COVID-19 is a novel disease, predicting the rehabilitation needs for residents in recovery are based on evidence from the general critical care population. Based on this evidence, it is expected that acute interventions for the management of residents with severe and critical COVID-19, including mechanical ventilation, sedation and/or prolonged bed rest may result in a range of impairments including but not limited to:
- Physical deconditioning
- Respiratory compromise
- Swallowing deficits
- Cognitive and mental health impairments
These symptoms are collectively referred to as post-intensive care syndrome (PICS). Older people and those with chronic diseases may be most susceptible to their impact.
It is recommended that the following patient groups be routinely assessed for mobility, functional, swallow, cognitive impairments, and mental health concerns throughout the acute phase of the illness. Based on these assessments, determine follow up needs:
- Residents who have been in and discharged from intensive care
- Residents who have experienced severe cases of the virus
- Residents who exhibit signs of any of the above impairments
The assessment process is critical and validated, standardized assessment tools should be utilized to determine the presence and severity of impairment. The assessment process should focus on the resident’s situation including prior status, social support, and ability to participate in rehabilitation activities. This is especially important for residents with chronic disabilities and comorbidities who may have more complex requirements. Involve the resident, family, and caregivers in the assessment and decision-making process regarding rehabilitation and discharge planning.
When rehabilitation needs are identified:
- Ensure an appropriate infection control program is available in the rehabilitation areas that are caring for residents with COVID-19 who remain infectious
- Provide rehabilitation programming based on each resident’s individual needs
- Ensure a multidisciplinary rehabilitation team is available to ensure residents are able to access professionals to address their needs
- Include physical therapists, occupational therapists, speech and language therapists, mental health, and psychosocial providers
- The program should be based on the resident’s needs and goals and may include exercise, education, self-management strategies including cognition, swallowing and ADLs, respiratory techniques (breathing exercises and techniques), assistive devices, group therapies, stress management, etc.
- When rehabilitation needs are associated with severe respiratory illness and symptoms include persisting fatigue, reduced exercise tolerance, and difficulty with ADLs, the resident may benefit from a pulmonary consult/pulmonary rehabilitation
- If the etiology of persisting symptoms is unclear, a physiatry consult may be beneficial
It is important to remember that COVID-19 is a debilitating virus that can have a huge impact on a resident’s status. It is our responsibility as providers to assist in challenging the resident to be all that they can be. Involve your team, keep the spirits up and activity level high! Motivation is a huge factor in successful rehabilitation and with limited access to loved ones, you have become an honorary family member for your residents! Thanks for all you do, stay well, stay tuned!
© World Health Organization 2020. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence.
WHO reference number: WHO/2019-nCoV/clinical/2020.5