Preliminary experiences in acute occupational therapy for in-patients with coronavirus-19 (COVID-19): leveraging assistive technology in three case studies of male veterans

Abstract

Purpose

Coronavirus 2019 (COVID-19) was first identified in December 2019 with millions of cases reported globally in the succeeding months. Initial hospitalisation strives to minimise multisystem organ failure and of those that survive, individuals can present with profound rehabilitation needs. The purpose of this case series is to describe occupational therapy (OT) and special technology considerations for three male Veteran patients hospitalised with suspected or confirmed COVID-19.

Methods

This is a descriptive case series using a retrospective electronic health record review at a Veterans Administration hospital. The case series includes three male Veterans with confirmed or suspected COVID-19 (ages 69–78) who were referred to OT. The cases were selected to demonstrate the novel use of technology and strategies to reduce the risk of transmission. In two of three of our cases, we describe acute rehabilitation with a focus on activity tolerance, participation in occupations, and discharge planning. In all cases, we measured vital signs and activity tolerance as primary outcomes.

Results and conclusions

The findings suggest that outcome measures focussing on activity tolerance to maintain stable vital signs during the recovery phase is central to the progression of activities. We observed in our cases that the Person-Environment-Occupation-Performance (PEOP) model can guide practice and complement the medical model in management of these patients. We utilised technology to engage family members in the rehabilitation care and minimise exposure risks.

IMPLICATIONS FOR REHABILITATION

• Acute occupational therapy for rehabilitation early in the recovery of Cornavirus-2019 can be guided by the Person-Occupation-Environment-Performance model as seen in this case series of three Veteran patients.

• Assistive technology can serve dual roles in supporting the rehabilitation of individuals with Cornavirus-2019 and lowering the risk of virus transmission to staff.

Keywords:

• Cognition
• Coronavirus-19
• intensive care unit
• activities of daily living
• occupational therapy
• rehabilitation
• assistive technology

Introduction

Coronavirus 2019 (COVID-19) is a global pandemic with >8.5 million people infected and >200,000 deaths since January 2019 in the United States alone [1]. COVID-19 is a diffuse inflammatory condition affecting the pulmonary system with broad multisystemic effects [2]. The clinical course and prognosis for individuals with COVID-19 is largely unpredictable. Data from a recent retrospective study of 191 patients suggests that individuals with COVID-19 can develop sepsis with acute respiratory distress syndrome (ARDS) in < 12 days after initial exposure with approximately 26% of patients requiring intensive care [2,3]. An individual’s susceptibility for grave medical complications increases exponentially with pre-existing co-morbidities and advanced age [4]. For those that survive a complicated medical course, individuals will present with extensive rehabilitation needs as result of profuse debilitation, hypoxia, and multisystem failure [3]. The symptoms contribute to severe deficits in self-regulation, activity tolerance, and cognition, all of which are further exacerbated by pre-existing conditions. Occupational therapists, as members of a multidisciplinary rehabilitation team, serve a critical role in the acute and long-term management of these individuals.

Although acute occupational therapy (OT) services reduce the risk of hospital re-admission due to OT practitioner’s holistic focus on function and social needs, a typical acute hospital course is guided by the medical model [5]. A consequence of the medical model is the reductionistic view leading to problem-based care and an absence of an occupation-centered approach [6,7]. One existing model to guide acute care OT is the Person-Environment-Occupation-Performance (PEOP) model [8].

By incorporating the PEOP model into the evaluation and treatment of performance and participation in daily activities, the occupational therapist can establish a person-centered care plan (Table 1) [9]. The model integrates four components including (1) person, (2) environment, (3) occupations, and (4) performance. Person factors include physiological, psychological, cognitive, neurobehavioral, and spiritual factors. Occupational therapists incorporate assistive technology into the plan of care to compensate for components that limit the person’s ability to engage in desired activities. Some individuals with COVID-19 present with person factors that are worsened by severe physiological dysregulation and compounded by the COVID-19 environment (Figure 1). Environmental factors consider the natural and built environment, technology, and social support, among others.

Figure 1. Application of the Person-Environment-Occupation-Performance model to individuals with Coronavirus-2019. Application of the Person-Environment-Occupation-Performance model (modified from Baum et al. [9]) to reflect the observed intrinsic and extrinsic factors that impacted an individual’s ability to engage in desired occupations when recovering from Coronavirus-2019 (COVID-19).

Table 1. Acute occupational therapy evaluation guided by the Person-Environment-Occupation-Performance (PEOP) Model.

	Acute care evaluation subcomponents
Person	Current medical status and changes from baseline in intrinsic factors Physiological: Pre-existing systemic conditions, weakness, vital signs Cognition: Orientation, ability to follow directions, retention of new information, self-regulation, presence of hospital-induced cognitive issues (e.g., delirium) Psychological: Presence of pre-existing conditions and community supports Neurobehavioral: Motor skills, mobility, balance
Environment	Existing baseline extrinsic factors: Social environment: Social supports, level of caregiver assistance available Physical Environment: Home accessibility, durable medical equipment needs Environment and Technology: Consideration of technology to augment safety needs (e.g., emergency alert systems, novel use of voice command technologies for social supports) Cultural Environment Societal Environment: Access to community-based resources for transportation, day programming, check-in support.
Occupation	Baseline occupational performance Identification of the occupations needed for a safe discharge to the prior living environment.
Performance	Current physical performance of occupations in the hospital environment

The droplet nature of transmission necessitates changing all aspects of how rehabilitation services are provided in a COVID-19 environment to minimise the exposure risk to patients and staff. COVID-19 specific evidence-based guidelines are not yet developed with existing care primarily relying on the medical model. Case studies can start to bridge this gap in evidence-based practice by illustrating how the PEOP model could guide acute OT services in the COVID-19 environment. The specific aim of this study was to provide a case series with a description of the OT process involving the evaluation and treatment of patients with COVID-19 guided by the PEOP model.

Materials and methods

Study design

This study is a descriptive case series of three Veteran patients receiving acute OT in the COVID-19 environment. Twooccupational therapists (BH and AD) staffed the COVID-19 inpatient team and performed the evaluation and treatment sessions.

Participants

Local institutional review board (IRB) reviewed the request for a case series and the IRB administrator indicated that written consent and IRB oversight was not required for this case series. Verbal consent was obtained. Participants were male Veteran patients hospitalised with suspected or confirmed COVID-19 in a Level 1 A polytrauma hospital served at a Midwest Veterans Administration Health Care System. Cases were selected to examine the continuum of outcomes for recovery from COVID-19 in order to illustrate the variable severity of presenting impairment. Additionally, we describe how COVID-19 considerations influenced the practice domains of acute OT (e.g., rehabilitation, equipment needs, and use of technology). Data were collected using a retrospective review of the electronic health record. In preparing the case series, clarification was sought from the evaluating and treating therapists as needed. Inclusion criteria were as follows: (1) suspected or confirmed COVID-19 diagnosis, (2) hospitalised for COVID-19-related care, and (3) involvement in OT. Exclusion criteria were as follows: (1) COVID-19 negative testing and (2) not currently receiving OT services.

Measures

We observed an inconsistent clinical presentation in our Veterans recovering from COVID-19 given differences in baseline functioning and hospital course. These differences limited the occupational therapists from using a standard battery of outcome measures. For this case series, the primary outcome measure was activity tolerance as a measure of pulmonary function and recovery. The secondary outcome measure was the number of person factors impacted, cognition, and number of goals achieved by discharge. The measures are summarised in Table 2.

Table 2. Outcome measures following Occupational Therapy evaluation and intervention (if indicated).

	Mr. A		Mr. B		Mr. C
Outcome	Baseline	Discharge	Baseline	Discharge	Baseline	Discharge
Supplemental oxygen	6L High flow via NC	Room air	Room air	Room air	1L via NC	Room air
Therapy session duration	45 min	70 min	15 min	Eval only	30 min	43 min
# of Intrinsic factors impacted	4/5	4/5	1/5	0/5	2/5	0/5
Ability to follow commands	1 step	3 steps	WFL	WFL	WFL	WFL
Orientation	X2	X4	X4	X4	X3	X3
Grip Strength (Lbs)	Unreadable	62# Right UE, 58# Left UE	WFL	WFL	NT	NT
Assistance with bed mobility	Max A ×2	Min A ×1	Independent	Independent	Max assist	Able to laterally scoot once upright
Activity tolerance	0 min unsupported sitting at edge of bed	38 min unsupported sitting at edge of bed, mechanically assisted standing	Reported in room activity per nursing	Independent with in room and basic occupations	Dependent for all mobility	Sat for 5-10 min, tolerated 5 sit to stand transfers via non-mechanical lift
Number of acute care goals achieved at discharge		3 out of 4 goals	N/A. Evaluation only			3 out of 3 goals

Note. The baseline reflects the initial occupational therapy (OT) evaluation and the discharge reflects the completion of acute care OT services. In all three Veteran cases, the Veteran maintained >90% oxygen saturations on the prescribed supplemental oxygen or room air as indicated. The five intrinsic factors as incorporated into the Person-Environment-Occupation-Performance model include: physiological, cognition, spiritual, neurobehavioral, and psychological. A lower number of intrinsic factors impacted by the Coronavirus-2019 subjectively suggests lower severity of impairments. Full orientation × 4 reflects orientation to person, place, time, and situation. Grip strength that is reported within functional limits (WFL) indicates no reports of change grip strength and sufficient grip strength for functional tasks (transfers, use of basic grooming tools). Due to infectious disease policies, OT did not formally test grip strength if the indicators suggested grip strength was WFL. A: Assistance, Lbs: pounds, N/A: Not applicable, NC: Nasal cannula, NT: Not tested, UE: Upper extremity.

Results

Case 1

Baseline environment and performance

Mr. A is a 69-year-old African American male Veteran who lives in an accessible home. He was independent with activities of daily living skills (ADLs) and his significant other assisted with all instrumental ADLs (IADLs).

Medical history

The Veteran’s past medical history included comorbidities affecting multiple body systems with compromised respiratory and cardiac systems. He was admitted due to severe ARDS secondary to COVID-19. The Veteran’s hospital course was complicated by a 14-day intubation and he required prone positioning for 5 days for the treatment of ARDS [10].

Evaluation

Upon extubation, OT and physical therapy (PT) were consulted on day 14 to begin rehabilitation. The Veteran was co-evaluated by OT and PT as the Veteran required maximum assistance of two clinicians for basic bed mobility. During the evaluation, the Veteran was able to sit at the edge of the bed with maximum assistance of two clinicians while on high flow oxygen. Throughout the evaluation, the Veteran was able to maintain his vitals within an acceptable range (e.g., oxygenation levels >90%). The occupational therapist observed the Veteran’s participation in basic occupations of daily activities was limited by multiple person factors including postural control (e.g., weakness, upper extremity muscle tightness), activity tolerance, and self-regulation (e.g., alertness). The Veteran experienced intensive care induced delirium and was oriented to self and place only. Following the OT evaluation, the Veteran gave permission for the therapist to contact his family for additional information.

Intervention

The Veteran was seen daily for a PT and OT co-treatment session. In an effort to track progress during and across sessions, the clinicians tracked several outcomes including vital signs (i.e., heart rate, blood pressure, respiratory rate, oxygenation saturations), strength (i.e., manual muscle testing, grip strength), function (i.e., level of assist needed for various activities), activity tolerance (i.e., time tolerated during activity), and cognition.

Cognitively, the occupational therapist incorporated the Short-Blessed Test (SBT) to provide a standardised screen of cognition during the second session [11]. The SBT was selected due to its brevity and ability to be completed verbally to avoid the transfer of testing items in and out of the room. Due to impaired cognition and orientation, the Veteran was placed on delirium precautions to minimise the risk of further dysregulation. The therapists educated the Veteran on sleep/wake cycles and then worked with the medicine team to implement strategies to modify the environmental factors to promote orientation, improve sleep at night, and engage cognitively. The team’s use of strategies to promote sleep/wake cycles (e.g., scheduling window shades and lights on during the day, sitting up in the chair during the day) supported the Veteran’s medical status improvement and he started to demonstrate improvements in cognition, level of alertness, and engagement in his medical care plan as his health status improved.

Physically, the Veteran progressed quickly from supported sitting to preparatory movements for dynamic seated ADLs. The Veteran eventually progressed to mechanically assisted standing ADLs (i.e., Sara Plus Power Standing Lift). As the Veteran’s physical performance improved in follow up visits, he reported feelings of isolation and sadness with the overall recovery process. These feelings were compounded by the facility restriction on visitation due to the risk of exposure. To meet the Veteran’s emotional needs and advance his occupational engagement, the team consulted with assistive technology (AT) specialists to enhance social support while simultaneously minimising the risk of transmission. The AT specialists set up an iPad with the FaceTime function for video communication with the Veteran’s family. The iPad was attached to a rolling floor mount with adjustable height and angle. The use of “Screen Time Restrictions” were put in place for security to prevent passcode and account changes without impacting accessibility of the device. The occupational therapist, in partnership with the AT specialist, incorporated technology into the Veteran’s everyday activities and adapted the device to his accessibility needs (i.e., using voice commands, modifying fingerprint security access to phone). The occupational therapist incorporated technology into IADL performance (e.g., paying his phone bill, household tasks, etc.) during treatment sessions. As treatment progressed, the Veteran reported that his use of FaceTime, combined with additional mental health services, positively impacted his emotional status. The clinicians also observed noticeable improvements in his overall coping.

Discharge

The Veteran remained medically stable and transferred to the in-patient COVID-19 Rehabilitation Unit for intensive rehabilitation.

Case summary

Guided by the medical model, the therapist used the Veteran’s vital signs as a measure of activity tolerance to guide both the grading of activities and identification of when rest or termination of the session was indicated. The therapist’s tracking and interpretation of vital signs was critical to avoid exacerbating symptoms which could cause a worsening in his medical stability. This case demonstrates how the PEOP model can complement the medical model to provide a framework that focuses on occupational engagement.

By the therapist incorporating novel AT throughout the plan, the environment and routines were modified and personalised to the Veteran’s interests and goals. The use of AT positively impacted the Veteran’s person factors of orientation level, mood, and engagement in therapy. Creating an opportunity for social engagement by communicating with his family via technology supported the Veteran’s mental health and provided cognitive stimulation to engage in real-world responsibilities. The occupational therapist provided holistic treatment in collaboration with the medicine team and facilitated this Veteran’s progression to in-patient subacute rehabilitation.

Case 2

Baseline environment and performance

Mr. B is a 73-year-old Caucasian male Veteran who lived in an accessible home with his daughter. He reported being independent in all ADLs and mobility while receiving IADL assistance from daughter.

Medical history

The Veteran’s past medical history was significant for several comorbidities impacting multiple systems including respiratory and mental health. The Veteran was admitted due to a necrotic toe and as a COVID-19 person under investigation (PUI) due to COVID-19 symptoms. At our facility, individuals who were hospitalised as a PUI required isolation/droplet precautions and were treated as a positive case.

Evaluation

OT was consulted on day 2 to evaluate the Veteran’s weakness and to provide discharge recommendations. Nursing reported the Veteran was independent in basic occupations (e.g., self-care, toileting) and in-room activity. After discussion with the nursing staff about their observations and confidence in the Veteran’s physical abilities, the occupational therapist determined it was safe to initiate the evaluation using a novel remote video monitoring system. Remote monitoring is analogous to using telehealth technologies with one monitor fixed inside the Veteran’s room and the occupational therapist located at a computer outside of the Veteran’s room at the nurse’s station, able to view and interact with the Veteran through video [12].

The occupational therapist started the evaluation by talking to the Veteran using the remote monitoring system. The therapist reviewed the safety considerations for the evaluation. The Veteran was asked to verbalise how he was feeling during activities and if he had to sit down or felt unsafe, the therapist would discontinue remote monitoring and enter the room with appropriate PPE donned. The Veteran was agreeable to this plan and the therapist proceeded with an interview to establish the occupational profile. Following the interview, the occupational therapist progressed to functional activities. The Veteran reported excellent tolerance for basic activities (e.g., easily sitting up at the edge of the bed, transferring self to chair) and progressed to in-room ambulation to the bathroom. The Veteran provided feedback on his overall safety throughout the activities.

Intervention

Following successful completion of all physical activities, the occupational therapist reviewed the evaluation findings. The therapist’s recommendations included general discharge needs and strategies to encourage participation in daily occupations with in-room activities and ADLs to prevent deconditioning. The Veteran did not require ongoing intervention following the evaluation.

Discharge

With no equipment or additional care needs identified for the home environment, the occupational therapist recommended a return to home once the Veteran was medically safe for discharge.

Case summary

This case study explores the use of remote monitoring to evaluate the Veteran’s physical performance of the occupations needed for a safe discharge to home and potential equipment needs for the Veteran’s home environment. Through the unique application of technology, the occupational therapist was able to address the needs of the patient without prolonging the hospital course while reducing the risk of transmission to staff.

Case 3

Baseline environment and performance

Mr. C is a 78-year-old African American Veteran who lived in an accessible home with family. He used a power wheelchair for mobility. Mr. C reported assistance for self-care skills and extensive direct care from his family.

Medical history

The Veteran’s past medical history was significant for several comorbidities including multiple strokes with residual weakness, a below knee amputation, and cognitive impairment. The Veteran tested positive for COVID-19 upon admission.

Evaluation

OT was consulted on day 9 of the hospitalisation. Prior to the evaluation, the Veteran gave his permission for the occupational therapist to conduct a phone interview with his family. This strategy limited the risk of staff exposure to COVID-19 by reducing the time spent in Veteran’s room. The Veteran’s family indicated that they used a non-mechanical lift for transfers.

During the in-person portion of the OT evaluation, the Veteran required maximum assistance for bed mobility, repositioning, and dressing tasks. The Veteran’s vital signs remained stable on supplemental oxygen; however, the Veteran was observed to have an increased respiratory rate with bed mobility skills. A transfer was not attempted based on the assistance required with bed mobility and concerns about bringing non-mechanical lift equipment into the Veteran’s hospital room and the lift becoming a contaminated surface. The therapist incorporated treatment into the evaluation session by focussing on education for the Veteran and nursing staff on an upper and lower body exercise program for strength and activity tolerance. The Veteran’s participation in daily activities was limited by the person factors of decreased extremity strength, poor activity tolerance, and cognitive impairment. Following the evaluation, the occupational therapist recommended a trial of inpatient rehabilitation, but the Veteran desired to discharge directly to home. The Veteran’s family concurred and indicated that the only barrier to returning home was the Veteran’s ability to tolerate transfers using his non-mechanical lift.

Intervention

At the follow-up session, the Veteran was able to sit up on the edge of bed with increased engagement and sitting tolerance to participate in basic ADLs. Additionally, he was able to transfer to the edge of the bed. The team devised a plan to meet facility standards and minimise the risk of contamination with a non-mechanical lift by bringing in only the required equipment into the room. These modifications facilitated the successful trial of Veteran’s ability to transfer with the same non-mechanical lift (Romedic ReTurn 7500i) that Veteran had at home. The Veteran’s vital signs remained stable throughout the session.

Discharge

Based on the Veteran’s activity tolerance for transfers with the non-mechanical lift, the occupational therapist recommended that the Veteran was safe to return to home with assistance from his family, pending clearance from the medicine team.

Case summary

The assessment of the Veteran’s person factors indicated that he was functioning below his baseline and may benefit from rehabilitation. However, when combined with the Veteran’s environmental factors (i.e., accessible environment, social support), the occupational therapist created a client-centered intervention plan facilitating the achievement of the Veteran’s goal of discharging to home. This case study demonstrates special considerations for durable medical equipment use to achieve desired occupations within the constraints of a COVID-19 environment (Table 3).

Table 3. Acute occupational therapy evaluation and intervention session considerations.

	Strategies	Special considerations
Preparatory to Evaluation	Augment medical chart reviews with phone interviews with the patient and/or family to reduce exposure time.	Follow privacy considerations, obtain permission from the patient prior to contacting family members.
Model to Guide the Evaluation	Consider focussing the evaluation on the intrinsic and extrinsic factors of the PEOP model.	Collaborate with other disciplines on the desired outcome measures to avoid testing fatigue, consider using remote monitoring technology (i.e., telehealth) for the evaluation.
Communicating with Family Members	Explore the novel use of technology to enhance the evaluation or treatment session.	Utilize the patient’s own technology (smart phone/tablet) when possible, work with facility privacy officers for additional supports such as tablet video conferencing options for patients to their family members, incorporate technology by having a second clinician outside of the treatment room on remote monitoring to record outcome data.
Treatment Planning	Prepare the supplies prior to entry into the room and bring in only the necessary supplies, consider a co-treatment session with another discipline for physical assistance.	Laminate rating scales to allow a patient to point in response to a question and use of verbal screening tools to avoid paper/pencil, Address positioning of the patient to avoid muscle tightness by working with nursing. Streamline shared equipment (e.g., remove additional padding at the knees on a patient lift when it does not alter use of equipment, avoid use of the sling if it is not necessary to assess person’s ability to perform sit to stand transfer).
Vital Sign Monitoring	Conduct vigilant monitoring of Vital Signs (i.e., HR, RR, supplemental oxygen, exertion).	Current practices recommend avoiding < 90% oxygenation, RR > 30, HR < 60 or >120, SBp < 90 or > 180
Outcome Measurement	Measure outcomes each session with standardised measures when possible or qualitatively describe the effects of your session by documenting activity tolerance and achievement of goals.	Incorporate infectious disease protocols for sanitising outcome measure supplies. Progress to standardised outcome measures as the individual’s cognition allows, Documentation of outcome measures can be conducted through remote monitoring with second clinician or medical personnel documenting the results. Selection of outcome measures should weigh the duration of testing with the information gained to avoid testing fatigue.

Note. Refer to facility guidance on titrating oxygen, activity, and the use of devices for communicating with family members. In the absence of COVID-19 specific pulmonary rehabilitation guidelines, we deferred to the medicine team and standard clinical practice for the vital sign parameters. The provider modified and individualised the parameters for vital sign monitoring based on the history of baseline comorbidities and patient’s hospital course. HR: Heart rate; PEOP: Person-Environment-Occupation-Performance; RR: Respiratory rate.

Discussion

The risk of transmission of COVID-19 to both patients and clinicians has changed nearly every aspect of usual, acute care practices and interactions. To limit exposure to staff, therapists must follow the facility’s infectious disease (ID) policies and special considerations for COVID-19 (Table 3). Our facility devised several strategies to meet both the ID requirements and the rehabilitation needs of these unique patients by leveraging multidisciplinary collaboration.

To maximise the rehabilitation plan, each medicine team member embraced flexibility in their roles and responsibilities to achieve effective multidisciplinary collaboration. Our facility guidance required staff to limit their time in the Veteran’s room during the active shedding of the virus as this phase of recovery posed a high transmission risk to others [13]. To achieve this aspect of COVID-19 care, we developed a routine of anticipating and planning for all materials and equipment needs (e.g., dressing/grooming materials, hygiene supplies, laminated outcome rating scales, home exercise programs) prior to entering the patient’s room. Additionally, we found that bundling care was effective strategy to reduce the exposure risk for staff. For example, OT/PT co-evaluations can occur when it is advantageous to have one clinician working with the patient and the other clinician using remote monitoring outside of the room for the recording of vital signs and outcome measures. We selected brief outcome measures that could be completed orally to omit the need for pen and paper assessments. We found that the novel use of AT (e.g., iOS accessibility features, mounts, video conferencing for remote monitoring and therapeutic use) was effective in meeting the needs of the Veteran patients, reducing the exposure risk to staff and the use of PPE. Our experiences are facility-specific and other facilities may differ in their ID guidance given the variable access to PPE, COVID-19 testing availability, and size of the facility. Multidisciplinary collaboration is essential to achieve optimal care for patients with COVID-19.

In the context of multisystem compromise and profuse debilitation, initial OT care focuses on person physiological factors described in Table 1 to prevent secondary conditions. A focus on physiological factors is a critical first step in the individual’s rehabilitation journey [14]. Individuals with COVID-19 are unique in that the risk of decompensation is high during the timeframe when vital signs are unstable. We observed that a decline in activity tolerance was related to pulmonary function and not the patient’s motivation as also described by others (personal communications, NYC Rusk Rehabilitation Webinar “COVID-19 Conversations: Rehabilitation through the Continuum of Care”, N.D.). Therefore, vigilant monitoring of the vital signs was a core component of rehabilitation evaluation and intervention and the primary outcome measure [15]. Activities must be modified in real-time based on the vital signs and changes in clinical symptoms.

Typically, the medical model has guided occupational therapists for the treatment of medically unstable patients, delaying a focus on meaningful occupations until the patient progresses. Clinicians in other acute domains such as mental health are reporting similar trends [16]. We found that when we incorporated treatment, influenced by the PEOP model early on in a Veteran’s hospitalisation for COVID-19 care, this approach resulted in an increased participation in meaningful occupations in our patients during their rehabilitation care. There are many unknowns with the COVID-19 recovery trajectories in patients; therefore, by shifting the focus to the occupations that the patient values, OT can provide holistic care, even in the intensive care environment (Figure 1).

This case series aimed to provide a rich description of our facility’s experience in holistic, acute OT care using a PEOP model for patients and the unique considerations for minimising transmission risk of COVID-19. Our observations are limited by the retrospective case series design and lack of existing evidenced-based COVID-19 rehabilitation guidelines. To contribute to future clinical practice guidelines, studies ideally will examine the optimal timing, duration, and intensity of rehabilitation services.

During the uncertainty of global pandemic, the OT role has shown to be pivotal to the rehabilitation care of patients with COVID-19. We share our case series as a vehicle to dispel fear and illuminate the role of OT in the care of patients with COVID-19. OT practitioners are evolving our practices in response to the rapidly developing knowledge base of COVID-19 to support the care and recovery of our patients including the use of assistive technology. As a discipline, our core tenet of occupation-centered, holistic care enables our profession to support the unique values and roles of each individual, which is more important than ever as we face the COVID-19 pandemic.

Acknowledgements

We thank the Veterans with whom we serve. We thank Dr. Michael Armstrong, Mandy Smoot, MOT, OTR/L, and Marnie Roiger, OTR/L for their leadership and tireless work to establish and support the COVID rehabilitation team. We thank the medicine teams and especially the nursing staff who partner with us in our rehabilitation care.

Disclosure statement

This material is the result of work supported by and conducted at the Minneapolis VA Health Care System. The materials presented here solely represent the views of the authors and does not represent the view of the U.S. Department of Veterans Affairs or the United States Government.