ABSTRACT
Background: The SARS-CoV-2 pandemic is a global crisis with massive effects on all areas of society, such as the labor market, social security systems, and healthcare. It represents a complex stress situation that hardly leaves anyone unscathed. As a result, a significant increase in mental stress and ill- ness has been observed since the beginning of the pandemic. The coronavirus pandemic almost paralyzed rehabilitation in the spring of 2020. When comparing the 1st quarter of 2019 with that of 2021 (cumulative), a decrease of –32.8% is recorded for 2021 in the applications for services for medical rehabilitation (total 2020 to 2019: –14.2%). For the rehabilitation centers, the central and vital question is under which conditions rehabilitation measures can be carried out safely and successfully even in times of a pandemic. This also includes the confi-dence of potential rehabilitation patients, referring physicians, and employees in the structural and procedural measures taken by the centers. Materials and methods: The study aims to shed light on the effects and coping attempts of the pandemic in medical rehabilitation from different perspectives and to provide indications for routine care in “COVID normal operation”. The focus is on a comparative analysis of the results of the routine survey in the period October 2019 to June 2020, interviews with the management level of the center as well as a cat-amnestic follow-up survey of rehabilitation patients who completed a psychosomatic rehabilitation measure in the center in the period January to September 2020. Results: The interviews at the management level and the analysis of the safety concept show that a crisis team was installed at a very early stage in the center and a safety concept was established, which met with a high level of acceptance among all participants and contributed to a feeling of safety. The comparison of the routine survey shows that, with the exception of individual cases, the rehabilitation measures were carried out and completed according to plan. In most areas, the ratings have even improved in the 1st half of 2020 compared to the 4th quarter of 2019. The results of the catamnestic survey confirm the results of the routine survey. The rehabilitation patients who were treat-ed at the Rehazentrum Bad Bocklet during the COVID pandemic showed pronounced psychosomatic and participation-related limitations in the period before or at admis-sion. Regarding concerns and fears about the COVID situation, almost half of all respondents stated strong or very strong fears about the effects of the COVID pandemic on personal or close persons. In the foreground are fears that a close person could become infected or die. The hospital’s safety measures in terms of hygiene and adapted struc-tures and processes were rated positively by around three quarters of respondents. This is also confirmed by the results of the outcome parameters examined. The personal therapy goals were achieved for about three quarters of the respondents. Positive chang-es were seen in terms of health, health com-plaints, anxiety and depression symptoms, global health and the development of the ability to work, among other things. The RTW rates are 71% (time point method) and 81% (cumulative time course). The benefit of the rehabilitation measure is rated as high by 73% of the respondents is the treatment satisfaction. Substantial influences of rehab motivation, admission periods, and percep-tion and evaluation of COVID measures at the center on key outcome parameters are shown. These results emphasize the role of appropriate safety and hygiene measures adapted to the current hazard situation in the context of rehabilitation measures. The results indicate that the hospital succeeded in implementing suitable measures right at the beginning of the pandemic, and in com-municating and living these measures ac-cordingly. In addition, they allow the conclu-sion that under suitable safety and hygiene conditions, rehabilitation measures can also be carried out safely in times of pandem c and still show stable effects in essential tar-get criteria of medical rehabilitation after one year.
ABSTRACT
Introduction: The SARS-CoV2 pandemic fundamentally changed our daily work. All rehabilitation clinics developed a comprehensive safety and hygiene concept at the beginning of 2020 to perform rehabilitation safely. In addition, we early started routine PCR screening of all patients. This comprehensive testing and safety strategy was accompanied by significant logistical and financial challenges. Methods: From April - September 2020 (first study period), PCR testing of all rehabilitation patients was performed on the day of arrival following pre-hospital screening for symptoms, contact history, information about testing, and the necessary 1-2 days of quarantine after arrival. From October 2020 - February 2021 (second study period) a rapid antigen test was performed in all patients on arrival and repeated 3-7 days later. In addition, routine screening of the clinic staff for SARS-CoV2 was performed. The testing strategy was accompanied by extensive hygiene measures covering all rehabilitation processes. Number and test results, age, indication, and period of stay were prospectively recorded and are reported here. Results: A total of 5051 patients underwent PCR testing during the first study period. Of these, 3204/5051 (63.4%) had an oncological and 1227/5051 (28.2%) had an orthopedic diagnosis. 367/5051 (7.3%) had a psychosomatic disease, and 252/5051 (4.9%) underwent an ophthalmological rehabilitation. 4/5051 patients (0.08%) were tested positive. 2/4 were tumour patients. In the 2nd study period from October 2020 to February 2021, 65/6885 (0.9%) of patients tested positive on a rapid antigen test kit. Of the tumour patients, 20/2574 (0.78%) were positive in the antigen test. Since the start of the employee testing in October, 25 employees with contact to patients have been tested positive. One clinic had to be closed for 1 week during this period by order of the local health department. Conclusions: As expected, the proportion of positively tested patients increased by a factor of 10 in the second study period from October 2020 - February 2021. Remarkably, the proportion of positively tested oncological patients who might be particularly vulnerable to infection did not differ from other (orthopedic/psychosomatic) patients. Our experience with >10 000 patients after more than 1 year of pandemic shows that with a comprehensive hygiene and testing concept, rehabilitation can be performed without increased risk of infection.