| COVID infectivity |
Limited patients' access to rehabilitation because of isolation procedures
4
,
14
,
47
,
62
,
72
and rehabilitation facility closures.
27
,
64
,
122
Physical distancing difficult to implement.
13
Constrained therapists' ability to provide rehabilitation in common areas as they typically would.
24
Restricted use of usual therapies owing to potential aerosol transmission.
58
,
59
,
65
,
74
Prevented the involvement of families in the care of COVID patients.
127
|
| Patients' health status |
Variability in severity of COVID infection made prescribing and initiating rehabilitation challenging.
4
,
49
,
56
,
60
,
70
Severe disability heightens risk of fatigue and respiratory decompensation, which limits the range of therapies that can be provided.24, 34, 40
Lack of clarity about which patients are stable enough to receive rehabilitation using a virtual modality, thereby limiting the use of telerehab.
69
|
| Lack of evidence/guidelines |
Makes reorganizing care difficult since it is not clear which patients require rehabilitation and the type(s) of rehabilitation to be provided.21, 30, 34, 53, 63, 78, 110, 123
Absence of evidence pertaining to virtual care especially challenging for provision of telerehab.69, 74
|
| Personal protective equipment |
Insufficient personal protective equipment causes rationing of supplies and thereby challenges team assembly, shift schedules, and the overall ability to provide rehabilitation in an infectious environment.4, 13, 27, 35, 49, 63, 64, 65, 73, 76, 106, 107, 127
Use of personal protective equipment also affects communication between clinicians and patients.
127
|
| Staff‐related issues |
Declines in staff wellness, increased burnout, and staff shortages limit the extent and quality of rehabilitation provision to COVID patients.20, 34, 35, 104, 107, 127
Increased workloads.
80
Health care provider fear of infection and transmission to own families was challenging.
138
|
| Health system issues |
Lack of coordination across all levels of the health care system limits effective delivery of rehabilitation to patients across care settings (e.g., in hospital, at home).
27
,
56
,
70
,
71
Existing billing procedures are stringent and burdensome for physicians and take away from patient care time and quality.
4
,
65
Key challenge for developing nations is that they may not have an existing comprehensive rehabilitation system or disaster‐response systems that include rehabilitation.
13
,
106
Lack of funding to support telerehab and other infrastructure.86, 107
|
