Abstract
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.
People discharged from the University of Leicester between March and December 2020 were followed up on a rehabilitation pathway, which included a phone call to identify any ongoing symptoms and rehabilitation needs. All individuals with a positive COVID-19 PCR test, or clinical diagnosis of COVID-19 were screened. One thousand five hundred thirty nine individuals were screened, of these, 566 (37%) were deemed not appropriate for an outpatient rehabilitation programme (reasons outlined in Fig. 1). Seven hundred sixty three individuals completed a telephone consultation, the mean [SD] age was 60 [16] years and average time from discharge to telephone consultation was 42 [22] days. Three hundred eighty six individuals identified rehabilitation needs (25% of all screened) and were added to a waiting list. One hundred sixty six individuals added to the waiting list had been contacted by end of January 2021 and offered the rehabilitation programme. The average length of time from hospital discharge to offer of rehabilitation was a mean [SD] of 192 days [72]. One hundred nine individuals (66%) accepted an appointment. Fifty seven individuals (34%) declined an assessment most commonly because their condition had improved (n = 22, 13%) or because they could not be contacted (n = 16, 10%). This data shows 25% of all individuals hospitalised with a positive test or clinical diagnosis of COVID-19 identified rehabilitation needs. This data suggests natural recovery with 24% declining rehabilitation at telephone consultation and a further four percent declining when offered an assessment for a COVID-19 rehabilitation programme.