Redefining Pathways into Acute Rehabilitation during the COVID‐19 Crisis

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has necessitated drastic changes across the spectrum of health care, all of which have occurred with unprecedented rapidity. The need to accommodate change on such a large scale has required ingenuity and decisive thinking. The field of physical medicine and rehabilitation has been faced with many of these challenges. Healthcare practitioners in New York City, the epicenter of the pandemic in the United States, were among the first to encounter many of these challenges. One of the largest lessons included learning how to streamline admissions and transfer process into an acute rehabilitation hospital as part of a concerted effort to make acute care hospital beds available as quickly as possible. Disclosure

Characteristics and outcomes of COVID-19-positive individuals admitted for inpatient rehabilitation in Toronto, Canada

“…Admission criteria were also based on what we knew about the disease in the early phases of the pandemic and how to logistically and safely set up a recovery unit for rehabilitation candidates who were still testing positive for COVID-19. This is in contrast to the experience in New York, USA, where there was such tremendous overflow from acute care that some rehabilitation facilities were set up urgently for hospital bed space overflow ( 27 ). Indeed, in our hospitals, some patients who had lengthy acute care stays as a result of COVID-19 were admitted to the most appropriate rehabilitation unit (as opposed to a designated COVID-19 recovery unit), as they had since tested negative.…”

Pulmonary Rehabilitation in COVID-19 patients: A scoping review of current practice and its application during the pandemic

“…This reorganization badly impacts over professional skills of RPTs, but it could provide practical insights to other facilities facing this crisis like COVID-19. Gitkind et al [ 47 ] USA Perspective Referring patients for rehabilitation should be judged case-case, based-on discussion with other professionals in the multidisciplinary team, less time consuming than before because of patient overload at emergency, rehabilitation specialist now is considered an integral part of a treating team, therapy period should also be readjusted. Wang et al [ 48 ] US Analysis-perspective Pulmonary rehabilitation in COVID-19 should include management of nutrition, air-way, posture, clearance technique, oxygen therapy, breathing exercises, stretching, manual therapy, and physical activity.…”

“…[ 77 ] To overcome patient load, organizational changes and remodeling of tasks of healthcare professionals are sometimes required, as seen in a Northern Italian rehabilitation hospital;[ 46 ] however, in a rehabilitation unit, a physiatrist is the ultimate authority and is responsible for monitoring patients’ nutrition, posture, airway, breathing, oxygen supply, and physical activity; physiatrist‐to‐physician communication in a multidisciplinary setting hasten the decision‐making process regarding patients’ referral to a rehabilitation unit. [ 47 , 48 , 55 ] The Italian societies of respiratory healthcare professionals promoted a position paper focused on the COVID-19 crisis, stressing that there should be separate PR facilities for both COVID-19 and non-COVID-19 cases. [ 49 ] In COVID-19 cases, the field of physical medicine and rehabilitation has been also faced with many challenges and is being acknowledged as an integral part of the healthcare system in the healthcare system of the United States.…”

“…Since COVID-19 may remain asymptomatic, survivors can get re-infected, and there is an absence of acknowledged or evidenced cure to date, COVID-19-PR at the community level could be a difficult task for the rehabilitation personnel. [ 47 , 81 ] Community-based rehabilitation for COVID-19 cases with compromised lung function requiring PR should be different from that of non- COVID-19 cases, as recurrences may occur even after complete recovery. [ 82 ] The response of society toward the COVID-19 survivors may also complicate community- based PR of COVID-19 cases.…”

What Now for Rehabilitation Specialists? Coronavirus Disease 2019 Questions and Answers

“…Specifics for management of admissions and expected percent of acutely hospitalized patients admitted for COVID-19 rehabilitation will vary as the health system becomes overwhelmed. 42 For institutions within a surge area, there may be conversion of rehabilitation units to acute care for medical surgical patients. Once the surge ends, there often are many patients who are recovering who have severe functional limitations.…”