Recovery and rehabilitation during and after the COVID-19 pandemic: framework for supporting people

6. Rehabilitation

The WHO defines rehabilitation as ‘a set of interventions designed to optimize functioning and reduce disability in individuals with health conditions in interaction with their environment. Health condition refers to disease (acute or chronic), disorder, injury or trauma. A health condition may also include other circumstances such as pregnancy, ageing, stress, congenital anomaly, or genetic predisposition. Rehabilitation thus maximizes people’s ability to live, work and learn to their best potential. Evidence also suggests that rehabilitation can reduce the functional difficulties associated with ageing and improve quality of life’’.

Rehabilitation is a process that requires participation and collaboration with the individual to enable them to recover, incorporating a wide range of enablers including, but not limited to, health and social care professionals, the individual and their family and carer and society as a whole. It is therefore a vital part of an individual’s recovery from injury, illness or deconditioning and is inclusive of their physical and mental health and wellbeing needs within their social environment.

This is particularly relevant to individuals hospitalised with coronavirus (COVID-19), shielded groups and people where the emerging literature highlights that there may be increased levels of anxiety, depression, delirium, cognitive impairment and post-traumatic stress disorder as outlined in previous sections.

WHO Rehabilitation in Health Framework (figure. 1) highlights the need for a tiered approach that should be community based and population led where possible. It is therefore essential that individuals, communities, third and independent sectors play a crucial role alongside the NHS, Health and Social Care Partnerships and Local Authorities in the delivery of contemporary rehabilitation and trauma informed care in Scotland. This includes involving formal local structures such as Community Planning Partnerships to facilitate engagement from the ground up.

It is important that the individual and their family or carers are at the centre of the approach and see the right person in the right place at the right time to meet their specific needs, in addition to building on and further strengthening current practice by ensuring expertise in both physical and mental health care are utilised. This includes taking all steps necessary to enable self-management to take place where appropriate.

The delivery of this is dependent on a community based multi-disciplinary team inclusive of professions from all sectors that may include but not be limited to physiotherapy, occupational therapy, speech and language therapy, dietetics, nursing, psychology, social work, and medicine.

The wider impact, which coronavirus (COVID-19) is having on people makes rehabilitation even more important now than ever.

Specialized, High-intensity Rehabilitation

Predominantly tertiary care for people with complex rehabilitation needs during the acute and sub-acute phase of care. Commonly occurs in longer-stay rehabilitation hospitals, centres, units and departments.

Rehabilitation Integrated Into Medical Specialties In Tertiary And Secondary Health Care

For people with less complex rehabilitation needs and often for a short period during the acute and sub-acute phase of care. Commonly occurs in tertiary and secondary level hospitals and clinics.

Rehabilitation Integrated Into Primary Health Care

Delivered within the context of primary health care, which includes the services and professionals that act as a first point of contact into the health system. Commonly occurs in primary health care centres, practices and may include community settings.

Community-delivered Rehabilitation

Predominantly secondary care delivered in community settings during the sub-acute and long-term phases of care. Commonly through multiple programmes that provide care in homes, schools workplaces and other community settings.

Informal And Self-directed Care

This form of care, not rehabilitation service, occurs where no rehabilitation or health personnel are present. Commonly occurs in homes, schools, parks, health club or resorts, community centres and long-term care facilities.