Occupational therapy can play an important role in the rehabilitation process for long Covid patients. — Photos: Filepic
Malaysia has hit more than 4.2 million Covid-19 cases, with a total of more than 35,000 deaths, in over two years of the global pandemic.
With an average hospital stay of six to 18 days, many were left with significant debilitation and functional impairment from complications of the infectious disease.
Such patients experienced continuing symptoms up to 12 weeks (or longer) after their initial infection, even when they were supposed to have already recovered.
The UK National Institute for Health and Care Excellence (NICE) defines post-acute Covid-19, also called long Covid, as:
- Ongoing symptomatic Covid-19 for people who still have symptoms between four and 12 weeks after the start of acute symptoms, and
- Post-Covid-19 syndrome for people who still have symptoms for more than 12 weeks after the start of acute symptoms.
These symptoms are the result of the infection’s effects on the function of various organs and body systems in a patient.
According to Health director-general Tan Sri Dr Noor Hisham Abdullah, a clinical study conducted by the Health Ministry revealed that two out of three patients from categories 4 and 5 suffered from long Covid.
Long Covid may also occur in the mild to moderate category 1 to 3 infections.
The symptoms usually present in overlapping clusters that change over time, affecting different systems within the body.
The persisting and new possible symptoms of long Covid are extensive (see video below).
Among them are significant ongoing health problems such as breathing difficulties, enduring fatigue, reduced muscle strength, impaired ability to perform important daily tasks, and mental health problems.
The consequences of such persisting symptoms may prevent the patient from resuming normal life, thus reducing their quality of life, disturbing their career and productivity, and potentially causing other serious impacts such as increased illness, disability and loss of income.
Occupational therapy for long Covid
All post-Covid-19 patients in categories 4 and 5 will be followed up and given an appointment upon discharge, whereas those in the other categories can be referred to health facilities for further assessment and management if their symptoms persist.
The treatment for long Covid is based on the symptoms and body functions involved.
Without specific treatment, the condition will persist and require a longer recovery period before the patient is fully functional again.
In addition to medical follow-up and investigation, long Covid patients require rehabilitation services such as occupational therapy and physiotherapy to facilitate their return to either normal function or adapting to normal activities if they have some residual disability.
Occupational therapy focuses on addressing occupational performance and impairments to functional cognition that may follow long Covid.
By using a holistic approach, occupational therapists (OTs) will conduct a comprehensive assessment on the physical, cognitive, psychological and functional abilities of such patients.
The assessments will evaluate the persistency of symptoms affecting a person’s life and daily activities, including work, education, mobility, independence and psychological well-being.
OTs have a range of established intervention options to specifically address the effects of symptoms on occupational performance and cognitive function.
Examples of such interventions include daily living skills training, return to driving and return to work programmes, cognitive stimulation, environmental adaptations, and use of compensatory strategies in daily tasks.
Below are the main ways OTs can help long Covid patients:
Fatigue is one of the most significant symptoms of long Covid.
This symptom subsequently reduces the ability to perform daily living activities, mobility and work.
OTs will train patients to perform basic daily activities of living, such as transferring (e.g. from bed to chair), grooming, toileting, bathing and feeding, and instrumental activities of daily living, such as cooking, doing laundry and safety precautions.
The aim of daily living skills training is to ensure that patients can perform activities of daily living safely and independently, as much as possible, in a gradual manner.
During this training, OTs will guide and encourage patients to explore various ways to perform the target tasks.
They are encouraged to use equipment that can assist in reducing both time and energy consumption, such as electrical appliances, lightweight pots and pans, and bathing using a long-handled sponge, comb and/or brush.
To maximise their energy reserves, patients are encouraged to use energy conservation techniques, such as sitting on a stool while doing activities, using a cart to avoid lifting and carrying, and cooking larger portions to avoid having to frequently cook.
Additionally, they can rearrange and store their most used and heavier items in the lower kitchen cabinets, closets and refrigerator for easy reach.
This will assist in preserving energy among lethargic and fatigued patients.
Long Covid symptoms could affect those who are still working.
Such patients commonly experience continuing fatigue, breathlessness, wheezing while talking, short-term memory problems, and limitations in decision-making.
During occupational therapy intervention, patients are guided to apply energy conservation and work simplification techniques in their work activities.
At the same time, they are recommended to plan and prioritise their daily tasks.
Important and more complex tasks are advised to be completed at the beginning of the day, while non-essential tasks are suggested to be eliminated.
Larger tasks can be broken down into smaller tasks and distributed throughout the day.
Patients are taught to self-monitor to accommodate the level of energy needed on daily tasks, such as sitting down whenever suitable and frequently changing body positions.
Taking more regular breaks also helps to accommodate the changes to the respiratory system and reduce tiredness.
Patients are also advised not to rush to complete tasks.
Some may even need to change their roles and routines.
OTs will do task and habit training to assist patients to adapt to their symptoms and daily needs.
The use of compensatory strategies such as adaptive equipment and work environment modifications will help lighten tasks and reduce fatigue.
Light and acceptable physical exercise is encouraged to increase endurance and body fitness.
Gradual introduction of physical exercise into the daily routine will help patients cope with fatigue and low endurance.
Patients are advised to be physically active gradually, in a safe manner.
Post-Covid-19 patients do not necessarily have to start with intensive exercise.
They can begin by doing daily activities and avoiding sedentary behaviour like watching television, sleeping or resting the whole day.
In response to the functional cognitive impairment of long Covid, OTs will use core aspects of the occupational therapy process to assess the patient’s most common cognitive symptoms.
For those who are constantly fatigued, OTs can advise on energy conservation techniques, such as sitting whenever possible while doing daily activities like cooking (used for illustration purposes only).
These can include confusion, slower processing, executive function difficulties, impaired safety awareness, short-term memory impairment, lack of insight and brain fog.
For example, with short-term memory problems, patients may experience limitations in their performance of previously routine tasks.
To manage this, they are encouraged to use compensatory strategies such as external memory aids like smartphones, writing notes, calendar reminders and an orientation board to compensate for the functional cognitive impairment.
Family members, colleagues and employers should also accommodate the impairment by allowing patients to have more response and processing time.
Tolerance and patience are important to create an ideal and supportive environment for patients.
During occupational therapy intervention, cognitive stimulation will be given to promote a healthier brain and resumption of its functionality.
OTs have a variety of therapeutic cognitive activities to accomplish this, including memory games, table games, card games, arts and crafts, social activities, etc.
Long Covid patients may have psychological problems due to their symptoms or other related factors before and after the infection.
These psychological effects include reduction in the sense of accomplishment and satisfaction due to limitations in performing activities, disruption of their role function, and diminished quality of life due to changes in functional abilities and isolation.
These effects can lead to anxiety, depression and other psychological problems.
OTs address psychological issues by fostering the patient’s occupational engagement, empowering self-efficacy and enabling coping skills.
Using specific therapeutic interventions, OTs will demonstrate the correct relaxation techniques to reduce recurrence of symptoms by way of slowing the heart and breathing rates, lowering blood pressure, increasing blood flow and reducing stress hormones.
Improving function
Occupational therapy interventions can be done individually or in a group based on the goals of the treatment.
Interventions are mainly conducted in the hospital or rehabilitation centre, but OTs will always provide patients with exercises or tasks to practice and perform at home.
Consistency and compliance to rehabilitation will improve the patients’ occupational performance and quality of life tremendously.
Long Covid patients with persistent symptoms and functional impairment are strongly encouraged to go for occupational therapy to help them return to their normal level of daily functioning.
Siti Fairuz Ismail is an occupational therapist and lecturer at the Perdana University Graduate School of Medicine. This article is courtesy of Perdana University. For more information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
