ANNUAL CONFERENCE REPORT
We need to develop the research , and evidence the strengths of pulmonary rehab as an intervention for people with post-COVID-19 symptoms , delegates hear
Professor Sally Singh , head of pulmonary and cardiac rehabilitation at University Hospitals of Leicester NHS Trust , delivered the opening plenary at the annual conference .
Sally is leading ground-breaking national research on pulmonary rehabilitation and digital interventions to support rehabilitation and recovery .
Pointing to the fact that pulmonary rehabilitation has conventionally been provided within hospital and community settings – where there is a strong evidence base for it – she said the new pandemic situation of the last 18 months ‘ has changed all that ’.
‘ There is limited evidence in the field for virtual rehabilitation ,’ she said , which means there is limited evidence and guidance . However , she stressed , this means that there is potential to increase the scope .
Using a number of different studies , Sally showed delegates that pre-COVID-19 , the vast majority of pulmonary rehabilitation in the UK – 98 per cent – took place at a centre , and while 34 per cent did offer home-based rehabilitation , only 1.6 per cent of people took up the offer .
While recognising that ‘ Long COVID ’ is a complex disease , and that ‘ we are learning on the job ’, she used data from Italy to ‘ nail down ’ the main symptoms to fatigue , breathlessness , and joint pain .
But importantly for allied health professionals , she said , ONS data has shown that there has been a huge impact on people ’ s activity levels , with 30 per cent of the COVID-19 population having ‘ significant , enduring impact on their ability to do tasks ’, citing fatigue , breathlessness , and impaired cognition and exercise capacity .
But what are we going to do to support these people , she asked ? Referring to a recent article published in the BMJ , she said that pulmonary rehabilitation has been suggested as a ‘ preferred intervention ’ for a number of these people .
Specifically an interdisciplinary programme of care for people with chronic respiratory disease , what is so important about pulmonary rehabilitation , she stressed , ‘ is that it is individually tailored and designed to optimise an individual ’ s physical and social performance and comprises an individually prescribed exercise and education package ’.
Looking at the existing data and what the need for pulmonary rehabilitation need might be , she said : ‘ We think that about 25 percent of hospitalised patients will have a self-identified need for rehabilitation – which is a huge population .
Professor Sally Singh
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’ And very early evidence is suggesting that people with COVID-19 will benefit from pulmonary rehabilitation intervention , both in terms of quality of life and a return to activities ,’ she concluded .
Early on in the pandemic , she said , there was a survey of healthcare professionals to try to understand what an assessment and package of care might look like for people post-COVID , and she noted that there is ‘ huge debate as to how we manage the post COVID patient ’.
Some of the areas of concern considered to be unique to this population are fatigue , psychological and cognitive disturbances – not only because of the impact of the disease itself , but also lockdown and social isolation . But it was acknowledged that there is evidence for rehabilitation reducing anxiety and depression by increasing people ’ s ability to engage again in activities and participate in daily life .
In terms of the benefits of rehabilitation being delivered via faceto-face groups , on digital platforms , or even by ‘ paper based ’ programmes , she acknowledged that COVID-19 has likely influenced the digital habits of pulmonary rehabilitation service users , and that there is ‘ lots of work to be done ’ in the areas of ‘ novel tech ’, such as virtual reality .
But a key ‘ take home ’ message from the session was around the importance of shared decision-making : ‘ It is important that we support our patients to choose the right options and to make the right decision that suits them , that will maximise their engagement and hopefully the impact ,’ she said .
COVID-19 has encouraged the development of digital models for pulmonary rehabilitation – and challenged services to better meet the needs of their service users – but we need now to develop research and evidence the strengths , and services need to accommodate their preferences .
Research is needed to develop engaging digital interventions to support symptom reduction and behaviour change .
Professor Sally Singh Head of pulmonary and cardiac rehabilitation at University Hospitals of Leicester NHS Trust
‘ Research is needed to develop engaging digital interventions to support symptom reduction and behaviour change ,’ she concluded .
OTnews July 2021 17