CSP COVID-19 rehabilitation standards image

The Chartered Society of Physiotherapy (CSP) has launched a third set of standards, which cover community rehabilitation and physiotherapy care for adults with COVID-19.

They apply to anyone with rehabilitation needs– aged 18 or over – who has or has had the coronavirus. The standards are relevant to people at all stages of their COVID-19 recovery, their families and carers. This is whether their care is managed in community settings throughout or if they were admitted to hospital at any stage.

Aimed at physiotherapy workers, the rehabilitation standards set out to ensure COVID-19 patients receive a high standard of care when recovering from the virus, giving them the best chance of recovering and regaining their pre-illness level of independence and quality of life.

There are seven quality standards outlined in the document:

  1. Needs assessment, rehabilitation planning and review
  2. Personalised rehabilitation
  3. Self-management
  4. Communication and information
  5. Coordinated rehabilitation and care pathways
  6. Evaluation, audit and research
  7. Personal protective equipment and infection control
  8. Ensuring a high standard of care for all COVID-19 survivors

Throughout the standards, the use of rehabilitation technology and remote monitoring is highlighted, demonstrating how technology can be used to enhance an individual’s rehabilitation plan.

Commenting on the new guidance, Sarah Di Biase, Chair of AGILE, said: “It is vital that physiotherapy workers and service managers give equal consideration to these standards if we are to ensure all Covid-19 survivors living in their communities receive the same high standard of care as those requiring hospitalisation for their Covid illness.

“Comprehensive assessment of need must be available to all adults with Covid-19 and rehabilitation needs, irrespective of the setting for their care.

“Such assessments need not only take place in the acute phase of Covid-19 illness: everyone who has survived Covid should have optimal care and support, to give them the best chance of recovering and regaining their pre-illness level of independence and quality of life.”

The standards are aimed at the physiotherapy workforce delivering rehabilitation and care in a multidisciplinary care context. CSP advises that the standards are used in coordination with local policies and procedures.

“Community rehabilitation for people who have had Covid requires a holistic approach and must consider the individual’s comorbidity or multimorbidity, not just their Covid signs and symptoms – the standards make this explicit,” Sarah added.

“It is wonderful to see an emphasis on self-management within the standards – including the need for tailored support and resources to enable self-management, which recognises the contribution of family and carers.”

1. Needs assessment, rehabilitation planning and review

This quality standard recommends that physiotherapy workers offer people with COVID-19 in community settings comprehensive, holistic needs assessments, with the opportunity to discuss, co-produce and review a personalised rehabilitation plan.

CSP advises that rehabilitation planning and goal setting should be personalised and involve shared decision making, based on what matters to the individual and their individual strengths, needs and preferences.

The society says that focussing on assessing needs, rather than the diagnosis of coronavirus, helps the person and multidisciplinary team (MDT) to develop a personalised plan to manage those needs, which includes considering other underlying health conditions as well as medical, physical, psychological, cultural and social needs.

“Needs assessment, personalised care planning and review should be an ongoing and proactive process that is both planned and responsive to changing needs,” CSP adds.

“The needs of people with Covid-19 can fluctuate, therefore care plans and rehabilitation goals should be continually reviewed. People with Covid-19 may deteriorate rapidly and need urgent hospital admission. Regular needs assessment helps ensure signs of deterioration are recognised and appropriate care and/or rehabilitation is in place.”

2. Personalised rehabilitation

The rehabilitation standards also suggest that people with COVID-19 in community settings are offered personalised, equitable and timely rehabilitation that is appropriate to their needs and preferences. According to CSP, this will facilitate faster recoveries and enable patients to potentially return to work sooner.

Importantly, the standards recognise the potential of technology to support an individual’s rehabilitation programme, noting: “The potential of technology-enabled rehabilitation requires consideration taking into account the person’s needs and preferences.”

In July 2020, CSP commissioned the University of Manchester to evaluate the use of remote physiotherapy consultations during the coronavirus pandemic, discovering which technologies are successful in different contexts.

Findings from the research project will provide a clear indication of which technologies are successful in different contexts, recommendations for successful implementation and examples of good service models.

3. Self-management

Furthermore, the quality standards suggest that people with COVID-19 in community settings are offered supported self-management to develop their capability to manage their own health and wellbeing.

According to the society, self-management should take into account a person’s level of activation, level of dependency on others, health literacy and understanding in order to tailor support and resources accordingly.

Again, CSP highlights that rehabilitation technology should be taken into consideration, where appropriate, to further support the individual’s recovery. This could include apps, patient networks and online platforms such as the NHS’ Your Covid Recovery.

4. Communication and information

“Communication with people with Covid-19 in community settings and their families and carers is effective and information offered in an accessible way, personalised to their needs and preferences,” the rehabilitation standards further outline.

CSP says that information should be communicated with the COVID-19 patient in a timely and accessible way in order to support decision making. According to the society, this opens up a two-way communication channel between the physiotherapy worker and the patient, ensuring that their rehabilitation needs are continuously met throughout their recovery.

Although the standards endorse the use of technology to communicate information with patients, CSP underlines that some people might be digitally excluded, so their needs should be considered to ensure they have access to information quickly.

5. Coordinated rehabilitation and care pathways

Physiotherapy workers are also advised to ensure that people with COVID-19 in community settings receive equitable, personalised rehabilitation that is seamlessly coordinated within multidisciplinary teams, and across all relevant settings and services.

Focusing on integrated care, CSP outlines that patients should have a seamless rehabilitation experience, with clear and accurate information exchange between relevant health and social care professionals. This may involve integrating a combination of core and specialist expertise.

6. Evaluation, audit and research

The sixth rehabilitation standard recommends that community physiotherapy services undertake evaluation, audit, research and share good practice to understand the needs of people with COVID-19, improve the quality of services, optimise outcome and experience, and address inequalities.

Again highlighting the importance of collaboration across services, CSP adds that community physiotherapy and rehabilitation services should collaborate with people with COVID-19, their families and carers to evaluate, improve and redesign services.

7. Personal Protective Equipment and infection control

The final rehabilitation standard focuses on personal protective equipment (PPE), stating that the physiotherapy workforce should have access to appropriate PPE when providing face-to-face care.

Physiotherapy workers are advised to liaise with local infection control policies as well as follow national PPE guidance to ensure both staff and patients are protected from catching or spreading COVID-19.

As part of this standard, CSP says that adequate training on the correct of use of PPE needs to be provided to the physiotherapy workforce to ensure confidence in using the equipment before and after delivering rehabilitation sessions. This also includes ensuring correct disposal of PPE.

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