The COVID-19 crisis has dramatically transformed the organization of public rehabilitation services around the world. Rehabilitation practitioners have faced different challenges at all stages of patient management from acute departments to home, especially in the periphery of the country.
The Physical Medicine and Rehabilitation department atthe Soroka University Hospital is a part of the Southern regional rehabilitation network, and was forced to find optimal solutions to all kinds of organizational challenges from the first days of the crisis. Most of those solutions, which, in our opinion, showed their effectiveness in managing our patients in this confused situation, are presented and discussed in the article.
We are sure, that our adapted strategies can be helpful to our colleagues in other parts of the world.
Rehabilitation; Corona crisis; COVID-19; Management
The corona crisis has raised many difficulties to health systems, both, in Israel and around the world, causing the necessity to make systemic changes-often “on the run” and sometimes as an immediate, emergent solution to problems encountered throughout components of the entire system [1-3]. Although most of the pressure at this stage was exerted on the resources of urgent and less so, preventive medicine, rehabilitation healthcare systems were also required to adapt to the constantly changing terrain during this period [4,5]. It should be noted that Physical Medicine and Rehabilitation, as a profession, is uniquely positioned to help COVID-19 patients, both, conceptually and practically. Physical Medicine and Rehabilitation physicians have always put the quality of life of a patient affected by illness or injury front and center [6,7]. This is a necessary approach to COVID-19 sufferers and survivors, from the initial disease stages up to and including maximal improvement of the patient .
As clinical reports are just beginning to be publicized, and there is no clear scientific or evidence-based consensus, all the specific aspects of rehabilitation of COVID-19 patients are still unclear . However, a fair amount of experience has already been gained both, in our country and the world, regarding the mechanics of the rehabilitation system in an environment of epidemiologic, social and institutional limitations during the corona crisis . In our opinion, especially in light of reports indicating the possibility of the crisis continuing over a prolonged time, it is of great importance to analyze and share the adapted management mechanisms of the rehabilitation system at local, regional or state levels [11,12]. The medical system in the periphery of a country has special restrictions and organizational problems everywhere, including Israel, so the analysis of local regional challenges and solutions during the corona crisis in rehabilitation is especially important.
The Department of Physical Medicine and Rehabilitation at Soroka University Hospital in Be’er Sheva, Israel was established five years ago. The department has twenty beds and a catchment area of the entire southern half of Israel. It is a general rehabilitation unit, caring for patients with all diagnoses, including stroke, spinal cord injury, brain injury, orthopedic surgeries, neuropathies, and trauma. We are located within an acute-care hospital, which is a Level 1 trauma center servicing the entire southern half of the country. We function as a part of the Southern Regional Rehabilitation Network together with the outpatient Rehabilitation Unit of the Clalit Health Fund. This structure gives us the professional opportunity to follow and manage our patients from the acute department to inpatient rehabilitation and from there to outpatient programs as one seamless process. Here, we'll present and discuss our COVID-19 crisis challenges and solutions in our region at the periphery of the country.
Social distancing and an awareness of the danger of being infected cause a number of social phenomena, such as:
A) Fear of leaving the house (and certainly to present to a hospital) results in a delay to seek and receive emergency medical treatment. This increases the number of patients with severe functional impairment and the need for prolonged rehabilitative care. Had they sought medical care in a timely fashion the impairments would have been minimalized.
B) Fear of contact with people and lack of awareness of the consequences of refraining from rehabilitating causes cancellation of participation in day hospitalization programs, in some cases leading to closure of outpatient rehabilitation day programs. This has especially occurred in the periphery of the country, which has fewer physicians, beds, and a lower socioeconomic population.
C) There is a preference for some families and patients who have undergone significant health events to opt for rehabilitation at home rather than to receive intensive inpatient rehabilitation.
D) There has been refusal by patients in the periphery to seek outpatient rehabilitation care in the center of the country due to difficulties in getting relatives to transport them, or due to transport limitations.
E) Closure of some of the support post-rehabilitation frameworks that assist chronic patients, such as social clubs, due to incompatibility with the requirements of social distancing.
Possible challenges and solutions in community rehabilitation
The ongoing COVID-19 crisis presents different challenges to regional rehabilitation systems, especially at the periphery of the country. Our solutions, presented here, showed their effectiveness in our regional rehabilitation network, and can be helpful to our colleagues in different places in the world, facing the same or similar problems of system management.
Citation: Treger LL, Friedman A, Treger I (2020) Rehabilitation during the COVID-19 Crisis: A View from the Periphery. J Clin Immunol Immunother 6: 028.
Copyright: © 2020 Lena Lutsky Treger, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.