Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.
St Barnabas Hospices, Worthing, UK.
Palliat Med. 2022 Feb;36(2):319-331. doi: 10.1177/02692163211063397. Epub 2021 Dec 29.
Palliative rehabilitation involves multi-professional processes and interventions aimed at optimising patients' symptom self-management, independence and social participation throughout advanced illness. Rehabilitation services were highly disrupted during the Covid-19 pandemic.
To understand rehabilitation provision in palliative care services during the Covid-19 pandemic, identifying and reflecting on adaptative and innovative practice to inform ongoing provision.
Cross-sectional national online survey.
SETTING/PARTICIPANTS: Rehabilitation leads for specialist palliative care services across hospice, hospital, or community settings, conducted from 30/07/20 to 21/09/2020.
61 completed responses (England, = 55; Scotland, = 4; Wales, = 1; and Northern Ireland, = 1) most frequently from services based in hospices (56/61, 92%) providing adult rehabilitation. Most services (55/61, 90%) reported rehabilitation provision becoming remote during Covid-19 and half reported reduced caseloads. Rehabilitation teams frequently had staff members on sick-leave with suspected/confirmed Covid-19 (27/61, 44%), redeployed to other services/organisations (25/61, 41%) or furloughed (15/61, 26%). Free text responses were constructed into four themes: (i) fluctuating shared spaces; (ii) remote and digitised rehabilitation offer; (iii) capacity to provide and participate in rehabilitation; (iv) Covid-19 as a springboard for positive change. These represent how rehabilitation services contracted, reconfigured, and were redirected to more remote modes of delivery, and how this affected the capacity of clinicians and patients to participate in rehabilitation.
This study demonstrates how changes in provision of rehabilitation during the pandemic could act as a springboard for positive changes. Hybrid models of rehabilitation have the potential to expand the equity of access and reach of rehabilitation within specialist palliative care.
姑息康复涉及多专业的流程和干预措施，旨在优化患者在晚期疾病期间的症状自我管理、独立性和社会参与度。在 COVID-19 大流行期间，康复服务受到了严重干扰。
了解 COVID-19 大流行期间姑息治疗服务中的康复服务提供情况，确定和反思适应性和创新性实践，以为持续提供服务提供信息。
横断面全国在线调查。
地点/参与者：来自临终关怀、医院或社区环境中的专科姑息治疗服务的康复负责人，于 2020 年 7 月 30 日至 9 月 21 日进行。
61 份完整回复（英格兰， = 55；苏格兰， = 4；威尔士， = 1；北爱尔兰， = 1），主要来自 56/61（92%）家以临终关怀为基础的成人康复服务机构。大多数服务（55/61，90%）报告 COVID-19 期间康复服务转为远程服务，一半报告减少了病例量。康复团队中经常有疑似/确诊 COVID-19 的员工（27/61，44%）请病假、被重新部署到其他服务/组织（25/61，41%）或被休假（15/61，26%）。自由文本回复被构建为四个主题：（一）不断变化的共享空间；（二）远程和数字化康复服务；（三）提供和参与康复的能力；（四）COVID-19 成为积极变革的跳板。这些主题代表了康复服务如何收缩、重新配置和转向更远程的交付模式，以及这如何影响临床医生和患者参与康复的能力。
本研究表明，大流行期间康复服务的变化如何成为积极变革的跳板。混合模式的康复有可能扩大专科姑息治疗中康复服务的公平性和可及性。
