Beyond a Hashtag: Strategies to Move Toward a More Inclusive Physiatry Workforce.

ABSTRACT: The field of physical medicine and rehabilitation should strive for a physician workforce that is ethnically/racially, sex, and ability diverse. Considering the recent realities of disparities in health outcomes related to COVID-19 and in racial injustice in the United States, we are called to be champions for antiracism and equity. The specialty of physical medicine and rehabilitation should be the leaders in fostering a culture of inclusion and pay special attention to the population of applicants who are underrepresented in medicine. The specialty needs tools to start addressing these disparities. This article aims to provide strategic and intentional evidence-based recommendations for programs to follow. Holistic review, implicit bias training, structured interviews, and targeted outreach for those underrepresented in medicine are some of the tools that will help students enter and become successful in our specialty. Furthermore, this article provides novel guidance and considerations for virtual interviews during the COVID-19 pandemic.

Physical Medicine and Rehabilitation in Rhode Island during the COVID-19 Pandemic.

The COVID-19 pandemic has transformed the practice of medicine. We interviewed Physical Medicine and Rehabilitation (PM&R) specialist physicians providing rehabilitation services throughout Rhode Island to organize a narrative assessing the pandemic's impact on the state's rehabilitation community and the responses of its leaders. Almost half of rehabilitation providers needed to suspend their services during the initial peak of the pandemic. Most experienced reductions in the size of their practices, as well as personnel issues that contributed to burnout. All physicians used telemedicine to connect with patients. Many reported issues with accessing personal protective equipment and providing clinical opportunities for trainees. Inpatient rehabilitation policies and practices helped to maintain access for COVID-positive and negative patients, yet challenges were faced when configuring physical space to abide by CDC social distancing guidelines and providing care without patient visitors. Despite setbacks, the pandemic outlined opportunities for improvement of healthcare organization and delivery.

What Now for Rehabilitation Specialists? Coronavirus Disease 2019 Questions and Answers.

Recognizing a need for more guidance on the coronavirus disease 2019 (COVID-19) pandemic, members of the Archives of Physical Medicine and Rehabilitation Editorial Board invited several clinicians with early experience managing the disease to collaborate on a document to help guide rehabilitation clinicians in the community. This consensus document is written in a "question and answer" format and contains information on the following items: common manifestations of the disease; rehabilitation recommendations in the acute hospital setting, recommendations for inpatient rehabilitation and special considerations. These suggestions are intended for use by rehabilitation clinicians in the inpatient setting caring for patients with confirmed or suspected COVID-19. The text represents the authors' best judgment at the time it was written. However, our knowledge of COVID-19 is growing rapidly. The reader should take advantage of the most up-to-date information when making clinical decisions.

Managing the Rehabilitation Wave: Rehabilitation Services for COVID-19 Survivors.

The coronavirus disease 2019 (COVID-19) pandemic is having a profound effect on the provision of medical care. As the curve progresses and patients are discharged, the rehabilitation wave brings a high number of postacute COVID-19 patients suffering from physical, mental, and cognitive impairments threatening their return to normal life. The complexity and severity of disease in patients recovering from severe COVID-19 infection require an approach that is implemented as early in the recovery phase as possible, in a concerted and systematic way. To address the rehabilitation wave, we describe a spectrum of interventions that start in the intensive care unit and continue through all the appropriate levels of care. This approach requires organized rehabilitation teams including physical therapists, occupational therapists, speech-language pathologists, rehabilitation psychologists or neuropsychologists, and physiatrists collaborating with acute medical teams. Here, we also discuss administrative factors that influence the provision of care during the COVID-19 pandemic. The services that can be provided are described in detail to allow the reader to understand what services may be appropriate locally. We have been learning and adapting real time during this crisis and hope that sharing our experience facilitates the work of others as the pandemic evolves. It is our goal to help reduce the potentially long-lasting challenges faced by COVID-19 survivors.

COVID 19: Importance of Physical Rehabilitation Medicine Capacity Building.

No Abstract.

Living with a disability during the pandemic. "Instant paper from the field" on rehabilitation answers to the COVID-19 emergency.

COVID-19 pandemic is creating collateral damage to persons with disabling conditions of different aetiology. The restrictions imposed to contain the spread of infection is limiting the access to many health services, including rehabilitation. It is expected that such situation will lead to long lasting negative consequences for persons with disability, increasing functional limitations in chronic conditions and hindering the recovery after acute events. The aim of this paper is to explore the impact on people with disability, reporting the contents of the sixth Italian Society of Physical and Rehabilitation Medicine (SIMFER) webinar on the COVID-19 impact on rehabilitation ("Covinars"). Seven representatives of Associations of persons affected by different disabling conditions described the difficulties they are facing during the pandemic, the initiatives undertaken to support their members and their future perspectives and expectations. The users' inputs will be helpful in planning the future phases of the emergency and improve preparedness for other emergencies.

Up to 2.2 million people experiencing disability suffer collateral damage each day of COVID-19 lockdown in Europe.

BACKGROUND: The COVID-19 pandemic is having a great impact on health services. Patients not receiving care due to closure of outpatient services suffer a collateral damage. Our aim was to provide first data on impact of COVID-19 on people experiencing disability in Europe. METHODS: We developed an estimation from a survey and publicly available data. Thirty-eight countries have been inquired through the European Bodies of Physical and Rehabilitation Medicine - the rehabilitation medical specialty. The nine questions of the survey focused on March 31st, 2020. We used the following indicators: for inpatients, acute and rehabilitative hospital beds; for outpatients, missing uniform European data, we used information from Italy, Belgium and the UK, and estimated for Europe basing on population, number of rehabilitation physicians, physiotherapists, and people with self-reported limitations. RESULTS: Thirty-five countries (92%) including 99% of the population (809.9 million) answered. Stop of admissions to rehabilitation, early discharge and reduction of activities involved 194,800 inpatients in 10 countries. Outpatient activities stopped for 87%, involving 318,000 patients per day in Italy, Belgium and the UK, leading to an estimate range of 1.3-2.2 million in Europe. Seven countries reported experiences on rehabilitation for acute COVID-19 patients. CONCLUSIONS: COVID-19 emergency is having a huge impact on rehabilitation of people experiencing disability. This may lead to future cumulative effects due to reduced functional outcome and consequent increased burden of care. When the emergency will fade, rehabilitation demand will probably grow due to an expected return wave of these not well treated patients, but probably also of post-COVID-19 patients' needs.

Redefining Pathways into Acute Rehabilitation during the COVID-19 Crisis.

The coronavirus disease 2019 (COVID-19) pandemic has necessitated drastic changes across the spectrum of health care, all of which have occurred with unprecedented rapidity. The need to accommodate change on such a large scale has required ingenuity and decisive thinking. The field of physical medicine and rehabilitation has been faced with many of these challenges. Healthcare practitioners in New York City, the epicenter of the pandemic in the United States, were among the first to encounter many of these challenges. One of the largest lessons included learning how to streamline admissions and transfer process into an acute rehabilitation hospital as part of a concerted effort to make acute care hospital beds available as quickly as possible.

Telemedicine from research to practice during the pandemic. "Instant paper from the field" on rehabilitation answers to the COVID-19 emergency.

COVID-19 pandemic is creating collateral damage to outpatients, whose rehabilitation services have been disrupted in most of the European countries. Telemedicine has been advocated as a possible solution. This paper reports the contents of the third Italian Society of Physical and Rehabilitation Medicine (SIMFER) webinar on "experiences from the field" COVID-19 impact on rehabilitation ("Covinars"). It provides readily available, first-hand information about the application of telemedicine in rehabilitation. The experiences reported were very different for population (number and health conditions), interventions, professionals, service payment, and technologies used. Commonalities included the pushing need due to the emergency, previous experiences, and a dynamic research and innovation environment. Lights included feasibility, results, reduction of isolation, cost decrease, stimulation to innovation, satisfaction of patients, families, and professionals beyond the starting diffidence. Shadows included that telemedicine can integrate but will never substitute face-to-face rehabilitation base on the encounter among human beings; age, and technology barriers (devices absence, bad connection and human diffidence) have also been reported. Possible issues included privacy and informed consent, payments, cultural difficulties in understanding that telemedicine is a real rehabilitation intervention. There was a final agreement that this experience will be incorporated by participants in their future services: technology is ready, but the real challenge is to change PRM physicians' and patients' habits, while better specific regulation is warranted.

First impact of COVID-19 on services and their preparation. "Instant paper from the field" on rehabilitation answers to the COVID-19 emergency.

This paper reports the immediate impact of the epidemic on rehabilitation services in Italy, the first country in Europe hit by COVID-19. In a country with almost 5000 Physical and Rehabilitation Medicine physicians, the webinar had 230 live viewers (4.5%), and more than 8900 individual visualizations of the recorded version. The overall inadequate preparation of the rehabilitation system to face a sudden epidemic was clear, and similar to that of the acute services. The original idea of confining the COVID-19 cases to some areas of rehabilitation wards and/or hospitals, preserving others, proved not to be feasible. Continuous reorganization and adaptation were required due to the rapid changes. Overall, rehabilitation needs had to surrender to the more acute emergency, with total conversion of beds, wards and even hospitals. The quarantine needs heavily involved also outpatient services that were mostly closed. Rehabilitation professionals needed support, but also acted properly, again similarly to what happened in the acute wards. The typical needs of rehabilitation, such as human and physical contacts, but also social interactions including patient, team, family and caregivers, appeared clearly in the current unavoidable need of being suppressed. These notes could serve the preparation of other services worldwide.