We don’t fully understand yet how COVID-19 is going to affect the occupational therapy (OT) profession long-term. Right now, depending on where you work as an OT, you may still be going into work (as in my case working at a hospital). You may be navigating the implementation of virtual therapy (as are many of my school-based colleagues and friends are doing). You may work in academia where your primary focus is now on online coursework. Further still, you may work in a private practice or institution that can no longer afford you and you are without a job.
COVID-19 Impact on the OT Profession
Wherever you are as an OT, there is no doubt that COVID-19 has impacted your daily work. For me, as someone who is still expected to go into work, we are seeing fewer and fewer patients and are constantly wondering what other challenges we might face. Like many of us still working, we have worried coworkers who have children or elderly parents at home and are burdened with the uncertainty of how safe it is to be at work while still being expected to focus on tasks outside of direct patient care. Productivity, as we know it, will be affected as we try to reconcile our new normal.
This is an opportunity, albeit a forced one, to be creative in our treatment and care for our patients. If this pandemic had happened 20 or 30 years ago, we would not have had the options we have now with the innovation within technology. We are physically isolated but virtually intertwined. With our OT treatments, we need to think outside the box and use the technology and tools we have. As OTs we are nothing if not creative, right?
Staying Connected to OT Patients
First, therapists can remain connected to their patients, check in on them, and reassure them via technology like MyChart apps, email, video conferencing, text, or even via a good old phone call. OTs can do live one-on-one video conferencing with platforms like Zoom, Webex, or FaceTime. Virtual sessions can allow OTs to teach patients basic techniques like assisted range of motion, scar massage, and desensitization, as well as demonstrate and complete exercises in real time.
OTs can film themselves showing exercises and send these to their patients. Some platforms, like PhysiTrack, have virtual exercise services where therapists can assign exercises to patients and send them via email. Many of these programs come with accountability tracking to assist with compliance. OTs can also utilize group calling as needed, as well as write and send newsletters to patients to keep them feeling calm, informed, and connected.
Supporting OT Patient Progress
Second, OTs can help enable patients, where possible, to take control of their treatment and rehabilitation. At the very least OTs can work toward the goal for patients to be independent in their home exercise programs (HEPs) and use technology to support them through this. With the current situation, OTs can really make this goal a focus, concurrently supporting the patient’s autonomy and sense of self-reliance in a client-centered way.
Get Family Members Involved
Third, this is an opportunity for families to be actively involved in care as they are able and comfortable. Patients can involve kids in their therapy where they can do exercises together. Exercises can be structured by the OT to work with this new set of parameters and it can be a way for families to bond and come together.
For those with patient populations that need more physical assistance, OTs can focus on caregivers and train them on techniques that are appropriate and safe to do at home, alongside regular check-ins and virtual support. Time of crisis can foster creativity and innovation if we allow them too and people may surprise you with their ingenuity.
OT Teletherapy Options During COVID-19
Fourth, teletherapy can be a great option as the world focuses on physical distancing. With OT patients, there are different aspects to consider in determining the ability for patients to succeed in teletherapy: technology accessibility, age, health status, socioeconomics, severity of condition, surgery or not, and specialized skills. For example, as a hand therapist in an outpatient clinic, many of my patients can have successful gains through teletherapy. They can cognitively grasp instruction and most of them are internet literate and can use a technology like video conferencing and email.
There are some cases where teletherapy may be more challenging. For example, postoperative patients often require wound care, dressing changes, and splinting. Typically, post-surgery, they will see their surgeon within the first week to ten days after surgery to check dressings and be fitted with an orthosis. If a therapist is unavailable to fabricate an orthosis (splint), a doctor or physician assistant can create a modified dressing for the patient, such as with a flexor tendon repair.
During an outbreak like this, elective surgeries are postponed but incidents still occur that may require surgery. In the event that someone is waiting on an elective surgery, such as a cubital tunnel release, hip replacement, or rotator cuff repair, the therapist can be invaluable remotely by educating the patient on positioning, use of prefabricated orthoses (if applicable), night time positioning, and movement of unaffected joints and body parts while the patient awaits a procedure. In trying times, teletherapy can help even if it just reduces the required number of visits to a doctor’s office through virtual follow-ups. Video sessions allow therapists to observe the patient performing their exercises or to see their scar and advise appropriately.
The Overall Impact of COVID-19
Hopefully, COVID-19 has taught us to be more prepared for disasters with staff trained for pandemics and the provision of sufficient personal protective equipment. For occupational therapy, this is an opportunity to practice in a new way. It can be difficult to change, but we need to focus on how we can adapt to circumstances to best help our patients. COVID-19 has taught us that we need to rely on one another now more than ever and has given us the opportunity to assess what is really important. We are a resilient species who have overcome many catastrophic events. I have no doubt we will conquer this if we shift our mindset and focus on the silver lining.
Dr. Julie Fernandes is a graduate of the post-professional Doctor of Occupational Therapy program at Rocky Mountain University of Health Profession. Currently, she works as a Clinical Specialist at NYU Langone Health. When not at work, she enjoys discussing topics around working moms, traveling with kids, parenting mindset, reducing screen time, and more.
YouTube: Babies Who Brunch
E-mail: [email protected]