Occupational Therapy-Based Energy Management Education in People with Post-COVID-19 Condition-Related Fatigue: Results from a Focus Group Discussion.

Persons with post-COVID-19 conditions have prolonged symptoms and longer-term consequences which can prevent them from returning to previous everyday functioning. Fatigue is the most frequent symptom reported in literature. Occupational therapists (OTs) are specialized in client-centered problem analysis, counseling, and education to recover occupational engagement and performance in everyday life. Since the beginning of the COVID-19 pandemic, OTs have been challenged to respond with services adequate to the needs of this patient group. Energy management education (EME) was initially developed for persons with multiple sclerosis-related fatigue and then made independent of diagnosis suitable to persons living with chronic disease-related fatigue. EME, a structured self-management education, is becoming a part of the new services. This study was aimed at exploring the initial experiences of OTs using the EME protocol and materials with persons with postacute COVID-19 and/or post-COVID-19 condition-related fatigue and gathering their recommendations for improvements and adaptions. One online focus group discussion took place in May 2021 with OTs experienced in using the EME protocol. The topics addressed were the institutional context of the OTs and their experiences during the treatment. A thematic analysis was performed. According to nine OTs working in different settings in Switzerland, the EME protocol is exploitable in both in- and outpatient settings and was judged appropriate by them, even if the EME materials can be improved. The main challenges for the OTs were the short period their patients had lived with fatigue; the discrepancy between self-concept, self-perception, and performance; and the insecurity, fear, and anxiety related to recovery. Further research is needed to include the perspective of EME participants and to measure quantitative outcomes such as fatigue impact, self-efficacy, occupational performance, and quality of life. Until the existing EME protocol is improved, it is applicable to persons with post-COVID-19 condition-related fatigue.

[Late neurological consequences of a SARS-CoV-2 infection]. / Neurologische Spätfolgen einer SARS-CoV-2-Infektion.

BACKGROUND: Persistent neurological late symptoms of SARS-CoV-2 infection are common and require regular follow-up treatment. In order to establish uniform therapy concepts, it is necessary to evaluate individual therapeutic approaches for long COVID and post-COVID-19 syndrome. ANAMNESE: A 62-year-old patient was admitted to our rehab clinic for follow-up treatment after severe SARS-CoV-2 infection with neurological symptoms. The initially extensive laboratory and imaging investigation did not reveal any organic cause for the sometimes apoplectiform, complex clinical picture, so that the patient was transferred directly to our rehabilitation clinic in the event of everyday restrictions and rollator dependency. EXAMINATION AND FINDINGS: Clinically, there was a reduced general condition and the mood was depressed. Neurological symptoms were gait ataxia, hand tremor, amnesic aphasia and reduced ability to concentrate. PET / CT showed no evidence of tumor or inflammation. THERAPY AND PROGRESS: A multimodal therapy program consisting of physiotherapy and occupational therapy as well as psychological support was carried out. In addition, off-label therapy with oral glucocorticoids and colchicine was initiated. In the course of the disease, there was a clear reduction in all symptoms with little residual hand tremor. CONCLUSIONS: Whole body and brain FDG PET can be helpful in long COVID and post-COVID-19 syndrome patients with neurological symptoms of unknown origin. These patients benefit from systematic rehabilitation. Glucocorticoids and colchicine appear to accelerate symptom reduction. The rehabilitative therapy should be continued on an outpatient basis.

Toward successful future use of telehealth in occupational therapy practice: What the COVID-19 rapid shift revealed.

BACKGROUND: Prior to the onset of the COVID-19 pandemic, occupational therapy (OT) services delivered through telehealth demonstrated comparative effectiveness to in-person services. At the onset of the pandemic, occupational therapy practitioners (OTPs) needed to continue delivering care to clients without being in-person. Many OT practitioners pivoted rapidly to telehealth, in many instances, with very little training. OBJECTIVE: The objective of this study was to describe the use of telehealth in occupational therapy during the early stages of the pandemic, and to explore how participants traversed the barriers. The perceived benefits and barriers to success with rapid telehealth adoption as experienced by OTPs, along with the specific strategies used to promote favorable outcomes may inform ongoing successful telehealth use in occupational therapy. METHOD: This study used a mixed-methods sequential explanatory design. Data was collected from September to December 2020 with an electronic survey. RESULTS: A total of 193 OTPs completed the survey, representing the delivery of OT services in 13 countries. Three main barriers to the use of telehealth were availability of materials, mastery of technology, and collaboration with caregivers/e-helpers. These barriers were negatively and significantly correlated with the participants' confidence level in the use of telehealth. Participants overcame barriers by independently obtaining telehealth training, including training within one's organization, support from social media, self-directed learning, and paid online telehealth webinars. CONCLUSION: Employers and educators can remove barriers to telehealth use by OTPs by providing a variety of learning opportunities and supports to enhance practitioners' confidence, thus increasing the likelihood of continued use of telehealth as a powerful and gap-bridging delivery model in occupational therapy.

Apparent Discordance Between the Epidemiology of COVID-19 and Recommended Outcomes and Treatments: A Scoping Review.

OBJECTIVE: Many survivors of COVID-19 experience ongoing signs and symptoms affecting multiple body systems that impair function and negatively affect participation and quality of life. The purpose of this review was to identify and synthesize outpatient rehabilitation assessment and treatment recommendations for adults in postacute COVID-19 stages. METHODS: MEDLINE (Ovid), EMBASE (Ovid), Central, CINAHL, and Scopus were searched from January 1, 2020, to December 7, 2020. Teams of 2 reviewers independently assessed study eligibility and extracted data. All study designs that included rehabilitation recommendations were included. Study design, country, study population, purpose, and rehabilitation recommendations were recorded. Select questions from the Appraisal of Guidelines for Research and Evaluation instrument were used to evaluate the quality of consensus guidelines. RESULTS: Forty-eight articles fit the inclusion and exclusion criteria (11 systematic reviews, 1 scoping review, 6 original research studies, 4 consensus guidelines, 26 narrative reviews, and editorials/commentaries). Recommended outcomes included exercise tolerance, respiratory function, muscle strength, and activities of daily living or functional independence. Recommended treatments included respiratory rehabilitation, exercise therapy, education, psychological support, activities of daily living and gait training, traditional Chinese medicine, and cognitive and vocational rehabilitation. CONCLUSION: There were incongruities between what is known about postacute COVID-19 and what was recommended in the literature. Given the relatively large proportion of survivors who experience ongoing symptomatic COVID-19 or post-COVID-19 syndrome, it is important to quickly develop tools for self-management and access to rehabilitation specialists in multidisciplinary teams. IMPACT: Physical therapists, occupational therapists, and respiratory therapists have an important role to play. Clinicians should focus on epidemiological evidence and emerging information on late sequelae of COVID-19 to inform rehabilitation programming and future research.

Adapting Interventions for Occupational Therapy Practice: Application of the FRAME Coding Structure.

Occupational therapy practitioners often adapt evidence-based interventions for implementation into practice, yet these adaptations are seldom captured systematically. The purpose of this study was to apply the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to describe adaptations to one intervention modified for teletherapy in the wake of COVID-19. An embedded multiple case study design was used to track adaptations made to a vestibular and bilateral integration (VBI) protocol-traditionally delivered in-person-that was implemented via teletherapy in a pediatric outpatient clinic. The "Modification and Adaptation Checklist" was used to track protocol adaptations. Data were examined through descriptive analyses; 63 adaptations were made to the VBI protocol. The most frequently noted adaptation was "Repeating protocol activities," whereas the "Integrating another treatment approach with the VBI protocol" was the least common adaptation. The FRAME may be useful for tracking adaptations and evaluating how adaptations influence intervention effectiveness.

Responding to an Emerging Need: Implementing Telehealth in Acute Hospital Rehabilitation.

This article outlines a multidisciplinary approach to implementing a telehealth program in the acute care hospital setting during the coronavirus disease 2019 (COVID-19) pandemic. Telehealth has been used in many practice areas, although it can be a particular challenge to establish in an acute care hospital given the fast-paced environment. However, the COVID-19 pandemic presented a unique situation. In-person treatment interactions became increasingly high risk for both patient and provider, and there was an emerging need to conserve personal protective equipment and limit exposure. In response to these developments, physical therapists, occupational therapists, and speech language pathologists treating an adult population turned to telehealth to supplement in-person treatment. This article outlines the clinical reasoning and practical application to implementing a telehealth program in an acute care hospital and includes regulations, identified successful strategies, barriers, considerations, decision-making algorithms, and discipline-specific interventions.

Impact of COVID-19 pandemic lockdown on occupational therapy practice and use of telerehabilitation - A cross sectional study.

OBJECTIVE: COVID-19 has become a global public health emergency affecting 223 countries and territories, and it drastically changed the life of public and health care delivery systems. Although many guidelines have been proposed to avoid infection from COVID-19 and to promote the use of telerehabilitation, there is still no clear answer for the current scenario and strategies of therapists' practice during the COVID-19 pandemic lockdown. This study aimed to explore the impact of COVID-19 lockdown on Occupational Therapists' (OTs) practice, the use of telerehabilitation strategies by OTs, and their employment and mental health. Also, this study aimed to explore the OTs perspective on the role of telerehabilitation during this pandemic lockdown. MATERIALS AND METHODS: Online cross-sectional survey was conducted between April 2020 and May 2020. RESULTS: 114 OTs completed the survey. The results of this study showed that 52.8% of therapists had stress and anxiety due to COVID-19 lockdown. We found that 60.7% of OTs (n=65) used telerehabilitation, versus 36.1% (n=39) before the lockdown. Telerehabilitation approaches were mostly implemented during this lockdown for children with autistic problems (66.6%), stroke (12.9%), cerebral palsy (6.4%), learning disabilities (9.6%), Parkinson's diseases (1.6%), and other medical conditions (2.8%). 10% of therapists reported that they lost their job, and 76% reported that this lockdown affected their income negatively. Overall, 87.8% of therapists reported that mobile technology was very useful to overcome the stress due to COVID-19 related lockdown, social isolation, and social distancing. CONCLUSIONS: The COVID-19 pandemic lockdown experiences made us rethink the current approach of therapy services into alternative method (mixed mode) delivery of occupational therapy practice, which is including the combined method of video-based (telerehabilitation) consultation and face to face intervention.

Can occupational therapy manpower be replaced with social robots in a singing group during COVID-19?

BACKGROUND: Prior to the COVID-19 global health emergency, reducing direct contacts between therapists and patients is an important issue, and could be achieved by using robots to perform certain caring activities. OBJECTIVE: This study compares therapeutic factors of singing group activities directed by social robots and by occupational therapists at elderly care centers during this COVID-19 outbreak. METHODS: This project has a quasi-experimental research design, based on a pilot study of 14 subjects aged above 65 years. They received eight sessions of singing group therapy given by a social robot or an occupational therapist. Completed copies of a therapeutic-factor questionnaire were then collected. RESULTS: At the 4th week, the scores for 8 therapeutic factors were higher in sessions with the occupational therapist than the robot-directed sessions, reaching a statistically significant level; at the 8th week, the scores for 3 therapeutic factors, including imparting of information, were higher in sessions with the occupational therapist than in sessions with the robot. The top scoring therapeutic factor in the robot sessions was group cohesiveness. CONCLUSIONS: Social robots may be good companion tools for elderly care during this COVID-19 outbreak, but group therapy sessions supervised by real-person therapists still have higher therapeutic factor scores than those conducted by robots. The number of subjects needs to be increased to enhance the validity of future study results.

Was a global pandemic needed to adopt the use of telehealth in occupational therapy?

BACKGROUND: An analysis of data from an international survey was undertaken to determine the impact of the COVID-19 pandemic on telehealth practice in occupational therapy worldwide, in addition to facilitators and barriers in utilising this form of service delivery. METHOD: The global online survey was circulated in the occupational therapy community by the World Federation of Occupational Therapists (WFOT) between April and July 2020, collecting responses to closed-ended questions, in addition to free-text comments. Descriptive statistics and bivariate analyses were used to assess relationships between respondent characteristics and the utilisation of telehealth. Thematic statement analysis provided further insight regarding factors impacting telehealth use. RESULTS: Findings revealed a significant increase in the use of telehealth strategies with the onset of the pandemic among survey respondents, with many reported benefits. Bivariate analyses indicated telehealth users were more likely to score higher feelings of safety and positive work morale, as well as perceive employer expectations to be reasonable. Restricted access to technology, limitations of remote practice, funding issues and slow pace of change were identified as barriers for some respondents to utilising telehealth. Facilitators included availability of supportive policy, guidelines and strategies, in addition to education and training. CONCLUSION: This study advances the understanding of the current scope of occupational therapy telehealth practice in the context of the ongoing COVID-19 pandemic. Although results suggest long-term potential for telehealth use as an adjunct to traditional service provision, important considerations were identified regarding factors influencing integration of such strategies.