No need to ‘reinvent the wheel’ on post-COVID rehab programs, say clinicians

Infectious diseases

25 May 2020

Building on existing well-established pulmonary rehabilitation services is likely the best approach for supporting patients with COVID-19 after they are discharged from hospital, a UK cross-specialty survey of clinicians has found.

Responses from more than 1,000 consultants, physiotherapists, dieticians and other health care professionals highlighted the “huge interest and urgent need” for a coherent recovery program for people are who discharged from hospital after being infected with the virus.

The results showed overwhelming support for an early post-discharge recovery program that advised patients on symptom management including fatigue, breathlessness and mood disturbances.

And at six to eight weeks post discharge, respondents to the survey were keen to see advice on returning to usual exercise habits and engaging in outdoor activities included in rehabilitation programmes for COVID-19 patients.

Advice on returning to work as well as psychological support, should also be included, the majority of respondents said in a survey supported by the British Thoracic Society.

While services would need to adapt as more evidence was published on the recovery from COVID-19, it was clear that respondents felt this would be an opportunity to adapt and improve current pulmonary rehabilitation models rather than ‘reinvent the wheel’, the researchers reported .

Other issues that came out in the survey responses included the need for a clear referral pathway to rehabilitation programmes and reassurances that financial support would be available for the development of the new model.

It follows recent guidance from the BTS on the setting up of ‘COVID clinics’ by respiratory teams to follow up patients with radiology-confirmed pneumonia after contracting coronavirus.

In the guidance the BTS noted that rehabilitation services, which are currently under national review in response to the outbreak, are expected to offer comprehensive assessments including psychosocial assessments.

Study lead Professor Sally Singh, Professor of Pulmonary and Cardiac Rehabilitation at the University of Leicester and co-chair of the BTS Pulmonary Rehabilitation Group, said people were starting to work out how rehabilitation would be provided for COVID-19 patients.

The paper points out that this group may be younger and have more diverse needs than those with chronic respiratory disease who would usually be seen by pulmonary rehabilitation teams.

“We know what a good pulmonary rehabilitation programme looks like but we don’t really know what a good COVID rehabilitation programme looks like,” she said. “We are beginning to bring together those working on it and adapted pulmonary rehabilitation might be suitable.”

But she added: “Traditional rehabilitation models have been delivered face to face so that becomes a challenge when you look at a post-COVID delivery pathway.”

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