Long Covid
Feature
Rehabilitation and return to work
Jasmine Yule explains how occupational therapists have evolved an existing service to creatively support people with Long Covid in their individual return-to-work journeys .
O ccupational therapists at Group Rehabilitation , University Hospitals of Derby and Burton NHS Foundation Trust , have proudly offered musculoskeletal rehabilitation for over 20 years .
Meeting the ever-changing needs of the local community and NHS trust , over this time it has evolved from a heavy workshop to a specialist vocational rehabilitation service . An intentionally permissive referral criteria ensures that those patients who do not fit into a specialist rehabilitation pathway are still able to access vital return to work support .
The service first received referrals for people with persisting symptoms of Coronavirus in May 2020 , through the internal staff service and from community respiratory nurses . Later to be patient defined as Long Covid , people presented with symptoms including breathlessness , exhaustion and cognitive impairment .
In the absence of medical intervention for the majority , patients sought support as they endeavoured to regain functional independence . With many patients experiencing a relatively mild acute phase of the virus , they also sought a sense of validation and permission to accept that their symptoms were real .
Our occupational therapists and physiotherapists frequently receive over 400 referrals a month . To keep the waiting list low and to ensure that work needs are addressed as quickly as possible , groups of up to 15 patients would normally be facilitated in the therapy gyms throughout the day .
Patients receive one-to-one assessments and reviews from an occupational therapist to develop a rehab programme that reflects specific work-related demands . Therapists use objective task analysis and subjective experience to provide well-informed recommendations to the patients ’ employer .
However , many patients with Long Covid experience a disproportionate response to exercise , known as post-exertional malaise . The fluctuating nature of their fatigue also presented other barriers to face-to-face treatment , such as difficulty with selfcare and travel .
Gym-based group work was therefore inappropriate for many people with Long Covid , but with no additional staffing or resources it was essential that we quickly evolved and had a creative approach to new interventions .
All initial assessments were completed over the telephone , allowing therapists to develop a rehabilitation plan that reflected a patient ’ s imminent work-related needs and their unique presentation of symptoms .
A senior occupational therapist and senior therapy assistant set up a weekly virtual group over MS Teams . The session began with a light 10-minute Tai-Chi routine , followed by a 10-minute symptom management presentation , which included the practice of diaphragmatic breathing , pacing techniques , sleep , nutrition , negative thought patterns and dealing with setbacks .
The final 20-minutes were protected , allowing the therapist to facilitate group conversation and peersupport . The sessions would frequently be attended by between 35 to 40 people .
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July 2022 OTnews 37