Snapshot of rehab services for long Covid patients in Scotland raises concern over 'unknowns'
Community-based physios and their colleagues urgently need more information on treating patients with the symptoms of long Covid, according to a research paper published earlier this month.
Written by Edward Duncan, an associate professor at the faculty of health sciences and sport at the University of Stirling, and five others, the paper gives an insight into what is currently happening in the NHS in Scotland.
The researchers conducted an online survey among directors of allied health professions (AHPs) in all of the 14 health boards in Scotland from the middle of October to early November.
Most (13) directors said their long Covid patients were being treated within pre-existing rehabilitation services. One board was running a new service for them while another was in the process of setting one up.
But most directors were unable to say how many patients were receiving treatment during the period in question, suggesting that data were not yet being routinely collected in a universal manner, Dr Duncan and his colleagues state.
While community rehabilitation has been routinely provided within the NHS in Scotland for many years, there are many unknowns regarding the delivery of community rehabilitation for people with long Covid
A contrasting picture emerges in different parts of Scotland, perhaps not surprisingly given that health boards vary dramatically in size and the types of populations served.
‘In services that were able to provide referral number data (2/14), one respondent (from a rural island locality) stated that they had received a referral for one patient in total, while the health board with a specialist long Covid service stated that they had received 95 referrals in eight weeks.
The authors point out that community rehabilitation is a ‘complex intervention’, with factors such as clinical need, geographical location and financial cost influencing decisions. The onset of long Covid has added further complexity as the 'impact of the clinical sequalae is still unknown'.
‘While community rehabilitation has been routinely provided within the NHS in Scotland for many years, there are many unknowns regarding the delivery of community rehabilitation for people with long Covid.
‘Therefore, research is urgently required to evaluate which models of community rehabilitation work, in what circumstances, and with whom,’ the authors note.
Commonly reported symptoms from 14 health boards
- fatigue (11 out of 14)
- respiratory conditions (9 out of 14)
- musculoskeletal conditions (6 out of 14)
- mental health (5 out of 14)
- neurological impairments (4 out of 14)
One director reported that patients were referred with the symptoms of fatigue (86 per cent), respiratory issues (67 per cent), reduced mobility/exercise tolerance (60 per cent), low mood, anxiety, depression (43 per cent), cardiac symptoms (24 per cent), sleep disturbance (24 per cent), and because of weight management concerns (12 per cent).
Physiotherapy is a key component
While few details emerged on the precise nature of the therapeutic interventions being supplied, a picture did emerge of the multidisciplinary nature of the responses.
Physiotherapy and occupational therapy were the two most common professions involved in delivering rehabilitation, with 13 of the 14 boards reporting they both played a part. Eleven said dietitians, nine said speech and language therapists, and seven said psychologists were involved in the response.
Contributions were also made by post-intensive treatment nursing teams, therapy assistant practitioners, outpatient services for people with neurological conditions, spiritual care teams and specialist rehabilitation medical consultant services.
Thirteen AHP directors said their long Covid rehabilitation services were delivered through a mixture of face-to-face and digital contact, with contrasting comments being added. ‘One respondent reported that their primary delivery route was digital. Another reported only delivering long Covid rehabilitation face-to-face, with no digital service.’
The authors, whose study has not yet been peer reviewed, believe it is the first to focus on community rehabilitation and long Covid. They accept that it has limitations, acknowledging, for example, that it remains unclear which model of service delivery in the community will prove the most beneficial.
More research needed
Experts have called for a ‘stepped, needs-based approach’ with key elements being the provision of information, self-management support and access to specialist services. One board reported their planned long Covid specialist service would be mainly digital, the authors note.
‘Detailed data on services and their recipients is vital and urgently required, to guide effective and efficient clinical practice and service planning and delivery,’ they add.
‘With growing numbers of people presenting with symptoms of long Covid, further research is urgently required to investigate the implementation, outcomes and cost-effectiveness of differing models of community rehabilitation for this patient population.’
Dr Duncan’s co-authors are Kay Cooper, Julie Cowie, Lyndsay Alexander, Jacqui Morris and Jenny Preston
A national survey of community rehabilitation service provision for people with long Covid in Scotland [version 1; peer review: awaiting peer review]. F1000Research 2020, 9:1416 https://doi.org/10.12688/f1000research.27894.1
Author: Ian A McMillan