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Occupational Therapy Rehabilitation and Covid-19

The pandemic’s disruption of our everyday lives has led to a rise in mental health concerns. For many, the crisis has taken away the routine and security that come from the meaningful ‘occupations’ that define our lives. As a result, Occupational Therapy and the preservation of everyday occupations have become increasingly important during the pandemic’s “prolonged state of emergency”.

The pandemic’s disruption of our everyday lives has led to a rise in mental health concerns. For many, the crisis has taken away the routine and security that come from the meaningful ‘occupations’ that define our lives. As a result, Occupational Therapy and the preservation of everyday occupations have become increasingly important during the pandemic’s “prolonged state of emergency”. In spite of the complexities of today’s reality, there is evidence that presents a positive outlook on post-covid patient recovery, normalisation and re-inclusion.

“Occupations” refer to the everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to and are expected to do (Zemke et al., 1996). Occupational therapists therapeutically support persons with disabilities.  However, if we look at disability from a bio-psychosocial perspective, and consider the global impact of the COVID-19 virus, it is clear that we have all been experiencing a temporary form of disability since the start of the pandemic. 

Occupational therapists have been trained to assist patients adjusting to a ‘new normal’, helping them establish meaningful routines that support quality of life. With this in mind, it is understandable why there has been a growth in the need and importance of occupational therapists during a prolonged emergency - particularly for those who are experiencing the disease (Hoel et al., 2021). 

There has been great demand for occupational therapists to care for individuals affected by COVID-19 and those in need of post-COVID rehabilitation; patients with advanced age, multiple chronic diseases or organ failure, and/or who had a long hospitalisation period and/or needed the Intensive Care Unit (ICU)( Brugliera, et al, 2020). Rehabilitation after COVID-19, is similar to that provided to patients in geriatric rehabilitation units who suffered from debilitating illness or injury. Most patients present with a variety of sequelae associated with the viral disease and with a prolonged stay in the ICU, possibly including mechanical ventilation. Many will have pre-existing comorbidities. 

Commonly, people who require intensive care management face high risks of long-term physical, cognitive and emotional complications (British Psychological Association, 2020). Post-intensive care syndrome (PICS) describes a collection of difficulties that people may experience following a critical care admission. These include physical, cognitive and psychological difficulties which can be prolonged, lasting as long as 15 years, and are known to impact on return to usual occupations and work (Needham et al., 2012). Typically, patients who suffered from ARDS (Acute Respiratory Distress Syndrome, as that caused by SARS-CoV-2), may present with numerous persisting functional impairments, across bio-psycho-social domains, due to the psychological and cognitive sequelae of illness and PICS (Simpson & Robinson, 2020). Occupational therapy intervenes with a systematic assessment of the functional and psycho-social condition of the patient, to build a tailored, progressive treatment plan which focuses on function, disability, and return to participation in society which can help each patient to maximise their function and quality of life (Sheey 2020). 

To achieve this objective, occupational therapists scientifically analyse occupations, using the ‘activity analysis’ tool - deconstructing a single occupation into many components to see the best fit of individual needs, capabilities, activity characteristics in the actual environment or context - to help individuals carry out occupations they could not meaningfully engage in after the trauma (Kamalakannan et al., 2020). 

Concerning functional impairment related to post-COVID sequelae, occupational therapists can help individuals to solve problems that prevent them to accomplish everyday important occupations, such as getting dressed, eating, moving around the house (self-care); going to work or school, participating in the community (being productive) and sports, gardening, social activities (leisure activities) (McMaster University, on line). 

The process of occupational recovery for COVID-19 patients is multifaceted. However, the latest research has a positive perspective on rehabilitation and patient reintegration into society and back into meaningful occupations. 

Occupational Therapy takes a holistic approach to recovery. It encompasses psychological and cognitive rehabilitation, due to the profound impact of the disease on patients’ emotional and social sphere. The full extent of the rehabilitation needs of people recovering from COVID-19 are not yet known, however some predictions can be made on the basis of experiences and data collated over the past year and a half. The UK’s National Health Service (NHS), estimates that, among people who underwent hospitalisation for Covid-19:

• 50% will not require health or social care input post-discharge,

• 45% will be able to be discharged home with support from health and social care, 

• 4% will require rehabilitation in a bedded setting, 

• 1% will have experienced a life-changing event and will be unable to be discharged home from the acute setting (Royal College of Occupational Therapists, online). 

It is clear that patients’ requirements after COVID-19 could be different, and interventions needed will be diverse. Since the relatively recent emergence of the disease, protocols for rehabilitation are not fully standardised, but new guidelines have been recently proposed by several professional associations and academies. The NHS recently published a complete guide for occupational therapists involved in rehabilitation for people recovering from COVID-19, including direction for screening and assessment, goal setting, occupational engagement, psychological interventions, discharge planning and onward referrals for those patients who may need a long term follow up (Royal College of Occupational Therapists, online). 

As with all disabilities, the practice of occupational therapy for COVID-19 patients is client-centred. The therapist will assess patient’s difficulties and build a tailored approach to help the individual in re-building their everyday occupations and social lives. Optimising occupational participation through the provision of occupational therapy not only provides a cost-effective opportunity to promote health, but also ensures social inclusion and advances individual and societal recovery from the COVID-19 pandemic (WFOT, 2020).

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