Telerehab for patients recovering from COVID-19

Telerehab for COVID tips

• As with any virtual rehab, make sure the patient/their family is prepared for a remote consultation and has all the information they will need in advance. Signpost the patient to the ‘Your COVID Recovery’ website and encourage them to make a list of questions before the appointment.

• In your assessment, consider risk, comorbidities and what is currently known about COVID.
• Long-COVID symptoms can arise at any time. Look out for subtle signs that might give an early indication of a long-COVID diagnosis, including general apathy or if the patient is struggling to progress with rehab.
• Look out for long-COVID red flags that indicate a need for urgent treatment – for example, severe chest pain, rapidly worsening breathlessness, mononeuropathies or abnormal movements.

• Pacing is key – start small and don’t ask the patient to do too much. ‘Your COVID Recovery’ suggests logging activity in an activity diary for a week or two, and then looking for ‘boom and bust’ patterns, establishing a regular baseline of activity and then building activity by no more than 10% a week, guided by activity monitors.
• Encourage setting of personal, short-term and medium-term goals.
• Try to do the consultation at a time of day when the patient is less fatigued, and keep the session short. Consultations can be done from the patient’s bed if necessary.
• Be mindful of cognitive effort, not just physical effort:
  

  Do not overload the client as using technology is effortful and can be cognitively challenging.

  Occupational Therapist, Traumatic Brain Injury

• Recognise that the patient and their family may be anxious about COVID and its long term effects. Listen to their concerns and provide reassurance that this is normal and that they are not alone. (see 'Your COVID Recovery: After a stay in ICU'). This information is aimed at young people aged 12 years and above. (see 'Your COVID Recovery: 'Managing emotions and feelings').
• Provide general wellbeing advice including exercise, sleep and healthy eating (see ‘Your COVID Recovery: Your road to recovery’).
• Be aware that COVID affects people differently and there is no ‘set pathway’ for improvement. Rehabilitation needs will differ between individuals and may change over time.

• Depending on the intervention, some telephone support may assist with maintaining adherence and motivation to a programme. Many post critical care patients have issues that arise which make them wary of exercising, and so to wait until the next scheduled session often results in up to a week or more of inactivity which could have been prevented.

• You may find the Borg Rating of Perceived Exertion (RPE) scale helpful to assess effort and exertion, breathlessness and fatigue when the patient is resting or carrying out different tasks. This can be used in conjunction with heart rate monitoring if the patient has an activity monitor (such as a Fitbit®).
• For details of COVID-specific assessment tools (e.g. C19-YRS, PICUPS, PCFS), see our Remote measures and assessment tools section. These may be used for screening as well as assessment of outcomes.