Rehabilitation during the pandemic - FAQs 

Access to high quality community rehabilitation for those worst affected by Covid-19 will be critical. On the horizon is a significant increase in demand.  These services already face major disruption from the  pandemic due to the redeployment of the workforce and social distancing and shielding requirements.  We answer some of your frequently asked questions about what all this means for rehabilitation during the Covid-19 pandemic.

What are the rehabilitation needs of people recovering from Covid-19?  

We are learning all the time about rehabilitation after Covid-19.  Much of what we know about people’s rehabilitation needs is based upon what we know about ARDS, post ITU and severe influenza.  

What we know so far:

  • People coming out of acute hospitals will most likely have the most significant rehabilitation needs.
  • Up to 25% of hospitalised Covid-19 patients require intensive care, often for prolonged periods.  Most of them (67%) will have acute respiratory distress syndrome (ARDS).
  • A prolonged stay in the ICU, mostly including prolonged mechanical ventilation, has significant impact on lung function, physical functioning and emotional well-being.

Emerging evidence from CSP members is that rehabilitation needs are extremely complex.

People typically present with a range of rehabilitation needs – primarily fatigue, dyspnoea (breathlessness) and extreme deconditioning. 

People with pre-existing long term conditions may be more severely affected, and their rehabilitation needs are likely to be more complex.

The longer term impact of Covid-19 is not yet known and the global physiotherapy community is playing an important role in developing the evidence base.

 

(Last reviewed :  25 Nov 2020)


How does rehabilitation of Covid-19 patients save lives? 

Many people with Covid-19 will need rehabilitation to support their recovery.

Rehabilitation is a critical part of the whole care pathway including community based rehabilitation.

It is essential to keep the flow of people moving through hospital, freeing up beds and capacity to treat the critically ill.

If rehabilitation isn’t provided at all steps of the pathway then this will lead to bottlenecks in the system or people being readmitted.

 

(Last reviewed : 25 Nov 2020)


What forms of rehabilitation are likely to be needed by people recovering from Covid-19?

The CSP has produced standards to support service delivery for people recovering from Covid-19.

The physiotherapeutic principles of patient-centred, evidence-based rehabilitation apply for people recovering from Covid-19.  All decisions about care for people with or recovering from Covid-19 must be based on clinical need, presenting signs and symptoms, and local risk assessments. 

An individual assessment of rehabilitation needs is essential. This should include but is not limited to:

  • safe mobility
  • symptom control (dyspnoea, fatigue, and pain)
  • need for supplemental oxygen
  • adequate nutrition
  • psychological/social support

Rehabilitation plans need to address the assessment findings, with a focus on supporting people to build strength to reverse the decline from deconditioning, reduce breathlessness, reduce fatigue, manage pain and provide psychological support.

'Return to work' conversations should form part of the plan where it is appropriate.

Physiotherapists have a key role in empowering people to recover and build up resilience at their own pace, with specific support to self-manage.  This will be an important part of any rehabilitation and recovery plan.

Many people will need paced rehabilitation: short in duration, several times every day. The intensity and frequency of rehabilitation must be determined by the person’s individual tolerance, taking into account that symptoms of fatigue will be common.

As evidence on rehabilitation needs of Covid-19 patients emerges we will be adding to this guidance.

 

(Last reviewed : 25 Nov 2020) 


Should rehabilitation for non Covid-19 patients continue in the period of the pandemic? 

Yes. Rehabilitation services are essential to keep people out of hospital and reduce pressures on all parts of the health and care system. If rehabilitation does not continue then people’s needs will become more urgent, placing greater demands on the system.

Local risk assessments should be made in order that careful consideration is given as to whether this is through face-to-face contact or other means. Our current guidance on face-to-face consultations applies regardless of sector or setting.  Throughout the Covid-19 emergency the physiotherapy workforce, regardless of sector or setting, must be compliant with UK government advice and follow NHS guidance for healthcare professionals.

People should be offered face-to-face consultations if:  

  • they are in hospital and require physiotherapy.
  • there is a risk of serious deterioration from underlying pathology and you are unable to determine this remotely.
  • they have urgent rehabilitation needs, which if not met, will require care from General Practice, secondary care or social care agencies. This is particularly important if they are themselves a carer for someone who is vulnerable. 
  • they require rehabilitation to support their rapid discharge from secondary care. 

Our face-to-face consultation flow chart can support you in your decision making. 

To support social distancing and shielding of groups in the population who are very vulnerable to Covid-19, many services will need to be provided remotely where possible. See our guidance on delivering physiotherapy services remotely

Further guidance to support your decision making:

Where you make decisions to either support a patient face to face or not you should follow usual good record-keeping practices and ensure your clinical reasoning is documented in the patient’s clinical record. Wherever you are working face to face with patients you must ensure that you use the appropriate PPE. See our PPE FAQs and guidance.

 

(Last reviewed: 25 Nov 2020)


Where should rehabilitation happen? 

Rehabilitation must be consistently available at all stages of the pathway as people move from one part of the system to another. 

Community rehabilitation teams must be resourced and staffed sufficiently to meet the existing demand as well as the additional need of people recovering from Covid-19 returning home or to a care home.

The CSP supports the Discharge to Assess guidance produced by NHS England which estimates that 45% of people admitted to hospital with Covid-19 need some form of ongoing health and care services on discharge, which includes rehabilitation.

This guidance also estimates that 4% of people admitted with Covid-19 will require bedded rehabilitation on discharge from hospital.

 

(Last reviewed: 25 Nov 2020)


What should we do if we find patients recovering from Covid-19 are not being offered suitable rehabilitation locally? 

If you are concerned about patients' rehabilitation needs not being met, including Covid-19 patients, you should work with your management locally and propose solutions. If you have gaps in your team or if you need to increase staffing to meet demand, the temporary NHS workforce, including physiotherapy staff from private practice, returning to practice and students may be very well suited to providing physiotherapy in the community.

If too many physiotherapists and support workers are redeployed away from rehabilitation as part of an urgent Covid-19 response effort, or for too long, then there will be bottlenecks in hospitals. This will cost lives and must be prevented. Physiotherapy managers must ensure that their expertise is being fully used by local health system leaders.

This is also a priority area for the CSP and we are seeking to influence at every level. To be able to do this we need to know from members what is happening on the ground.

If you are not happy you should speak to your CSP rep or contact the CSP Enquiries Team on enquiries@csp.org.uk or 020 7306 6666.

For further guidance on this see our Redeployment and upskilling section and our Policy statement on rehabilitation during and after the pandemic.

(Last reviewed : 25 Nov 2020)


How are we going to meet people’s rehabilitation needs after the pandemic is over? 

It is clear that there will be a substantial increase in rehabilitation needs across the UK population.  These groups are likely to be (but not limited to):

  • those with rehabilitation needs associated with recovery from Covid-19 illness
  • service disruption for those with pre-existing rehabilitation needs
  • people whose physical function has deteriorated due to the requirements of social distancing and / or shielding
  • people who felt unable to seek help for new symptoms during the pandemic

Community rehabilitation provision has been historically patchy and inconsistent, thanks to decades of lack of development and investment. This is why, in 2019, the CSP brought together a Community Rehabilitation Alliance of professional bodies and charities with a shared concern in this area to work together.

This is also why now, along with our alliance partners, we are calling for the Government and the NHS to be preparing to meet people's rehabilitation needs by radically overhauling and expanding community rehabilitation services. 

See Community rehabilitation and Covid-19 policy statement and our Community rehabilitation content for more details.
 
(Last reviewed : 25 Nov 2020)


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