VOCATIONAL REHABILITATION FEATURE
discharged home and is looking to pick up where he left off with his
own business, but the cognitive issues put him at risk of making
significant errors, which could threaten his business.
Online working poses another common issue. As for many of
us, the team are having to deliver most of their work through video
conferencing, but they also have to get their patients ready to use
the technology when they get back to work.
‘Some people can’t tolerate a full hour meeting, but instead
need shorter sections because of fatigue,’ says Carina. For people
working from home, the team is needing to provide support to make
sure they have the right equipment.
But perhaps the biggest change for the team is the workload,
with more than double the number of patients. Even that rise won’t
represent the huge rise in unmet need currently in the community,
says Freya Powell, the team’s clinical lead, for a variety of reasons.
‘The numbers at the moment are fairly low, but lots of
people haven’t really had a follow-up
‘‘
review yet,’ she says. ‘Where
they are happening, any cognitive
problems may not be picked up.
‘Lots of people aren’t working
how they were before because of
furloughing and working from home.
‘And lots of people had lower
level needs which mean they didn’t
need intensive care treatment, such
as anxiety about going back to work,
but we just don’t know about them yet,
especially as GP surgeries aren’t working in
their normal way.
‘We’re only just starting to see the numbers,
but I think there will be much more.’
Freya is currently looking at the best way to quickly scope out
and work with that unmet need. ‘But we can’t spend too long doing
that as by then people will have lost their jobs,’ she says.
Fighting fatigue
Fatigue is proving a major issue for people who have had
COVID-19 and are returning to work. Beverly Knops is an
occupational therapist and executive manager at Vitality 360, which
provides rehabilitation programmes for people with persistent pain
and fatigue, and she says they are just starting to see some post-
COVID cases appear, with more expected because of the time lag
from being seriously ill to thinking about going back to work.
‘Fatigue is a massive symptom – and it’s not just someone feeling
weary or tired, they will feel flattened by it,’ she says. ‘They describe
walking through treacle, and you just can’t function.
‘But it can be variable, and that’s the difficulty with fatigue and
with COVID-19; you can have a period of time where it feels a bit
better and gives you a false of hope you are recovering so you
engage in more activities, and then it flattens you again. We’re
definitely seeing with COVID patients that after the very acute phase
when people are ill, they seem to get a bit better and think “okay, we
can think of this as a normal virus,” and then it has a second hit.’
Beverly says that the issue is not just about people who have
been in intensive care, but also people who have had milder versions
at home.
Fatigue is a
massive symptom – and
it’s not just someone feeling
weary or tired, they will feel
flattened by it. They describe
walking through treacle, and
you just can’t function.
Join the RCOT Specialist Section — Work, at: www.rcot.
co.uk/work.
Access RCOT’s resources on managing post-viral
fatigue at: www.rcot.co.uk/how-manage-post-viralfatigue-after-covid-19-0.
‘Even if you are at home, you can’t help but think about the
worst-case scenario which you have seen on the news; that threat
has been very difficult for people,’ she says. ‘Someone I spoke with
had called out paramedics three times who had decided she was
okay, but that process was obviously very scary.’
People in that situation face an additional potential
hurdle to getting back to work: bosses who may
not be sympathetic if they haven’t been in
intensive care. ‘It’s an odd set of symptoms
that for someone who hasn’t experienced it
won’t make complete sense,’ she says.
‘You can appear to be well and eloquent,
especially if you are trying hard because
you’re worried about your job and income,
but that may not be how you are always
feeling. So some of our work is around divulging
– who you divulge to about how you feel, and
how the symptoms are impacting
on your occupations. Your cognitive
fatigue is important but unless you can express
that and how you can cope, then that can cause
problems.’
Beverly recommends RCOT’s resources on
fatigue management to support people around
planning and pacing. For more serious, longerlasting
cases, Beverly gets clients to keep diaries
to build up their self-awareness of which tasks
have the biggest effects on their fatigue, and to
build a person-centred response to them.
‘There are so many variables in fatigue,’ she
says. ‘My 21-year-old son can be on a computer
all day and he says it won’t affect his fatigue
levels, but for me I’ll find it extremely fatiguing to
be in a spreadsheet all day. The art of therapy is
to help people to understand the influences on
fatigue, and then listen to those and adapt your
therapy accordingly.’
She also works clients to develop a full list
of challenges, needs, solutions and actions
so they can have a constructive conversation
with managers about returning to work. She
RESOURCES
OTnews July 2020 33