key: cord-0877388-7dk6wpgr authors: Daynes, Enya; Gerlis, Charlotte; Singh, Sally J. title: The demand for rehabilitation following COVID-19: A call to service providers date: 2021-05-24 journal: Physiotherapy DOI: 10.1016/j.physio.2021.05.004 sha: 493069dba8d1416f99da26d58074acd289bf9253 doc_id: 877388 cord_uid: 7dk6wpgr nan The demand for rehabilitation following COVID-19: A call to service providers This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. The COVID-19 pandemic has largely and rightly focussed on the acute needs of the population, however; as infection rates continue to fall the need for rehabilitation services continue to rise. Initially it was expected that people hospitalised with COVID-19, particularly those treated in intensive care and high dependency units would require rehabilitation to return to their usual activities but it has become clear that there is a demand for rehabilitation for those hospitalised and non-hospitalised-following infection (1, 2) . There have been a number of studies that have identified that symptoms of breathlessness, fatigue, generalised joint pain and reduced cognition persist long after the initial infection and can prevent return to work and reduced engagement in activities of daily living (3, 4) . Those experiencing symptoms 12 weeks after their initial infection, termed long COVID or long haulers, are in need of support and interventions to assist their recovery (5) . A number of specialist groups and governing bodies have identified the need for rehabilitation, and have suggested adaptive pulmonary rehabilitation services would be best place to meet the demands of the long COVID population (2, 6, 7). However, current pulmonary rehabilitation services are overstretched with high demand from the chronic respiratory disease population. Therefore there is a need to enhance capacity of such rehabilitation services to support the needs of the post COVID population. Recent data reports that 71% of hospitalised patients are not fully recovered at 5 months (4) suggesting an even more significant demand for rehabilitation services. However, we found 25% of hospitalised patients experience on-going symptoms that require support for recovery. The reasons J o u r n a l P r e -p r o o f for the disparity in the data may be twofold. Firstly, this data reports on everyone discharged from the hospital and provides a real world insight into those who are fully recovered that may not be captured by a research trial. Secondly, there may be ongoing symptoms in those who declined rehabilitation that are not addressed during a conventional rehabilitation programme addressing the previously highlighted symptoms and require different support, which may be captured in the PHOSP data e.g. taste /smell. That said; it is estimated that 1.1 million people in the UK are living with long COVID symptoms, many of which will not have been hospitalised and therefore not captured in these dataset and the requirements for recovery programmes are paramount (8) . COVID rehabilitation services have shown the potential of improving symptoms of long COVID however the ability for services to maintain this delivery will be difficult when usual services resume (9, 10) . Current services have modified or ceased their intervention during the pandemic due to shielding, lockdown restrictions and staff redeployment. Once routine services recommence there is likely to be a backlog of patients requiring conventional rehabilitation services, which will be exacerbated by the demand for COVID-19 rehabilitation services. Capacity of rehabilitation programme classes will be limited by social distancing and infection prevention measures. This will require services to be flexible in its delivery of programmes, and an option for face to face and digital interventions may help meet the demand of these people. It is important to consider the uncertainty surrounding the long term sequela expected in COVID-19 and services may need to rapidly adapt to keep up with the challenges of symptoms, and lockdown measures. Some patients may require minimal advice and support, rather than a comprehensive programme to return to usual activities, and therefore, lighter touch interventions or online resources could be beneficial such as Your COVID Recovery (www.yourcovidrecovery.nhs.uk)(7). The need for COVID-19 rehabilitation programmes is clear, with 25% of all individuals admitted to our hospitals identifying rehabilitation needs. This presents a significant challenge for services providing rehabilitation which will continue after the pressure on acute services has eased. In order J o u r n a l P r e -p r o o f COPD Assessment test for the evaulation of COVID-19 symptoms COVID-19: Interim Guidance on Rehabilitation in the Hospital and Post-Hospital Phase from a Persistent symptoms in patients after Acute COVID-19 Physical, cognitive and mental health impacts of COVID-19 following hospitilisation -a multi-centre prospective cohort study COVID-19 rapid guideline: managing the long term effects of COVID-19 2020 Delivering rehabilitation to patients surviving COVID-19 using an adapted pulmonary rehbailitation approach-BTS guidance 2020 [online] available from www.britthoracic.org.uk