Speech and Language Teletherapy Services During The COVID-19 Pandemic: A National Survey

Research Objectives To characterize the Covid-19 experience and telerehabilitation access, service delivery experiences, and perceived effectiveness in a national cohort of adults with aphasia. Design Online Survey. Setting Distributed nationally in early 2021 through aphasia centers, university clinics, and social media. Participants Individuals with aphasia. Interventions Not applicable. Main Outcome Measures The survey included questions related to demographics, knowledge and attitudes about the coronavirus, healthcare experiences including telehealth/ telerehabilitation immediately before and during the pandemic, familiarity with technology, physical and mental health during the pandemic, and life changes in regards to access to family and friends, routines, and family income/employment. Results A sample of 440 respondents with aphasia met eligibility criteria. 60% of respondents indicated that they felt nervous or stressed because of the coronavirus some of the time, and 18.5% most or all of the time. 80% of respondents indicated that the coronavirus pandemic had changed their access to healthcare. 47.6% of respondents indicated that they had missed or canceled a medical appointments because they were worried about getting the coronavirus. Of the 272 participants who were actively receiving some form of speech and language therapy, 70.5% indicated that they had an individual appointment with a speech language pathologist via telerehabilitation since the coronavirus pandemic began. The majority of respondents indicated that the telerehabilitation appointment was the same or better than traditional in-person speech and language therapy. Conclusions Respondents who perceived that they were at high risk of Covid-19 infection and death were more likely to accept telerehabilitation services than patients who perceived themselves at low risk. Utilization of telerehabilitation services varied by household access to high speed internet and familiarity with information technology resources. Author(s) Disclosures Supported by Grant #DC017174-02S1 Authors have no conflicts.

Quality Measure Concepts for Inpatient Rehabilitation That Are Best Understood From the Patient's Perspective.

PURPOSE: The aim of this study was to identify inpatient rehabilitation quality-of-care concepts that are best understood from the patient perspective. DESIGN: We conducted 12 focus groups with 95 former patients, caregivers, and rehabilitation clinicians and asked them to describe high-quality inpatient rehabilitation care. METHODS: We independently reviewed the focus group transcripts and then used an iterative process to identify the quality measure concepts identified by participants. RESULTS: Based on participants' comments, we identified 18 quality measure concepts: respect and dignity, clinician communication with patient, clinician communication with family, organizational culture, clinician engagement with patient, clinician engagement with family, rehabilitation goals, staff expertise, responsiveness, patient safety, physical environment, care coordination, discharge planning, patient and family education, peer support, symptom management (pain, anxiety, fatigue, sadness), sleep, and functioning. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING: Rehabilitation nurses should be aware of the quality-of-care issues that are important to patients and their caregivers. CONCLUSION: Important patient-reported domains of quality of care include interpersonal relationships, patient and family engagement, care planning and delivery, access to support, and quality of life.

The Effectiveness of Behavioral Interventions in Adults with Post-Traumatic Stress Disorder during Clinical Rehabilitation: A Rapid Review.

BACKGROUND: This review examined the effectiveness of behavioral interventions for adults with post-traumatic stress disorder (PTSD) triggered by physical injury or medical trauma. It discusses implications in support of rehabilitation management for COVID-19 survivors diagnosed with PTSD. METHODS: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Interim Guidance from the Cochrane Rapid Reviews Methods Group. The authors searched for randomized control trials in PubMed, Embase, and CENTRAL databases up to 31 March 2021. RESULTS: Five studies (n = 459) met the inclusion criteria. Each study measured a different comparison of interventions. The certainty of the evidence was judged to be very low for all outcomes. Post-traumatic stress disorder symptom reduction was found to be in favor of trauma-focused cognitive-behavioral therapy, cognitive therapy, and cognitive-behavioral therapy. Cognitive function improvements were observed in favor of the cognitive processing therapy control intervention. CONCLUSIONS: Overall, there is uncertainty about whether behavioral interventions are effective in reducing PTSD symptoms and improving functioning and quality of life when the disorder is triggered by a physical or medical trauma rather than a psychological trauma. Further research should investigate their efficacy in the context of rehabilitation management and gather evidence on this population.

The Effectiveness of Behavioral Interventions in Adults with Post-Traumatic Stress Disorder during Clinical Rehabilitation: A Rapid Review

Background: This review examined the effectiveness of behavioral interventions for adults with post-traumatic stress disorder (PTSD) triggered by physical injury or medical trauma. It discusses implications in support of rehabilitation management for COVID-19 survivors diagnosed with PTSD. Methods: This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Interim Guidance from the Cochrane Rapid Reviews Methods Group. The authors searched for randomized control trials in PubMed, Embase, and CENTRAL databases up to 31 March 2021. Results: Five studies (n = 459) met the inclusion criteria. Each study measured a different comparison of interventions. The certainty of the evidence was judged to be very low for all outcomes. Post-traumatic stress disorder symptom reduction was found to be in favor of trauma-focused cognitive-behavioral therapy, cognitive therapy, and cognitive-behavioral therapy. Cognitive function improvements were observed in favor of the cognitive processing therapy control intervention. Conclusions: Overall, there is uncertainty about whether behavioral interventions are effective in reducing PTSD symptoms and improving functioning and quality of life when the disorder is triggered by a physical or medical trauma rather than a psychological trauma. Further research should investigate their efficacy in the context of rehabilitation management and gather evidence on this population.

Impact of the COVID-19 Pandemic on Employment of People with Disabilities and Employers

This research aimed to describe how the COVID-19 pandemic affected the work status of people with disabilities (PWD) and employers involved in hiring and managing of PWD. Two cross-sectional surveys. PWD and employers involved in hiring and managing PWD, primarily in the Midwestern United States. Convenience sample of 733 PWD and 67 employers recruited through multiple sources. None. Employment consequences of the COVID-19 pandemic as experienced by PWD and employers. Among survey respondents with disabilities, 25% reported employment changes during the pandemic. Among participants reporting changes, 48% were not working, and 16% lost their jobs due to business reductions. For PWD who maintained employment, 67% reported that their work was moderately or greatly affected by the COVID-19 pandemic. PWD reported decreased pay or financial problems (42%) resulting from furloughs, leaves, or reduced work hours (40%), working remotely more than usual (41%), and experiencing a harder time getting their work done (23%). In contrast, nearly all employers (97%) reported being affected by the COVID-19 pandemic. Changes included switching to virtual operations (69%), temporarily closing a business (26%), furloughing employees (25%), and laying off employees (23%). Primary reasons for business changes included concerns about the spread of COVID-19, adherence to government policies, and difficulty providing services during the pandemic. The COVID-19 pandemic adversely affected employment of PWD as reported by workers and employers. Findings parallel the experience of the nondisabled workforce, but reveal vulnerabilities that reflect disability consequences and the need for job accommodations. Flexible work hours and opportunities to work remotely benefit PWD in particular. Policy implications reflect the benefits of flexible working hours and locations. The authors report no conflicts of interest.

Employment Consequences of COVID-19 for People with Disabilities and Employers.

Purpose The COVID-19 pandemic has disproportionately affected the lives of people with disabilities (PWD). How the pandemic affects the employment of PWD and employers has yet to be determined. We aimed to investigate the employment consequences of the pandemic as experienced by PWD and employers. The research questions were: (1) What employment effects do PWD experience, and what business changes do employers encounter as a result of the COVID-19 pandemic? (2) What challenges have PWD encountered during the pandemic? Methods Cross-sectional online surveys of 733 PWD and 67 employers in the Midwestern United States. Results Compared to non-disabled peers, PWD encountered more challenges in employment during the pandemic. We found high percentages of both employers and PWD experiencing employment changes and business shutdown during the pandemic. For PWD whose employment was not affected, 14.6% of the participants (n = 107) expected a loss of income and worried about the economic uncertainty of the pandemic. Unemployment for PWD is high due to illness or disability, being laid-off or furloughed, business reductions, and not feeling safe to work. However, only about 18.6% of unemployed PWD (n = 16) received pay or benefits for the time they were not working even though more than half filed for unemployment benefits. Conclusions The pandemic adversely affected employment of PWD as reported by workers and employers. Findings parallel the experience of the non-disabled workforce, but reveal vulnerabilities that reflect disability consequences and the need for job accommodations. Results reveal emergent needs for policy supports to reduce the disparities experienced by PWD in the workplace.

Lessons Learned by Rehabilitation Counselors and Physicians in Services to COVID-19 Long-Haulers: A Qualitative Study

Coronavirus disease (COVID-19) may cause long-lasting adverse consequences after acute recovery, including functional limitations and reduced work capacity. Individuals with long-lasting complications of COVID-19 are known as long-haulers. There is a knowledge gap on how COVID-19 complications affect return-to-work (RTW) efforts. We aimed to describe the challenges that long-haulers encounter when RTW from the perspectives of rehabilitation professionals. In this study, four certified rehabilitation counselors and four rehabilitation physicians in outpatient rehabilitation centers participated in focus groups. Participants discussed challenges in working with long-haulers, including personal attributes, post-COVID-19 symptoms and complications, uncertain recovery and unpredictable outcomes, limited health care accessibility and support, and unsupportive work environments. Participants provide individualized services to meet long-haulers? diverse needs as they do for all persons with disabilities, although they expressed uncertainty due to the variable disease course and risk of infection. Modifying workplace policies, especially gradual RTW, were frequently mentioned accommodations. The findings highlight the RTW issues of long-haulers. We provide recommendations on increasing awareness of the challenges and job accommodations of long-haulers.

Employment Consequences of COVID-19 on "Long-Haul" Survivors

Coronavirus (COVID-19) is an infectious disease that can cause long-lasting adverse consequences after recovery. COVID-19 can also result in functional limitations that affect daily activities and work capacity. Individuals with these lasting complications are known as long haulers. The demand for vocational services and post-acute rehabilitation is increasing and has become urgent. To address the need, we aimed to describe the challenges that individuals recovering from COVID-19 encounter when returning to work and the experiences of the healthcare professionals who assist them throughout that process. Qualitative research with focus groups. Outpatient and vocational rehabilitation (VR) clinics affiliated with a Midwest rehabilitation center. 4 VR counselors and 4 rehabilitation physicians who serve clients recovering from COVID-19. Not applicable. Not applicable. Uncertain COVID-19 recovery trajectory and unpredictable outcomes, various long-lasting symptoms, and disease complications were the three frequently mentioned challenges when returning to work. To support long haulers in regaining employment, VR counselors and physicians communicated with employers, helped clients adjust to COVID-19-related challenges, provided individualized VR support, and helped obtain or short- or long- term disability benefits. Physicians expressed uncertainty in working with patients with COVID-19 due to the unknown disease and its infectiousness. Counselors recommended various job accommodations including modifying workplace policies, flexible scheduling, changing workplace environment, and modifying job responsibilities. Both physicians and counselors recommend support groups and policy changes. Long haulers experience persisting physical, cognitive, and emotional consequences of COVID-19 infection requiring rehabilitation therapies and job accommodations. We provide recommendations to guide rehabilitation professionals in helping long haulers return to work. The authors have no conflict of interest to declare.