Table 3.

Impact of Covid-19 pandemic on HPs practice

POSITIVE impact on the rehabilitation work due to Covid-19 pandemic
-Remarking the importance of rehabilitation in MS
-More attention to patients’ needs
-New use/Increment of tele-rehabilitation (especially through video-call)
-Easier scheduling of tele-rehabilitation sessions
-Reaching more patients, especially those living in rural areas
-Improved awareness of the utility of e-health technologies for treatment and monitoring
-More rapid development of digital solution for healthcare systems
-Improved organizational flexibility towards the new needs (e.g. exercises, sessions and scheduling adaptation to the disease stage, environment in which the patient was, presence of caregivers, presence of children to be followed)
-More efficiency (e.g. reduced time-to-travel for at-home treatments for HPs, reduced transports for patients)
-Increased health education and prevention (e.g. more hygiene, protection and safety)
-Improved disposition to do networking with other HPs in the same or other rehabilitative service
-Patients reported having more control over their rehabilitation
-Patient dedicated more attention to take care of their health status and to follow the self-maintenance exercises delivered by the HPs
-Improved resilience of patients
NEGATIVE impact on the rehabilitation work due to Covid-19 pandemic
-Social distance rules reduce the contact therapist-patient
-Strenuous conditions of work
-Reduction or interruption of hands-on rehabilitation due to closing of the rehabilitation service and impossibility to provide it virtually
-Reduction or interruption of hands-on rehabilitation due to refusal by therapist and/or patient to avoid physical contact
-Reduction or interruption of rehabilitation due to reduced motivation (and adherence) of the patient
-Reduction or interruption of rehabilitation, especially for PwMS with high disability (depending on the degree of disability telerehabilitation is not optimal)
-Reduction or interruption of group sessions
-Interruption of rehabilitation due to refusal by therapist to treat post-Covid patients
-Worsening of the physical status of many patients due to decreased physical activity
-Digital illiterate patients could not be able to remotely learn the use of tele-rehabilitation tools (e.g. how to install the app, how it works, how to manage the tools)
-Some patients did not have a computer, a smartphone or internet at home (e.g. due to lack of economic resources).
-Tele-rehabilitation prevents a regular monitoring, consultation and correction of the exercises performance
-Limitation in maintaining the multidisciplinary organizational framework
-Use of PPE impedes therapy delivery (e.g. the use of face masks limits the activity of the speech therapist)
-Anxiety, obsessive-compulsive symptomatology, depression due to Covid-19 among both therapists and patients
-Reduced work (e.g. reduction of treatments, interruption due to contact with an infected patient), reduced income
-Difficulty to educate relatives of patients