Rehabilitation as a vehicle for change is driving occupational therapy to the healthcare frontline
Call a rehab cab! Rehabilitation as a “vehicle for change” is driving occupational therapy to the healthcare frontline – but with long covid cases surging, are OTs ready?
As predicted exactly a year ago this month by the World Health Organisation [1], specialist rehabilitation providers such as occupational therapists (OTs) are now in high demand.
Increasing numbers of people are being diagnosed with long covid and its sapping, long term symptoms [2], including:
- Fatigue.
- ‘Brain fog’ (memory and concentration difficulties).
- Sleeping problems.
- Depression and anxiety.
- Joint pain.
- Olfactory dysfunction (affecting smell and taste).
- Dizziness and breathlessness.
Now, the chief professional adviser to the Royal College of Occupational Therapists (RCOT), Karin Orman, has warned all professional members to make ready to ride the rehabilitation “vehicle for change”.
The profession cannot continue to demand inclusion in services without demonstrating its cost-effectiveness and value. 
In an editorial in this month’s British Journal of Occupational Therapy [3], Karin says: “The coronavirus pandemic has highlighted more than ever the importance of rehabilitation.
“This spotlight has also held up a lens to many of our accepted norms - that is, the predominance of reactive, acute access to occupational therapy and the narrowing of practice leading to loss of skills and the lack of outcome data.”
But, she stresses, for OTs and other Allied Health Professionals (AHPs), “the crisis has further illustrated that rehabilitation is the thread that connects services and the key to addressing some of the fundamental weaknesses of health and social care delivery.”
Karin points to “transitions between services, narrow specialisms and disjointed and reactive delivery” as examples of some of those weaknesses.
And complicating matters further, she states, are the complexities of the health conditions being tackled and inconsistencies and gaps in rehabilitation provision.
“The majority of people requiring services have multiple needs (many of which are not direct health issues but the impact on their health), and these communities are often poorly served,” she writes.
Community rehabilitation is not universal.
“People may receive rehabilitation through outpatient clinics, through condition-specific pathways or following discharge from hospital.
“Wider determinants of health may be recognised but rarely addressed as services are primarily measured against acute, crisis criteria.”
But the acute crisis of the covid pandemic and rising cases of long covid have forced a momentous shift in the nation’s healthcare priorities.
“In response to demographic need, national governments in the UK have designed policies to position services towards integrated, public health delivery with the pilot and case-for-change sites demonstrating how these might be realised,” Karin says.
“These can offer foundations for the profession to consider and action change to where and how we work with individuals and communities.”
OT on point
In the meantime, the RCOT has been advising Government teams on the most effective use of occupational therapy in meeting the rehab demands.
Recommendations include:
- Moving occupational therapy from acute and secondary settings to community and primary provision
- Keeping specialist rehabilitation as an acute option for people with high, complex need or in trauma recovery.
- Creating new community-based specialisms for OTs to retain their skills.
- Upholding evidence of occupational therapy’s impact.
The RCOT is also working with Health Education England to build a framework for advanced occupational therapy in primary care.
The framework will need to “embed approaches to population segmentation and/or stratification based on symptoms, function and need,” Karin says.
“Different approaches to population segmentation…can then be linked with acuity and dependency tools to determine the complexity of need.”
The RCOT set its top 10 priorities for occupational therapy research last year [4], but, Karin reveals, there’s a vital need for greater rigour in evidence gathering.
“Traditional data collection and research mechanisms have failed to capture evidence of sufficient quantity or quality to convince governments for the need for greater investment,” she says.
“It may now be time to move from individuals and services selecting outcome measures to a national agreement on collecting data.
“We need practitioners, researchers, and quality improvement leads to work together to develop an information model or a data set for occupational therapy.
“The profession cannot continue to demand inclusion in services without demonstrating its cost-effectiveness and value.”
