post COVID-19

Abstract

Coronavirus disease 2019 (COVID-19) emerged in Wuhan, China in December 2019 and it became a worldwide pandemic. 1,2 COVID-19 is highly infectious with an estimated basic reproductive number (R0) of 2.2 new cases/infected person. 3 This rapid transmission required extensive social distancing measures to be put in place. In many cases, even non-emergency health care has been avoided, including physical and occupational therapy. The social distancing guidelines, reduced rehabilitation access, and decreased physical activity experienced by older adults as a result of the pandemic will likely exacerbate this population's mobility impairments, deconditioning and frailty. 4 In addition, the resulting effects on those who have been infected and recovered can be long lasting and compound the decline in physical and respiratory function. 5 These are challenging times, but it also offers opportunity for reflection and growth. We need to rethink our practice to overcome the challenges imposed by the current pandemic and consider future ones. Physical and Occupational Therapists (P&OTs) have somewhat underutilized technologies available for distance rehabilitation, and the possibilities they provide us to expand on our ideal in-person treatments using telehealth and other online platforms such as Zoom and Skype, and integrate rehabilitation activities into everyday life through Telerehabilitation. 6 Expanding the use of this treatment delivery medium has never been as critical as during the current times. The use of online consulting and care by P&OTs is particularly important when attending to the needs of older adults because they are at increased risk of complications due to COVID 19 and other infections. The most severe cases and mortality occur in the older and frail population because they have high levels of chronic multimorbidity. Approximately 45% of deaths in the U.S. due to COVID-19 occurred in long-term care facilities. 7 These deaths highlight the vulnerability of institutionalized older adults, the challenges, and the systematic failures of the healthcare system. The expansion on the ways P&OTs do assessments and treatments, by further using online and telehealth technologies, can also benefit older adults in rural communities an in those with low accessibility to health care services. Many issues need to be resolved, including practice laws and regulations, insurance reimbursements for online care, treatment modalities, integration of reliable and valid testing apps and wearables, internet connectivity issues, digital literacy, and effective online treatment procedures and programs. We look forward to participate in these discussions and to review manuscripts submitted to P&OTinGeri related to these issues.We also need to discuss the importance for older people to get moving and staying active during the COVID-19 quarantine or pandemic. Some clinical recommendations are explored here from a knowledge transfer context and for education purposes for older population because research findings are often difficult ...

How telerehabilitation has been carried out across countries at different economic levels during COVID-19 pandemic? A scoping review. (Preprint)

“…All were published in English, from April to September 2020. Most part of the papers were from the United States of America (n = 4) 14,15,16,17 , followed by Italy (n = 2) 19,20 , and Australia (n = 2) 21,22 , Chile (n = 1) 23 and USA / Canada (n = 1) 18 , all classified as high-income countries. One paper was from an uppermiddle-income country (Iran, n = 1) 24 and one was from a lower-middle-income country (Egypt, n = 1) 25 .…”

“…In the United States, telerehabilitation has been regulated since 2014 and countries like Australia and Canada were pioneers in this implementation, which favors access and use of rehabilitation services. European countries, such as Italy and Spain, are looking for formulation of guidelines, protocols or regulations 18,21 . On the other hand, low and middle-income countries do not have their regulation defined yet to allow the use of telerehabilitation and have limited structure and incentives, which hinders advances and greater application of telerehabilitation in these countries.…”

Video Telehealth Occupational Therapy Services for Older Veterans: National Survey Study

“…This is the first study to provide insights into the state of OT video telehealth with older adults, a population of heightened interest because of changing demographics and their increased risk of complications and infections related to COVID-19 [ 46 ]. Before COVID-19, older adults were an underserved group for telehealth, as Medicare has until recently [ 47 ] been most restrictive regarding telehealth reimbursement [ 48 ].…”

Video Telehealth Occupational Therapy Services for Older Veterans: National Survey Study (Preprint)

“…This, coupled with our finding that respondent beliefs were more pronounced than organizational factors as facilitators, suggests the importance of clinicians' attitudes in the implementation of video telehealth. This is the first study to provide insights into the state of OT video telehealth with older adults, a population of heightened interest because of changing demographics and their increased risk of complications and infections related to COVID-19 [46]. Before COVID-19, older adults were an underserved group for telehealth, as Medicare has until recently [47] been most restrictive regarding telehealth reimbursement [48].…”