PhysioUpdate 23rd November 2021

Rehabilitation services are facing a ‘significant challenge’ in supporting people who have left hospital after receiving treatment for Covid-19 symptoms, according to three physiotherapists based in Leicester.

The view is put forward by Enya Daynes, Charlotte Gerlis and Sally Singh in a publication appearing in the December issue of the Elsevier journal, Physiotherapy (their paper was published in an online version earlier this year).

All three authors are based at the centre of exercise and rehabilitation sciences at the National Institute for Health Research (NIHR), Leicester Biomedical Research Centre-Respiratory, University Hospitals of Leicester. Dr Daynes and Professor Singh are also based at the department of respiratory sciences, University of Leicester.

In their editorial, the authors note that one person in four who had been admitted to hospital in the Leicester area with Covid-19 symptoms reported needing rehabilitation some time after being discharged.

The need for Covid-19 rehabilitation programmes is clear, with 25 per cent of all individuals admitted to our hospitals identifying rehabilitation needs [Enya Daynes et al]

‘The need for Covid-19 rehabilitation programmes is clear, with 25 per cent 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 to meet the needs of those with long Covid there needs to be nationwide support for the development and implementation of Covid recovery programmes.’

Rehabilitation pathway

People discharged from the trust’s hospitals from March to December last year were followed using a rehabilitation pathway, which included a phone call to identify any ongoing symptoms and rehabilitation needs. All those with a positive Covid-19 PCR test, or clinical diagnosis of Covid-19 were screened.

More than a thousand of them (1,539) were initially screened, of whom 386 (25 per cent) were eventually identified as having rehabilitation needs and were added to a waiting list.

Of the 166 individuals added to the rehab waiting list by the end of January 2021, 109 (66 per cent) accepted an appointment (some said their condition had improved or could not be contacted).

Services already 'overstretched'

The authors point out that several specialist groups and governing bodies have highlighted the need for rehabilitation, suggesting that adaptive pulmonary rehabilitation services would be best placed to meet the demands of people who fall into the 'long Covid' category. 

They continue: ‘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.’

Though the study was supported by the NIHR, the authors note that the views expressed in the paper are not necessarily those of the institute or the Department of Health and Social Care.

To see the open access paper, titled The demand for rehabilitation following COVID-19: a call to service providers, visit: https://doi.org/10.1016/j.physio.2021.05.004

Physiotherapists and other healthcare professionals are being encouraged to take part in a consultation exercise that could see them receiving the green light to complete DVLA medical questionnaires.

At present, only registered medical practitioners (doctors who are registered with the General Medical Council) can complete the questionnaires, and the DVLA is seeking views on widening pool of healthcare professionals who can do so.

It launched the consultation on 8 November, and the deadline for responding ends on 6 December. In a press release, the DVLA says that healthcare professionals, such as nurse practitioners, are often more involved in a patient’s treatment than a doctor and are well placed to complete questionnaires as a result.

This proposal would allow a wider pool of healthcare professionals to complete a driver’s medical questionnaire, reducing the burden on GPs and consultants [Julie Lennard, DVLA]

DVLA chief executive Julie Lennard said: ‘Year on year we are seeing an increase in medical licensing applications for drivers and we are continuously looking for ways to improve the process for customers and the medical profession.

‘This proposal would allow a wider pool of healthcare professionals to complete a driver’s medical questionnaire, reducing the burden on GPs and consultants.

‘We are particularly keen to seek views from registered healthcare professionals, medical practitioners and representative bodies within the health sector on making this change.’

By law all drivers must meet the medical standards for fitness to drive and each year DVLA makes 500,000 medical licensing decisions. These decisions are often influenced by the information in questionnaires that have been completed by a driver’s doctor or consultant. If the DVLA opts to allow a range of healthcare professionals to complete questionnaires, the Road Traffic Act 1988 would have to amended.

Interested parties urged to take part

Roads minister Baroness Vere said: ‘These plans are designed to make the medical licensing processes more efficient to both reduce waiting times and ease the burden on doctors and consultants.'

She added: ‘I encourage medical and healthcare professionals to provide their views to this consultation so we can ensure we can safely improve the system in a way that suits everyone.’

To find out more about the consultation – titled Amending the Road Traffic Act 1988 to allow registered healthcare professionals to complete DVLA medical questionnaires – visit: https://www.gov.uk/government/consultations/amending-the-road-traffic-act-1988-to-allow-registered-healthcare-professionals-to-complete-dvla-medical-questionnaires

The questionnaire takes about 25 minutes to complete.

Marie Loizides, a physiotherapist by background, has been appointed as associate director of performance analytics at Barking, Havering and Redbridge University Hospitals Trust.

It’s been a busy autumn for the newly-promoted Marie, whose blog on building and implementing a digital referral tool for the trust’s musculoskeletal (MSK) pathway appeared last month on Digital Health.London’s website.

At that time, Marie held a therapy manager’s post at the east London NHS trust and wrote in her capacity as one of Digital Health.London’s latest digital pioneer fellows.

What is Marie’s project about?

The aim of Marie's digital referral tool is to enable busy clinicians to reach decisions about patients with MSK issues at the point of referral, ensuring they are streamed to the correct service straight away.

The tool, she writes, could ‘free up’ GPs’ time (to the equivalent of 13,000 appointments a year), reduce waiting lists to orthopaedic services by 30 per cent and ensure patients receive the ‘best care’.  

Marie writes: ‘In a way it will be like having the consultant in the room with the GP, as the questions and answers the tool use are those that have been written jointly between consultants and GPs.'

Marie’s unusual career path

It was great to be able to work with individuals from different trusts and NHS backgrounds with a common goal to use digital technology to improve care for our patients and wellbeing of our staff [Marie Loizides]

Having left school at 16 and going on to work as a systems administrator and programmer, Marie decided to study physiotherapy at the University of East London. To keep herself in ‘marmite and toilet rolls’, she also worked part-time in programming until graduating in 2000. 

Her passion for the NHS – fuelled by being in ‘supportive teams’ and having ‘inspirational patients’ – led to Marie specialising in MSK outpatient physiotherapy over the next two decades (she also brought up two sons – now teenagers – with husband Pete).

Working as a therapy manager re-kindled Marie’s interest in digital matters and she successfully applied for a digital pioneer fellowship, which last one year. This gave her access to a programme of structured learning supplemented by coaching in action learning sets, Marie writes in her blog.

‘It was great to be able to work with individuals from different trusts and NHS backgrounds with a common goal to use digital technology to improve care for our patients and wellbeing of our staff.’

Looking to the future

Marie, who received an Empower award in recognition of her professional development during the fellowship, adds: ‘I feel very privileged and proud to be part of this improvement journey. With MSK providing a proof of concept, my vision for the future for our health economy is to have all outpatient services (not just MSK) on a digital referral tool. In our area this will have a positive influence for over a quarter of a million referrals.'

Marie’s hobbies

Having enjoyed scuba diving while visiting Australia, Marie became an instructor and now teaches others at a diving club in Essex. She is also a keen singer – a highlight was being a member of the Funky Voices choir that supported Erasure in front of an audience of 19,000 people at the O2 in London.

To find out more about Digital Health.London, visit: https://digitalhealth.london

Potential bloggers should email: info@digitalHealth.london

To read about physio Sean Buttner’s role at Digital Health.London, visit: https://www.physioupdate.co.uk/news/in-a-qa-for-physioupdate-sean-buttner-explains-what-his-role-as-a-digital-nhs-navigator-entails/