A new guide developed by a group of clinicians with early experience in managing patients with COVID-19 not only stresses the importance of early rehabilitation for those hospitalized with the disease, but provides basic recommendations on how to approach that rehab, as well as options after discharge. The experts who developed the resource include an APTA member PT.
Titled "What Now for Rehabilitation Specialists," the guide was published as a free-access document in the Archives of Physical Medicine and Rehabilitation, and is targeted at "rehabilitation clinicians working in the inpatient setting with patients with confirmed or suspected COIVID-19." The resource gathers recommendations from clinicians who were on the frontlines of hospitals that faced large numbers of COVID-19 patients earlier this year, primarily in New York, Boston, Baltimore, and the Washington, D.C. area. Sowmya Kumble, PT, MPT, was among the contributors to the report.
The guide uses a question-and-answer format to cover topics including clinical manifestations of COVID-19, the role of the acute care rehab team in preventing complications, rehabilitation of patients in inpatient rehabilitation facilities, and "special considerations" including necessary precautions and models of care in rehabilitation.
The resource puts an emphasis on early rehabilitation, beginning as soon as possible in the acute care hospital using a "transdisciplinary approach" that brings all rehab and medical team members together in ways that support both the overall recovery goal and efforts of team members to contribute to that goal; for example, the authors write, the participation of PTs in supporting respiratory therapy during this phase.
Authors of the study weren't able to make a confident prediction about the percentage of patients hospitalized for COVID-19 who will require inpatient rehabilitation services, writing that "a number of factors," including whether a community has been forced to convert IRF beds into acute care beds, could have an effect on the length and level of rehab services required in the hospital. "It is important to remain maximally flexible, recognizing that one solution may not suit all situations," they write, adding that "at this time, the optimal riming or rehabilitation is unknown and influenced by delivery care factors."
In terms of models of care used to manage rehab for patients recovering from COVID-19, the experts say that lessons learned from geriatric rehab — particularly around the concepts of frailty and resilience — may be useful. Authors write that similar to care for older persons with multiple morbidities, patients recovering from COVID-19 may benefit from a "6M" approach to care that focuses on mind, mobility, medications, multicomplexity (medical/social issues), "matters most," and motivation.
The overall intent of the resource is to demonstrate "the clear need for rehabilitation intervention in both the acute and postacute phases of the disease," authors write. "While there are substantial challenges to performing rehabilitation in this new environment, with appropriate safeguards high quality rehabilitation can still be delivered."