Similar symptoms at 3 months post discharge in ICU, COVID-19 ICU, and COVID-19 patients that received non-invasive ventilation in high dependency areas

Introduction: It is well documented that survivors of ICU admissions struggle to return to pre-admission level of function because of both physical and psychological burden. Current guidance therefore recommends a follow-up service to review patients 2-3 months post discharge from ICU [NICE 2009]. Prior to 2020 University Hospitals Bristol and Weston (UHBW) had no such service. With the increase in patient numbers seen during the COVID-19 pandemic, funding was received to provide a follow-up clinic to COVID-19 survivors. Spare clinic spaces were used for non COVID ICU patients. Objective(s): To review symptoms reported by patients in the following 3 groups, COVID-19 patients treated in ICU (COVID ICU), COVID-19 patients treated with continuous positive airway pressure ventilation in high dependency areas (COVID CPAP) and non COVID-19 ICU patients (ICU), at 2-3 months post discharge from UHBW. Method(s): Referred patients had an initial phone call at 8 weeks post discharge. The call identified both physical and psychological symptoms. Advice regarding recovery, signposting to resources and onwards referrals to appropriate specialities were provided. If symptoms indicated, patients would then be referred into the multidisciplinary team follow up clinic. Here they met with an intensivist, clinical psychologist, physiotherapist, occupational therapist, speech and language therapist and dietitian. Result(s): As Graph 1 shows all 3 patient groups had a wide variety of ongoing symptoms at 2-3 months post discharge. Fatigue was the most common symptom reported in all 3 groups. Breathlessness was the second most common symptom reported by COVID patients but was less frequently reported in the ICU population who had a variety of non-respiratory related reasons for admission. COVID ICU patients more commonly reported ongoing problems with their swallowing, voice and communication compared to the COVID CPAP group, most probably due to invasive ventilation. Psychological burden post critical illness was high in all 3 groups. More than 20% of all patients scored =10 on a PHQ-9 depression scale showing moderate to severe depression. More than 15% of all patients scored =10 on a GAD-7 showing moderately severe to severe anxiety. COVID ICU group had the highest incidence of post-traumatic stress disorder (PTSD). This may be linked to the higher level of delirium we saw in this group, as a result of change in practice, such as full PPE and absence of visiting during the pandemic. ICU patients presented with a significantly higher percentage of physiotherapy needs. This is likely because patients with the longest and most complex ICU admissions were selected for the clinic. Sleep likely goes under reported in these results as we only began questioning specifically about this later on in the clinic. Conclusion(s): This data goes some way in supporting current literature that the rehabilitation needs of COVID ICU patients equal that of ICU patients (Puthucheary et al 2021). It also shows the need to follow up patients who receive advanced respiratory support outside of the ICU environment, as their symptoms, and therefore rehabilitation needs are very similar to ICU patients at 2-3 months post discharge.

ICU follow-up clinic provides the opportunity to recognise and address symptoms post critical illness, which may otherwise have been missed

Introduction: It is well documented that survivors of ICU admissions struggle to return to pre-admission level of function because of both physical and psychological burden. Current guidance therefore recommends a follow-up service to review patients 2-3 months post discharge [NICE 2009]. Prior to 2020 University Hospitals Bristol and Weston had no such service. With the increase in patient numbers seen during the COVID-19 pandemic, funding was received to provide a follow-up clinic to COVID-19 survivors. Objective(s): To provide a service that supports and empowers patients with their recovery from critical illness. Improving quality of life, speed of recovery and reducing longer term health care needs. Method(s): Referral criteria for the clinic included COVID-19 patients who received advanced respiratory support within intensive care and the high dependence unit. 8 weeks post discharge patients had a telephone appointment where ongoing symptoms could be identified. Advice around recovery, signposting to resources and onward referrals to appropriate specialities were provided. At 10 weeks post discharge patients had lung function tests and a chest X-ray which were reviewed by respiratory consultants. Based on the combination of these assessments, patients would be discharged or referred into the multidisciplinary team (MDT) follow-up clinic. The face to face clinic consisted of appointments with an intensivist, clinical psychologist, physiotherapist, and occupational therapist. Where needed patients would also be seen by a speech and language therapist or dietitian. Patients were seen only once in follow up clinic but again would be referred onto appropriate services within trust or the community, including but not exclusively community therapy services, secondary care services, SALT, dietetic or psychology clinics. Result(s): One of the key outcomes was the need for 147 onward referrals (an average of 1.13 referrals per patient). This included, 31 referrals to musculoskeletal physiotherapy outpatients for problems originating or made worse by their admission. 20 referrals to secondary care, including cardiology and ENT. 16 referrals to community occupational therapy, for provision of equipment, home adaptations and support in accessing the community. Subjectively, patient feedback was excellent. When asked what they felt was the most valuable thing they had taken from the clinic they reported: "Reassurance";"To know I'm not alone, others feel like this";"They listened to me and gave advice";"The ability to ask anything I wanted and the obvious kindness and support from all the clinicians I saw". Conclusion(s): Onward referral rates made by the follow-up clinic highlight the many issues faced by patients following discharge from ICU and hospital. With timely recognition and management, we can prevent a majority of these symptoms manifesting into chronic problems. This has the potential to lower the long-term burden on health care and improve quality of life for patients in both the short and long term. Without the follow-up clinic, these issues may have been missed or delayed. This reinforces the importance of the follow-up clinic and the need for ongoing investment.

Online Mdt Patient Education for Early Inflammatory Arthritis

Background/Aims Patient education in early inflammatory arthritis (EIA) promotes understanding and engagement with treatment, empowering patients to use self-management in their long-term health condition. It is embedded in national guidance and audit. Individual appointments are time consuming, and groups sessions became impossible during the COVID-19 pandemic. Our education sessions have evolved to a monthly online meeting which aims to be engaging, effective and time efficient. Methods Face-to-face group education afternoons were previously embedded into our early arthritis pathway. Presentations and opportunities for questions were given by a rheumatology consultant, nurse, physiotherapist, podiatrist and occupational therapist. Sessions lasted 2 hours and local charity representatives attended. Group education sessions completely stopped with the COVID-19 pandemic restrictions. This successful MDT model was moved to a monthly Microsoft Teams meeting and condensed to 1 hour. Sessions continue to consist of five short presentations, introduction to charity representatives and opportunity for questions. Following the session, all patients received links to videos of the talks for future reference, contact details for the MDT and local charities, and a link to download our local rheumatology self management app. Patients who are unable to attend also receive this content by email. Patient feedback was gathered through an online questionnaire. Results Attendance has increased over time with 75% of our new EIA patients now attending each month. Feedback from 16 patients rated 75% of all talks as extremely useful or useful. 89% are interested in attending future meetings. 93% had already used or plan to use our rheumatology self management app. Positive patient feedback included: ''the whole team were brilliant giving advice and answering questions'', ''nice to see the specialists' faces, and to get the feeling they really cared'', and ''a perfectly sensible and productive way to introduce all the options for help and support''. Some patients did not feel confident to ask questions in the meeting. Email and telephone advice lines were signposted. Attendance was increased by 40% by a short telephone reminder of the appointment. Conclusion An online meeting has proven to be a time efficient and effective way of providing multidisciplinary education and introducing self management. A short time investment from each MDT member gives breadth to the education. Inviting all newly diagnosed early arthritis patients and encouraging attendance by a short telephone call has maximised reach. Ensuring all patients are sent presentation videos to re-watch and the self referral details further facilitates self management. The format could easily be adapted to other patient education events.

Experiences of the Occupational Therapists During the COVID-19 Pandemic: A Scoping Review.

Occupational therapy has been impacted by the worldwide COVID-19 pandemic and has transitioned from a traditional face-to-face therapy method to an online one. In the wake of the pandemic, occupational therapist faced the challenge of providing online services to people with disabilities. The review aimed to identify and synthesize the best available evidence on the experience of occupational therapists in psychiatric rehabilitation settings during the COVID-19 pandemic. Additionally, the challenges posed by changes in the mode of training were examined. Electronic database search included PubMed, PsycINFO, PsycNET, Cochrane Library, Ovid, MEDLINE, CINAHL, SAGE Journals, Elsevier Science Direct, Springer, Wiley Online Library, JAMA Psychiatry, and Society E-Journals. Inclusion criteria were studies describing the experience of the occupational therapists during the COVID-19 pandemic in psychiatric rehabilitation settings. A systematic search identified 8 studies included quantitative, qualitative and mixed methodology conducted between 2020 and 2022. The findings from the reviewed articles revealed that the complexities and challenges faced by occupational therapists during the COVID-19 pandemic were professional, personal, and organizational; innovative practices were implemented in the psychiatric settings. The review findings expressed both positive (accepting a new mode of training, time saving) and negative experiences (problems with interaction & internet) perceived by the rehabilitation professionals. Enhancing the training of occupational therapists will help in easing the access and know-how of using telerehabilitation services for patients and coping with COVID-19-like situations in the future.

Telehealth development of virtual environmental home visits to facilitate stroke patients discharges from Hospital

Introduction: The Covid-19 pandemic has progressed the use of digital technology in the NHS to enable remote working and reduce the risk of infection transmission in NHS settings (Hutchings 2020) Telehealth is the use of electronic information and telecommunications technologies to enable and support clinical health care, patient and professionals to provide care virtually (Clipper 2020). A research study published by BJOT (2020) identified that remote home visits were feasible depending on visitor abilities, training and visit standardisation (BJOT 2020). Environmental Home visits (EHV) are fundamental to the discharge process to enable identification of appropriate equipment for the safe and timely discharge of stroke survivors. According to the National Clinical Guidelines for Stroke, stroke survivors should be offered assessment and provision of equipment and adaptations (National Clinical Guidelines for Stroke, 2016). In response to the Covid-19 pandemic to ensure safe discharge and reduced direct face-to-face contact virtual environmental home visits (VEHV) on a stroke ward was developed. Method(s): Microsoft Teams was the technology platform used to facilitate VEHV. Visits were arranged with families and caregivers who had access to the technology and were able to understand the technology. Therapists directed the patient's home environment and asked the individuals completing the VEHV for appropriate dimensions and measurements and an environmental home visit document was completed. Result(s): VEHV were completed by both qualified occupational therapists and therapy assistants were then trained to be able to implement VEHV. The use of Microsoft Teams was found to be a suitable technology platform with families and care givers who were technology competent. However where patients families and care givers did not have access to the appropriate technology or were not sufficiently computer literate VEHV's were not appropriate. Conclusion(s): The VEHV were found to be time efficient, improved patient flow, enabled a number of VEHV to be completed in a day and reduced direct face-to-face contact during Covid-19 while still maintaining communication with patient families and care givers.

An early return-to-work program for COVID-19 close contacts in healthcare during the Omicron wave in Japan

During the coronavirus disease 2019 (COVID-19) pandemic, maintaining adequate staffing in healthcare facilities is important to provide a safe work environment for healthcare workers (HCWs). Japan's early return-to-work (RTW) program may be a rational strategy at a time when there is an increased demand for the services of HCWs. We assessed whether the early RTW program for HCWs who have been in close contact with a COVID-19 case in our hospital was justified. Close contacts were identified according to the guidance document of the World Health Organization. HCWs who met all of the following conditions were eligible to apply to an early RTW program: (1) difficult to replace with another HCW, (2) received the third dose of a COVID-19 mRNA vaccine, (3) a negative COVID-19 antigen test before each work shift, and (4) consent from relevant HCWs and their managers to participate in the program. Between January and March 2022, 256 HCWs were identified as close contacts (median age, 35 years;192 female). Thirty-seven (14%) secondary attack cases of COVID-19 were detected. Among 141 HCWs (55%) who applied to the early RTW program, nurses and physicians comprised about three-quarters of participants, with a higher participation rate by physicians (78%) than nurses (59%). Eighteen HCWs tested positive for COVID-19 by the sixth day after starting the early RTW program. No COVID-19 infection clusters were reported during the observation period. These findings suggest that the early RTW program for COVID-19 close contacts was a reasonable strategy for HCWs during the Omicron wave. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

Early Career Occupational Therapists' Experiences during the COVID-19 Pandemic.

Occupational therapists entering the clinical workforce during the COVID-19 pandemic experienced levels of uncertainty and stress. This study's aim was to explore the clinical experiences and concerns of early-career occupational therapists entering the workforce during the COVID-19 pandemic (n = 27). We administered an open-ended online survey and analyzed the data using inductive thematic analysis. Resulting themes included: safety, exposure, and transmission; implementation and enforcement of safety protocols; quality of care; and impact of the pandemic on overall health highlighting the issues that need to be addressed to be more prepared for future practice in an evolving environment.

Setting up a Post Covid-19 Syndrome Service for Children and Young People across London - a Collaboration across Three Trusts

Aims Describe an interdisciplinary hub and spoke healthcare model for children and young people (CYP) with Post COVID-19 Syndrome Methods From November 2020, with NHS London and NHS England support, clinicians and AHP chief with backgrounds in infectious disease, adolescent medicine and psychiatry from across trusts in London collaborated to set up a hub and spoke model for delivering care to CYP with post COVID-19 syndrome. This was an iterative process with involvement of patient cohort. CYP are referred into a central weekly virtual multi-disciplinary 'hub' meeting for discussion with specialists across infectious disease;respiratory;rheumatology;neurology;chronic conditions (including ME/CFS );mental health;and allied health practitioners (AHP) with experience of rehabilitation including occupational therapists, and physiotherapists, dieticians, safeguarding practitioners. The groups has a diversity lead.The group has regular evidence-based CPD. Referrers (local paediatricians or GPs for 17-18 year olds) present patient to the MDT for discussion of diagnosis, investigation and management. Website-housed referral pathways including recommended baseline assessments are provided for referrers. A developing group of local integrated care service paediatric and AHP champions support local management, pathways and education around post COVID-19 syndrome. Patients follow one of two pathways: 1. Local management, using already available services which the MDT support 2. Face-to-face interdisciplinary consultation and rehabilitation for severe or complex cases. Local support MDT discussion, and advice to local team with letters to patients outlining impression and advice;school adjustments letters;leaflets for health professionals and CYP/ family across a range of known Post COVID symptoms and difficulties. AHP delivered virtual groups and webinars include pacing;emotional wellbeing;symptom management;eating, and sleep. As the first established post- COVID-19 service for CYP in England, we have led and supported the development of 14 other MDTs nationally. Results Between 1st April 2021 and 1st February 2022 89 patients were referred to the virtual MDT. All have received information leaflets to aid recovery. 25 CYP/families have attended the virtual groups so far. 57 CYP have received an interdisciplinary consultation and received bespoke MDT input. (see table 1) Conclusion In response to the clinical need of CYP with post COVID symptoms, the collaborative development of a Pan London service across 2 clinical sites, and 3 NHS trusts is an example of how specialist clinical care can be delivered virtually using a hub and spoke model for a proportion of patients with a complex disorder. The service development element is applicable to other future emerging diseases as well as a possible model for conditions that require multiple specialist inputs and can have confused pathways or delays in diagnosis (such as functional disorders or multi-organ pathology).

The Role of Physiotherapy and Occupational Therapy in Post COVID-19 Critical Care Follow-Up Clinic Follow up clinic

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.

EMPOWER: A pilot project of outpatient rehabilitation classes to address the symptoms of Post Intensive Care Syndrome (PICS)

Introduction: The EMPOWER (Early Mobilisation PrOject With Extended Rehabilitation) classes at University Hospital Southampton (UHS) originated in direct response to patient voice. During an interview study exploring patient and family experience of rehabilitation on ICU,1 the wife of an ICU patient stated: There was no point in spending all of that money on keeping him alive if you're not gonna get him better. He's alive, but he's not functioning Objective: To explore if post ICU outpatient rehabilitation classes can be effective in addressing symptoms of PICS, for patients previously admitted to critical care at UHS. Methods: Funding was obtained to trial a pilot project of 8 classes over 8 weeks, starting in September 2019. Due to time constraints, original inclusion criteria were abolished and instead a convenience sample of 8 patients were selected, along with a relative if desired. Design was a 3-hour class, once a week, in a small gym venue within an acute hospital setting. Patient transport costs were covered, as had previously been highlighted as an incentive to participation in other studies.2 During the first hour of the class, former ICU patients completed an exercise circuit, while their relatives attended a separate peer support session, facilitated by experienced ICU volunteers. The second hour was an education session, provided by an ICU healthcare professional (e.g., dietitian, occupational therapist). The final hour was for peer support and goal setting. One participant withdrew from the pilot following the first week and was signposted elsewhere. The demographic details for the remaining 7 participants represent are included in Table 1. In addition, four female relatives also participated and evaluated the pilot. Results: Outcome measures reflected the physical, cognitive and psychological domains of PICS. These were collected from assessments at week 1 and week 8, and the mean results are presented in Table 2. In addition, qualitative data was collected before and after the 8-week course. Examples of quotes from participants at the start of the pilot include: I have reduced my working hours to spend more time at home with her I feel dreadful. I'm not getting better. I lose words midsentence, and have memory problems Feedback following the pilot was very positive. One participant reported: It's been a safe space for me, as a 'carer', to express my fears and concerns and to get help, advice and support from people who really understand the issues of post-ICU recovery. Our GP practice really doesn't seem to provide any after-care/ follow up care for this. Conclusion: In this small pilot project of post ICU outpatient rehabilitation classes, all outcome measures improved despite participant heterogeneity. Patient/ relative satisfaction for the classes was high. Wehave since managed to secure £30k through the Q Exchange to continue the work of EMPOWER following the COVID-19 pandemic.

The effect of energy conservation strategies on fatigue, function, and quality of life in adults with motor neuron disease: Randomized controlled trial

Background: Fatigue is one of the most frequent complaints in patients with motor neuron diseases (MNDs), with a significant impact on the quality of life (QOL). There is lack of enough evidence for current pharmacological or non-pharmacological treatments of fatigue in this population to be applied in clinical setting. Energy conservation strategies are one of the key interventions for fatigue management in chronic diseases. We aimed to investigate the effect of applying these techniques in the fatigue management of patients with MND. Methods: This randomized controlled trial (RCT) study was carried out on 28 patients with MND. Participants were randomly assigned to either the intervention or control group. In addition to routine treatment, patients in the intervention group participated in 3 weekly 1-hour energy conservation programs provided by an experienced occupational therapist. The Fatigue Severity Scale (FSS) score, 36-Item Short Form Survey (SF-36), and Canadian Occupational Performance Measure (COPM) were measured at baseline, immediately after the last intervention session, and one month later. Results: FSS and COPM significantly changed after the course in the intervention group (P < 0.001 and P = 0.001, respectively). Both FSS and COPM improved significantly toward the final assessment only in the intervention group. The SF-36 changes were not significant in each of the groups. Conclusion: According to the findings of the present study, using energy conservation strategies could lead to better mid-term fatigue management and occupational performance improvement, but it did not improve QOL in patients with MND.

LIVING WELL WITH AN ADVANCED LUNG CONDITION

Background Whilst our established support for people living with breathlessness was long-standing, it was not multidisciplinary or fully evidence-based. We wanted to address this for the benefit of patients and the wider health system. The Cambridge Breathlessness Intervention Service (CBIS) model is an evidence-based approach to support people living with advanced lung conditions to manage their breathlessness (Higginson, Bausewein, Reilly, et al., 2014). Consultation with service users suggested that patients wanted support to: manage breathlessness, improve mental wellbeing, mobility and symptom management as well as help with planning ahead and reducing isolation. Aims To implement and evaluate a breathlessness intervention using a multidisciplinary skill mix and trained community volunteers. Methods Using the CBIS model as a framework, we reshaped, redeployed and trained our team to deliver this intervention at home. We supplemented this with a layer of social support provided by experienced compassionate neighbour volunteers. We evaluated the impact of the intervention through: before and after breathlessness self-rating scales, interviews with patients and case studies documenting the use of different parts of the service (e.g. physiotherapist, nurse, occupational therapist, rehabilitation assistant, complementary therapy). Results This project has been delivered during the COVID-19 pandemic, so there were practical issues around seeing patients face-to-face, and we were unable to support as many as expected. To date, 28 patients have been referred to the service. Of these, 18 received input. We will report on changes in self-rating scores and feedback from interviews with patients and families. To date, only a few participants opted to have a compassionate neighbour. Conclusions Initial findings suggest that although delivery of this project was hampered by the pandemic, patients valued the service and benefitted from practical input from the MDT. Limitations on being able to provide face-to-face support may have influenced uptake of compassionate neighbours and reduced the number of patients seen.

Investigation of Adverse Events Occurring during Rehabilitation in Acute Care Hospital.

Adverse events (AEs) during intensive care unit (ICU) rehabilitation and serious AEs during acute care hospital stays have been reported previously. However, no AEs have been reported for all patients needing rehabilitation in a non-ICU setting at an acute care hospital. This study aimed to investigate all AEs during acute-phase rehabilitation. Reports of AEs occurring during acute-phase rehabilitation in a university hospital from 1 April 2021 to 31 March 2022 were retrospectively analyzed. Minor and severe AEs were defined as those that did not require new treatment and those that required intensive treatment and/or prolonged hospitalization, respectively. There were 113 incidences of AEs during rehabilitation. The majority of AEs were minor (93.8%) and did not require new treatment. Only one serious AE was documented. The most common AEs were peripheral intravenous tube removal, decreased level of consciousness, poor mood due to low blood pressure, and falling down. There was no significant correlation between years of experience and the frequency of AEs. The neurosurgery department had the highest cases of AEs. Physical, occupational, and speech-language-hearing therapists had different characteristics and experiences of AEs. Risk management strategies should consider exercise load and targeted disorders due to differences in therapists' specialties.

FOOD COMMUNITIES

Background: In recent years the focus on healthy food and lifestyle has become a more important part of everyday life for many-with or without RMD. Many NGO-initiatives engaging citizens cooking and eating together has seen the light of day;people meet to talk, laugh and have a good time while making a healthy meal. The kitchen is an often discussed topic among the volunteers and members of The Danish Rheumatism Association. 'Simple' tasks as opening a can of beans or cutting bread can be complicated for people with RMDs. The fundamentals of cooking are different for this group of people;hence the idea of communities around 'arthritis friendly' food unfolded during fall 2019. Objectives: The main objective is to create 'food communities' for people with RMDs, helping them to get a better understanding of how to make 'arthritis friendly food', dispel the myth that it is expensive and hard, and to give them inspiration to better working positions with assistive devices-resulting in a healthier lifestyle which is important to keep the infammation low and the quality of life high. Methods: To obtain these objectives, a dietitian is facilitating 6 three hour 'courses' guiding the participants through healthy cooking-each course with a different theme/subject which is introduced through a short presentation. Two volunteers are responsible for booking kitchen facilities (often school kitchens which is free of charge), coordination with the dietitian and making sure everything runs smoothly and that the atmosphere is top-notch. An occupational therapist is joining the group one time to ensure optimal working positions and introducing and demonstrating assistive devices. One of our main goals is to create sustainable and longer lasting (more than 6 facilitated courses) communities, which is why an important part of the volunteer's responsibility is to initiate a talk about the opportunity of meeting without a dietitian. The 6 facilitated courses aim to give the group the ability to fnd recipes (provided by DRA) and being comfortable cooking with ingredients that the average Dane might not use very often. Furthermore, our assumption is that the group creates social bonds and therefore an interest in keeping these relations. Results: About twenty groups all around Denmark has been a part of the course so far. The feedback from the participants is extremely good-they feel they are learning in an inspiring environment while having a great time with their new acquaintances. Unfortunately, only one of the groups has become a community that exists after the facilitated courses. One of the reasons is, without a doubt, that most of the groups have been affected by different Covid-19 restrictions which has had an impact on the level of social bonding and feeling of ownership. But most participants feel that the dietitian is crucial for further engagement. Conclusion: The concept has been very successful in terms of creating a course that imparts useful knowledge about 'arthritis friendly' food and lifestyle for people with RMD's. It seems we need to make corrections to create the basis for sustainable communities;small changes that helps the group visualizing how to overcome the challenge of the absence of a dietitian, the logistics of grocery shopping for a group etc. We plan to leave out the dietitian from the ffth of the six courses to prepare the group to establish their own 'food community' with lots of healthy food, learning experiences and high spirit.

CORRELATES of CANCELLED HEALTHCARE APPOINTMENTS in PATIENTS with SYSTEMIC SCLEROSIS during the COVID-19 PANDEMIC

Background: Rheumatologists have noted challenges in treating patients with systemic sclerosis (SSc) during the COVID-19 pandemic, such as patients on immunosuppressants and those with preexisting pulmonary issues.1 Also of potential concern was patients delaying treatment due to fears of COVID. Objectives: This study examined to what extent patients with SSc cancelled health-care appointments due to fears of COVID, how this correlated with their mental and physical functioning, and their levels of anxiety and depression. Methods: Participants were 60 people with SSc who had not had COVID-19 or been vaccinated for COVID. Participants had a mean age of 58 years (SD=11.5) and were primarily female (92%) and white (87%). Participants completed an online survey after learning about it from a sclero-derma organization newsletter or at their visit with a rheumatologist specializing in scleroderma in New York State, USA. Data were collected August 2020 through March 2021. Participants completed measures assessing health-related appointments attendance, Patient Reported Outcome Measurement Information System (PROMIS) measures (anxiety, depression, fatigue, sleep disturbance, pain intensity, physical function), coping strategies to deal with the pandemic, and reported functioning relevant to SSc (hand, gastrointestinal, dyspnea, and Raynaud's disease). Results: Due to COVID-19 concerns, 28 respondents (47%) cancelled one or more appointments with their primary care physician, specialist, physical or occupational therapist, pulmonologist, or dentist. Compared to those who did not cancel appointments due to COVID concerns, participants who cancelled reported higher anxiety, t(58) = 2.46, p =.02, higher sleep disturbance, t(56) = 3.31, p =.002, worse physical functioning, t(56) = 2.00, p =.05, more constipation, t(55) = 2.05, p =.045, and lower positive reframing as a coping strategy, t(56) = 2.08, p =.04. Many participants reported moderate or severe anxiety (36%), depression (22%), fatigue (32%), sleep disturbance (28%), and physical dysfunction (40%). As shown in Table 1, anxiety scores were positively correlated with scores on measures of fatigue, sleep disturbance, physical dysfunction, diarrhea, and the coping strategies of substance use, self-distraction, emotional support, behavioral disengagement, and venting. Depression scores were positively correlated with scores on measures of fatigue, sleep disturbance, physical dysfunction, pain intensity, dyspnea, diarrhea, and behavioral disengagement as a coping strategy. Conclusion: Almost half of participants cancelled one or more health appointments due to COVID fears. This subgroup reported significantly higher anxiety, sleep disturbance, constipation, worse physical functioning, and less coping with the pandemic by looking for the positive. Anxiety and/or depression also played a role in 42% of SSc patients and were related to a variety of worse mental and physical health correlates. Future research should examine the extent to which changes in health-related care during the pandemic have implications for disease progression in patients with SSc.

Remote disability and leprosy services via basic communications technology

This short report describes the rationale for and process of developing and refining a manual to assist professionals, workers, families, volunteers, and people with disabilities in low-and middle-income countries (LMIC), to make better use of appropriate and accessible communications technology. The manual is intended as a basic step towards enhancing disability and leprosy services where they are not accessible and/or affordable to people in remote areas of LMIC. A semi-formal process comprising several layers of feedback and review, and sub-sequent preliminary evaluation was encouraging. It suggests that the pilot version warrants further implementation as well as more formal research to rigorously evaluate the effectiveness and to refine the content of the manual.

Promoting telehealth knowledge, attitudes, and practice by an interprofessional online course

Introduction: The needs and challenges of community-based child development units transitioning to telehealth, starting with the COVID-19 outbreak and later on, led to a collaboration among a governmental, philanthropy, and a non-profit professional organization to develop a practical inter-professional online course. The course aims were to enhance knowledge, attitudes, and willingness to engage in pediatric telehealth and form a professional supporting network. Participants and Methods: 96 pediatric professionals, including occupational therapists (33%), physical therapists (16%), speech and language pathologists (25%), social workers (17%), and developmental psychologists (9%), responded to a survey before and after participation in a 30-hour online training. The training included best practices in telehealth delivered via lectures followed by online discussions to foster sharing of ideas, networking, and empowering participants to translate actions in practice. Results: Significant increases (p <0.01) were found in participants' knowledge of best practices, planning and managing care, working with diverse populations, technology, and guidelines. Participants reported a significant increase in positive attitudes and emotions towards telehealth. Most participants (72%) reported that they plan to use telehealth in their routine practice;27% reported maybe. Feedback on the learning experience was positive, and most learners wrote the course advanced their skills and exceeded their expectations. Conclusion: Training can. Online learning tailored to the learners' needs can promote knowledge, attitudes, and willingness to incorporate telehealth in routine care and foster networks that empower participants to gain and implement practical skills to improve the quality of care.

USE OF NEW MOBILITY SCORE AND A TRANS-DISCIPLINARY APPROACH TO REDUCE HOSPITAL LOS, RETURN TO ORIGINAL RESIDENCE, AND MORTALITY

Introduction: The National Hip Fracture Database indicated Guy's and St Thomas' Trust ranked in the fourth quartile nationally with reference to hospital length of stay (LOS), ∗Note 1 and 2 co lead authors return to original residence (ROR), and mortality in hip fracture patients in 2018. This quality improvement project aimed to improve and maintain these key factors via a twostage process. Methods: Stage one involved implementation of four key interventions through a transdisciplinary focus group, comprising ortho-geriatricians, orthopaedic surgeons, physiotherapists (PT), occupational therapists (OT), nursing staff, and a transfer of care navigator (TCN). Firstly, the New Mobility Score (NMS) was employed as a tool to guide estimated length of stay. Secondly, use of preoperative OT assessment allowed early evaluation of patient expectations concerning discharge planning. Third, facilitation of the discharge process was optimised by the recruitment of a TCN. Lastly, attendance of a senior orthogeriatrician during the daily board round was established. Stage two involved education of new members of the trans-disciplinary team to ensure that the key interventions listed above were maintained on hip fracture patients. Results: Following stage one, average acute hospital LOS and overall LOS decreased from 20.1 to 15.1 days and 22.4 to 18.3 days, respectively. Rate of ROR within 120 days of discharge improved from 72.4% to 86.9%, while mortality rates fell from 7.1 to 3.4. Following stage two, overall LOS improved to 17.1 days, while acute LOS and mortality were maintained at 15.6 and 3.9 days, respectively. While ROR fell to 82.8%, this remained higher than the national average at 69.9%. Conclusions: Utilisation of NMS and multi-disciplinary input effectively improved ROR, while reducing length of hospital stay and mortality rates in hip fracture patients. Education of new members of the trans-disciplinary team allowed sustained improvement despite challenges faced during the COVID-19 pandemic.

Death and Other Losses in the COVID-19 Pandemic in Long-Term Care Facilities for Older Adults in the Perception of Occupational Therapists: A Qualitative Study.

Long-term care facilities for older adults (LTCFs) were directly affected by the COVID-19 pandemic. This study aimed to discuss the perceptions of occupational therapists about deaths and other losses in LTCFs during the pandemic. This qualitative study is anchored in social phenomenology, and conducted in-depth interviews with eight occupational therapists who worked in LTCFs. Thus, two themes were generated after the Thematic Analyses: "The proximity of death" and "Losses associated with living and dying in a LTCF." In the first theme, the interviewees addressed the feeling of imminent death in the daily life of the LTCF, and feelings related to their own death, that of their family members and other older adults. In the second, the professionals highlighted three groups of losses: social, functional, and psychological/cognitive. These results highlighted the challenges faced by occupational therapists and can contribute to improve behavior and care for institutionalized older adults during the pandemic.