• Improving understanding of the occupational therapy role among the multidisciplinary team .
• Evaluating the role and promoting the value of occupational therapy in the COVID-19 critical care follow-up clinic and critical care follow-up clinic in general .
A total of 66 clinics were completed during this time . Of the 173 patients reviewed in clinic , the most prevalent post-COVID ITU symptoms were those that linked directly to need for therapies ; specifically fatigue , weakness , reduced functional mobility , cognitive issues and psychological difficulties .
Most clinics ran with just an occupational therapist , physiotherapist and a consultant ( see figure one ); the amount of therapies referrals and the specialist advice provided clearly highlight the benefit of having more permanent therapy input in COVID ITU clinics .
Clinics with : % Critical care consultant 100 Just physiotherapist 24 Just occupational therapist 17 Both physiotherapist and occupational therapist 59 Specialist nurse 21
Above : Figure one : Clinic multidisciplinary team composition
Having a nurse and psychologist for a fullyrounded multidisciplinary team would be ideal , but it demonstrated that therapists in particular are an invaluable addition and should be a permanent fixture to any post-ITU multidisciplinary team .
Occupational therapy is well positioned to identify and address cognitive changes , support fatigue management , aid mental health support , environmental assessment , return to work support – particularly as the average age of patients in the clinic is 53 years old ( the youngest being 28 ) – and address complexity related to multiple health needs using a personalised approach ( RCOT 2021 ).
Having specialist knowledge of these issues and the services that can help them , as well as initiating prompt provision of relevant selfmanagement resources , was therefore essential to ensuring these patients received the best care possible to optimise recovery .
Challenges and limitations
Unfortunately , due to a lack of resources and time in this temporary clinic , as part of a quality improvement development project rather than a research project , we were unable to use formal outcome measures to accurately capture the impact of the role on patients .
Feedback questionnaires as part of the multidisciplinary team service evaluation were developed , however these were sent out late due to a lack of administration support and we had very limited response from patients .
Several other challenges also presented limitations to the clinic project . The multidisciplinary team was significantly impacted by staff being redeployed due to COVID-related pressures , meaning there was a lack of nursing support , no available psychologist and limited administration support , time and resources .
There were also difficulties with virtual working , finding private rooms and issues with Wi-Fi and digital access for some .
There were challenges with accessing electronic records , particularly those of out-ofborough patients transferred to or from other hospitals , from which we needed to rely on patient report for . COVID services were also still in development at the time , with a vast variety of service models and procedures in different boroughs across London complicating or delaying onward referrals .
There were also sociocultural and language barriers impacting service provision , including issues with co-ordinating video calls with interpreters , limited resources in translating written information and difficulties for those who were illiterate , had visual difficulties , or cognitive challenges .
Follow up was also limited in duration and it would be interesting to review the impact on these patients several years later .
Overall , there is minimal research on the role of occupational therapy in critical care follow-up clinics , as well as general post-critical care rehabilitation , therefore further study investigating the efficacy of this input is needed .
The clinic provided insight onto gaps in existing services , such as rehabilitation for PICS / post intensive care acquired weakness , as well as a lack of clear pathways for Long Covid rehabilitation , at the time of the project .
Reflections
Working as an occupational therapist in the clinic was a unique learning experiencing . It opened my eyes to the extent of the psychosocial aspect of recovery from COVID-19 critical illness , in addition to other social difficulties caused by the pandemic . It highlighted the importance of liaison with
Improving Access to Psychological Therapies
26 OTnews April 2022