Understanding the impact of the Covid-19 pandemic on delivery of rehabilitation in specialist palliative care services: An analysis of the CovPall-Rehab survey data

  1. Joanne Bayly
  2. Andy Bradshaw
  3. Lucy Fettes
  4. Muhammed Omarjee
  5. Helena Talbot-Rice
  6. Catherine Walshe
  7. Katherine E Sleeman
  8. Sabrina Bajwah
  9. Lesley Dunleavy
  10. Mevhibe Hocaoglu
  11. Adejoke Oluyase
  12. Ian Garner
  13. Rachel L Cripps
  14. Nancy Preston
  15. Lorna K Fraser
  16. Fliss EM Murtagh
  17. Irene J Higginson
  18. Matthew Maddocks

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Abstract

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.

Aim:

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.

Design:

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.

Findings:

61 completed responses (England, n = 55; Scotland, n = 4; Wales, n = 1; and Northern Ireland, n = 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.

Conclusion:

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.

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  1. Version published to 10.1177/02692163211063397
  2. ScreenIT

    SciScore for 10.1101/2021.04.13.21255380: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Research ethics committee approval was obtained from King’s College London Research Ethics Committee (21/04/2020, Reference; LRS 19/20-18541 ISRCTN16561225).
    Consent: Completion of the survey indicated consent.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Experimental Models: Organisms/Strains
    SentencesResources
    Throughout this process, JB, AB, and MM and wider members of the CovPall team acted as ‘critical friends’ 26 by challenging, questioning, and contributing to the interpretation of findings.
    AB
    suggested: RRID:BDSC_203)
    Software and Algorithms
    SentencesResources
    Data Collection: REDCap was used to build and host the survey.
    REDCap
    suggested: (REDCap, RRID:SCR_003445)
    Data analysis: Descriptive analysis using SPSS (v24) was conducted to provide contextual data to inform qualitative analysis.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    Free text responses were analysed in NVivo (v12) using reflexive thematic analysis.22, 23 JB and AB familiarised themselves with the free-text data, coding inductively at a sematic level.
    NVivo
    suggested: (NVivo, RRID:SCR_014802)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    ISRCTN16561225NANA

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.04.13.21255380v1 on medRxiv