ABSTRACT
Introduction: The COVID-19 pandemic brought about an influx of patients admitted to critical care with higher length of stay and rates of complications. The subsequent health burden related to impaired recovery is substantial, compounded by the multi-system effects of both critical illness and COVID-19 symptoms (FICM, 2019;NHS, 2021). Emerging evidence demonstrates that the associated combination of long-term physical, cognitive, psychological, and social difficulties are highly debilitating for survivors, impacting on their day-to-day function, identity, quality of life as well as the well-being of their families and carers (NHS, 2021). With significant pressure pushed onto existing respiratory and critical care teams, this has led to the development of a temporary critical care follow-up clinic with multidisciplinary support to address increased needs holistically. Objectives: The aim of this project was to: 1. highlight the value of having physiotherapy (PT) and occupational therapy (OT) input in COVID-19 critical care follow-up clinic 2. identify post COVID-19 critical care symptoms and issues conducive to the need for physiotherapy and occupational therapy support 3. identify gaps in services and establish community links to improve therapy access, and overall patient care and satisfaction Methods: The COVID-19 critical care follow-up clinic ran between March 2021 and August 2021. It aimed to review patients approximately three months post-discharge. The inclusion criteria involved anyone admitted to intensive care unit (ICU) with COVID-19 at any of the Barts Health NHS Trust sites. Patients who have a very short stay on intensive care, those with no impairments on hospital discharge, and those who were palliated were excluded. The multidisciplinary team included a critical care consultant, specialist nurse, physiotherapist, occupational therapist, and psychologist. Clinics ran consisted of four one-hour appointment slots with pre and post meeting and administration time. Results: A total of 66 clinics were completed during this time frame. Of the patients seen in clinic (n=221), over 50% were still struggling with global weakness, reduced exercise tolerance, fatigue, pain and breathlessness. Discussion: Themain post COVID ITU symptoms were those that linked directly to therapies, specifically fatigue, weakness, reduced mobility, and cognitive issues. Therefore, having specialist knowledge of these issues and the services that can help them within the MDT was imperative to ensuring these patients got the best care possible. The percentage of clinics ran with just OT/PT and a consultant, the number of therapies referrals, and the specialist advice provided clearly highlights the need for more permanent therapy input in COVID ITU clinics. Having a nurse and psychologist for a fully rounded MDT would be ideal, but it shows that therapists are an invaluable addition and should be a permanent fixture to any post ICU MDT team. Conclusion: The COVID-19 pandemic has highlighted the importance of holistic multidisciplinary team support in critical illness recovery, particularly the value of the role of physiotherapy and occupational therapy in COVID-19 critical care follow-up clinic is demonstrated in this project. Various therapy interventions were appropriate to addressing on-going symptoms and issues identified in the clinic. This clinic also provided insight onto gaps in existing services, such as rehabilitation for post intensive care acquired weakness.