Content uploaded by Yelena Bogdanova
Author content
All content in this area was uploaded by Yelena Bogdanova on May 20, 2023
Content may be subject to copyright.
EDITED BY
Sureshkumar Kamalakannan,
Public Health Foundation of India, India
REVIEWED BY
Nirmal Surya,
Epilepsy Foundation India, India
*CORRESPONDENCE
Fransiska Bossuyt
fransiska.bossuyt@paraplegie.ch
RECEIVED 24 February 2023
ACCEPTED 21 April 2023
PUBLISHED 15 May 2023
CITATION
Bossuyt FM, Bogdanova Y, Kingsley KT,
Bergquist TF, Kolakowsky-Hayner SA, Omar ZB,
Popova ES, Tobita M and Constantinidou F
(2023) Evolution of rehabilitation services in
response to a global pandemic: reflection on
opportunities and challenges ahead.
Front. Rehabil. Sci. 4:1173558.
doi: 10.3389/fresc.2023.1173558
COPYRIGHT
© 2023 Bossuyt, Bogdanova, Kingsley,
Bergquist, Kolakowsky-Hayner, Omar, Popova,
Tobita and Constantinidou. This is an
open-access article distributed under the terms
of the Creative Commons Attribution License
(CC BY). The use, distribution or reproduction in
other forums is permitted, provided the original
author(s) and the copyright owner(s) are
credited and that the original publication in this
journal is cited, in accordance with accepted
academic practice. No use, distribution or
reproduction is permitted which does not
comply with these terms.
Evolution of rehabilitation services
in response to a global pandemic:
reflection on opportunities and
challenges ahead
Fransiska M. Bossuyt1*, Yelena Bogdanova2,3, Kristine T. Kingsley4,5,
Thomas F. Bergquist6, Stephanie A. Kolakowsky-Hayner7,
Zaliha Binti Omar8,9, Evguenia S. Popova10, Mari Tobita11,12
and FofiConstantinidou13
1
Neuro-musculoskeletal Functioning and Mobility Group, Swiss Paraplegic Research, Nottwil, Switzerland,
2
Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States,
3
Physical
Medicine & Rehabilitation, VA Boston Healthcare System, Boston, MA, United States,
4
Institute of
Emotional and Cognitive Wellness, New York, NY, United States,
5
Department of Psychology, Teachers
College, Columbia University, New York, NY, United States,
6
Department of Physical Medicine and
Rehabilitation, Mayo Clinic, Rochester, MN, United States,
7
Department of Research and Clinical
Outcomes, Good Shepherd Rehabilitation Network, Allentown, PA, United States,
8
Department of
Rehabilitation Medicine, University Malaya, Kuala Lumpur, Malaysia,
9
Department of Rehabilitation
Medicine 1, Fujita Health University, Aichi, Japan,
10
Department of Occupational Therapy, Rush University,
Chicago, IL, United States,
11
Rancho Los Amigos National Rehabilitation Center, Downey, CA, United
States,
12
Rancho Research Institute, Downey, CA, United States,
13
Center for Applied Neuroscience &
Department of Psychology, University of Cyprus, Nicosia, Cyprus
The rapidly evolving COVID-19 public health emergency has disrupted and
challenged traditional healthcare, rehabilitation services, and treatment delivery
worldwide. This perspective paper aimed to unite experiences and perspectives
from an international group of rehabilitation providers while reflecting on the
lessons learned from the challenges and opportunities raised during the
COVID-19 pandemic. We discuss the global appreciation for rehabilitation
services and changes in access to healthcare, including virtual, home-based
rehabilitation, and long-term care rehabilitation. We illustrate lessons learned by
highlighting successful rehabilitation approaches from the US, Belgium, and Japan.
KEYWORDS
pandemic, rehabilitation, COVID-19, long term care facilities, telerehabilitation
Introduction
One in every three people will need rehabilitation services at some point in their lifetime
(1). Yet, not only rehabilitation services remain underappreciated and under-resourced, the
ageing population and increase in non-communicable conditions resulted in a significant
increase in absolute physical rehabilitation needs of 66% worldwide between 1990 and
2017 (2). Importantly, this increase was nearly twice as high with 112% for low-income
countries which are expected to have underdeveloped rehabilitation services (2). More
specifically, Asia-Pacific, Latin America & Caribbean, as well as South Asia and Sub-
Saharan Africa regions presented greatest changes in the absolute, relative, and percentage
of physical rehabilitation needs (3). The Rehabilitation 2030 Initiative by the World
Health Organization (WHO) draws attention to the profound and global unmet need for
rehabilitation services (4). The COVID-19 pandemic further disrupted and challenged
traditional healthcare, rehabilitation services, and treatment delivery. Furthermore, the
pandemic established a new set of clinical priorities, with survivors of COVID-19 often
TYPE Perspective
PUBLISHED 15 May 2023
|
DOI 10.3389/fresc.2023.1173558
Frontiers in Rehabilitation Sciences 01 frontiersin.org
presenting with significant rehabilitation needs, which are now
being investigated by the rehabilitation community (5).
In addition to barriers to healthcare and rehabilitation services
(6–8), the implementation of social distancing measures through
various phases of the pandemic imposed multiple barriers and
challenges for already vulnerable populations, including the
elderly, women, economically disadvantaged, racial and ethnic
minorities, uninsured, homeless, and the disability communities
(9). Individual vulnerability combined with the lack of timely
access to healthcare may have led to and exacerbated the
disproportionate health risks experienced by people with
disabilities during the COVID-19 pandemic (10). Furthermore,
women were more likely to experience psychological disorders
and be subjected to intimate partner violence because of
quarantine (11,12). The COVID-19 pandemic has robustly
affected global mental health and highlighted the importance of
mental health care services. Specifically, a meta-analysis of 20
studies on psychological issues suggested an overall prevalence of
symptoms such as anxiety and depression among the general
population ranging from 28% to 36% (13). The negative physical
and mental health outcomes associated with COVID-19, stressed
the importance of timely quality care for patients within
vulnerable communities, including people with disabilities and
other pre-existing health conditions who were at a higher risk of
infection (14,15). Despite the barriers that emerged during the
pandemic, changes to care and rehabilitation were also found to
be a facilitator affecting the lives of vulnerable populations
through for example new innovations (7).
Although the COVID-19 pandemic resulted in an accelerated
publication rate in rehabilitation, with 18% of all publications
published between 2019 and 2022 including the term
“rehabilitation”(Pubmed, Jan 2023: 133.534), only recently, there
has been a first collection of publications addressing the
challenges and opportunities of health systems, rehabilitation
care, and COVID-19 (16). Therefore, this perspective paper aims
to unite findings, experiences, and perspectives from an
international group of rehabilitation providers on the challenges
and opportunities resulting from the COVID-19 pandemic.
Challenges and opportunities ahead
A new diagnosis
In January 2023, COVID-19 was diagnosed in more than 660
million individuals in 229 countries and territories around the
globe, resulting in 6.7 million deaths and over 638 million
recoveries (17). Though men and women are reported to
contract COVID-19 at similar rates, gender differences have been
noted in the prognosis. While men are reported to have higher
morbidity and mortality (18–20) and a more extensive lung
disease process (21); women are more likely to be affected by the
lingering effects of COVID-19 and with long-COVID syndrome,
otherwise known as long-COVID (22–25). Long-COVID refers
to a constellation of symptoms present three months after the
onset of COVID-19 symptomatology and persisting for at least
two months (26), and presents in a new type of disability for
healthcare and rehabilitation providers. A meta-analysis
demonstrated that over 20% of COVID-19 patients displayed
fatigue or cognitive impairment at 12 weeks post-infection,
regardless of infection severity or hospitalization (27). Researchers
across the globe continue their work to characterize the outcomes
(23,24,28) and causes of these symptoms, but the severe immune
response to COVID-19 seems to be one of the leading causes.
Large consortia have been created, and many government agencies
supported initiatives to prospectively study the course of long-
COVID. While research efforts are underway across the globe, the
U.S. Veterans Health Administration (VHA) has established more
than 20 long-COVID programs, providing multidisciplinary care
for veterans with long-COVID, as well as a Long-COVID
Community of Practice connecting clinicians leading efforts to
care for veterans with long-COVID (29). Of interest, the
community has been investigating the emerging neurobehavioral
phenotypes, including post-traumatic stress disorder, physical and
mental fatigue, and neurocognitive dysfunction. Growing
knowledge about the long-term impact of COVID-19 calls for
ongoing research and knowledge translation of novel rehabilitation
approaches designed to support COVID-19 recovery (30).
Responses to COVID-19 across the
globe
Differences in how countries responded to the pandemic and
adjusted their rehabilitation services demonstrate variability in
healthcare systems and priorities (31,32). For example, following
recommendations from the Centers for Disease Control and
Prevention (CDC) and the WHO, governments in Europe,
North/South America, Africa, and Asia including 12 low-income,
middle-income and high-income countries tried to reduce the
duration of inpatient treatments (31). To this effect, a scoping
review with studies from different countries including most
commonly the US, the U.K., and Brazil, showed significant
disruption to healthcare during the pandemic and worsening
health outcomes in persons with disabilities (7). In Germany, the
pandemic caused a reduction in the number of medical
rehabilitation requests by 14.5% (33). In a low-income country
such as Jordan, where rehabilitation services in public hospitals
are limited to outpatient clinics, retrospective data analysis of
records of 32,503 patients between January 2020 and February
2021 showed a significant decline in those reaching rehabilitation
services, reaching almost zero in May 2020, this was followed by
an increase exceeding the number of patients accessing
rehabilitation services prior to the onset of the pandemic (34).
As a response of the second wave, the number of patients who
visited the rehabilitation clinics reduced again reaching a plateau
in February 2021. In South Africa, with a national healthcare
system characterized by stark discrepancies between the public
and private sector on account of institutional segregation policies,
the vast majority of rehabilitation services were allocated to
private hospitals catering to the more affluent and White
populations (35). For persons with disabilities, results from 35
Bossuyt et al. 10.3389/fresc.2023.1173558
Frontiers in Rehabilitation Sciences 02 frontiersin.org
countries within Europe, including 99% of the population (809.9
million), showed a halt of admissions to rehabilitation, early
discharge, reduction of activities in 194.800 inpatients in 10
countries, and termination of outpatient activities for 87%
involving 318.000 patients per day in Italy, Belgium and the U.K.
(36). In addition, over 76% of the cardiac rehabilitation programs
across 70 countries in Africa, America, Eastern Mediterranean,
Europe, South-East Asian and Western Pacific were stopped or
ceased due to the pandemic (37).
This was not a global response; in other parts of the world
rehabilitation services were deemed more of a priority. A registry-
based study from Norway, including 1310 hospitalized patients
with traumatic brain injury (TBI), demonstrated that the direct
pathway to early specialized rehabilitation was maintained during
2020–2021 (38). Similarly, while Japan commonly follows the
recommendations of the CDC and WHO, the Japanese
government and the leading Medical Rehabilitation Organization
did not recommend early discharge from the hospital (39,40).
Although in isolation and depending on the individual medical
facility, some patients received inpatient rehabilitation until they
were able to regain full independence in the community. Given
Japan’s universal health insurance system, an extended stay in the
hospital did not result in higher costs from the point of infection
control for the entire country, where the living environment is
densely populated, compared to other countries. In addition, under
the pre-existing Universal Health Coverage (41) and long-term
care insurance (42), patients undergoing treatment for COVID-19
in Japan automatically qualified to receive rehabilitation services.
Access to care
One of the most significant transformations in the delivery of
healthcare services due to the pandemic has been innovation in
remote delivery of care, including the use of telehealth. What
seemed improbable pre-pandemic is now becoming an option of
care currently reimbursable by insurances for individuals with
limited access to physical healthcare facilities in many countries
(37). Rehabilitation interventions administered in-person pre-
COVID for individuals with cognitive disabilities and their
caregivers are now offered remotely and with good results.
Telehealth proved instrumental in rehabilitation, and offers
opportunities to continue supporting healthcare access and
optimize access for vulnerable populations through optimization
of financial, educational, and cyber-security infrastructure (43).
Many professional associations and some government agencies
across the globe [e.g., the European Speech and Language pathology
association (ESLA), Government agencies and professional
organizations guidance for Tele-rehab (44,45)] are creating and
publishing guidelines for remote consultation and treatment,
providing online and live webcast sessions with experts to train
rehabilitation providers and caregivers. In some countries, a
hybrid model of service delivery (combination in-person and
remote healthcare services) is becoming a standard of care. In
response to the COVID-19 pandemic, members of the Task Force
for research at the Indian Federation of Neurorehabilitation
reviewed the context of tele-neurorehabilitation providing
implications for practice of tele-neurorehabilitation in low- and
middle-income countries (46). As these services continue to
evolve, longitudinal health and functional outcome assessments
will be essential to monitor effectiveness and support the future
direction of healthcare and rehabilitation systems.
The growth of telehealth and other remote services is not only
seen with COVID-19 patients but also within the healthcare system
for medically vulnerable individuals and persons with limited
access to healthcare in isolated areas of the world, including rural
areas and parts of the world impacted by disaster and war.
Telehealth has been shown to support patient-provider
communication when face-to-face interaction is not possible (6).
Telehealth benefits, such as improved treatment accessibility,
continuous care, and opportunity for interdisciplinary
rehabilitation, as well as reduced cost and travel burden,
encourage the future development of telehealth-based treatment
programs and home-based rehabilitation protocols.
Telehealth and home-based rehabilitation
Telehealth, home-based rehabilitation programs, and various web-
based interventions were introduced early in some medical centers in
the US (47,48)andJapan(49–51). The Neurorehab TBI Clinic at the
Boston VA Healthcare System and Boston University School of
Medicine was among the first to utilize the new technology for
home-treatment delivery. The Virtual Care LED TBI Program
provides portable neuromodulation home treatment with telehealth
support for patients with chronic TBI, Post Traumatic Stress
Disorder, and sleep disturbance (47,52,53). The Neurorehab TBI
clinic was converted to virtual care immediately following the
COVID-19 social distancing guidelines and continues to provide
virtual clinical care to date. The patients who completed the
rehabilitation program reported improved cognitive and
neurobehavioral symptoms (29,48,54) and opted to continue the
long-term home treatment program and virtual care visits even after
the pandemic restrictions were lifted. Following the initial success of
the home-based treatment program, the Neurorehabilitation LED
TBI Clinical team expanded its services to provide virtual care to
patients post TBI in 15 other states across the U.S. Furthermore, the
team supported ongoing professional development by offering
virtual training for the VA PMR providers across the U.S.
In Japan, dedicated virtual consultation services were
introduced early in the pandemic through the Japanese Infectious
Disease Prevention Act, where public health centers became
responsible for infectious disease control and prevention (55,56).
An improved version of teleconsultation service, supported by
the local government, was reported in Hiroshima city, and
included a hotline for COVID-19 center available 24-hours a
day, providing online consultation in 10 languages. The
interdisciplinary team included a manager, medical doctors,
nurses, and pharmacists, that could be consulted on a variety of
medical needs resulting from COVID-19, ranging from
interpretation of symptoms, prescription, delivery of medications,
and arrangements for rehabilitation (57).
Bossuyt et al. 10.3389/fresc.2023.1173558
Frontiers in Rehabilitation Sciences 03 frontiersin.org
Despite the many benefits to telehealth, barriers to telehealth
access were also noted. In some cases, patients who were
receiving care at home did not have the resources (computers,
reliable internet, and privacy) to engage in telehealth sessions.
The lack of resources in low-income countries could explain why
approaches of telehealth were limited in e.g., Tanzania (31).
Indeed, a Cochrane qualitative review on factors that influence
the provision of home-based rehabilitation services including 223
studies of which 8 were performed in low- and middle-income
countries, found that despite multiple factors that facilitate
home-based rehabilitation, in low-income settings in specific,
worse or no internet connectivity, high technology costs, lack of
technology, risk of being robbed in public spaces when using
tablets, and capacity to invest in infrastructure and maintenance
were barriers for home-based rehabilitation (43). These results
demonstrate the importance of low- or no-cost technologies,
easy-to-use technologies, as well as training and support when
implementing home-based rehabilitation (43). In long-term
facilities, telehealth proved hard to structure because it still
required someone within the facility to set up and supervise the
process. In Europe, several countries have not yet established
laws to regulate telehealth, and in some countries, telehealth
practice is prohibited. In an effort to address regulation barriers
to telehealth access, ESLA issued a statement on the importance
of telehealth in service provision (58). The Directorate General of
Health, Food, and Drug in the European Union endorsed this
statement. This was a significant achievement that led the way to
changes in laws and regulations in Europe and had a spreading
effect on other healthcare professions.
Furthermore, telehealth, was noted to not be conducive to all
types of conditions and rehabilitation services. For example, in
speech-language pathology, online swallowing tests were
recommended only as screenings; full evaluations and
interventions were discouraged. In physical therapy, requests to
allow therapists to treat patients remotely were deemed
impractical or even unsafe. As a result, in the U.S., Centers for
Medicare & Medicaid Services motioned to deny payment for
certain types of telehealth services.
During this process, many allied health professionals became
strong advocates, not only for their patients but also for their
profession. On several occasions, professionals took action by
writing letters to Ministries of Health and introducing protocols
that would inform safe practice. These actions allowed allied
health professionals in Europe, for example, working with the
National Health System, to notify state officials and
administrators as to what rehabilitation specialty consists of and
what allied health care professionals do.
Impact on long-term care rehabilitation
Long-term care facilities (LTCFs) inhabiting vulnerable
populations, including the elderly and persons with disability, are
at significant risk for massive outbreaks of viruses, including
COVID-19 (59). COVID-19 deaths in LTCFs including nursing
homes, assisted living facilities and group homes made up over
20 percent of all COVID-19 deaths in the US (60,61). This
share has dropped over time for a variety of reasons including
high rates of vaccinations among residents and staff, an increased
emphasis on infection control procedures, declining nursing
home occupancy, but also lack of data in LTCFs in recent
months (60). While these challenges increased burden on the
staff (62,63), they also offered opportunities as presented in the
success stories below.
Success story from Belgium
Dominiek Savio is one of the most prominent institutes for
more than 500 children and adults with physical disabilities in
Belgium, a country in which on May 3rd 2020, 53% of all deaths
due to COVID-19 were in care homes (64). Given over 80% of
the population served suffer from chronic airway diseases,
Dominiek Savio reacted quickly to minimize any risk of an
outbreak within the institute. Their success was demonstrated
over the first 4.5 months of the pandemic; with 0% of
the patients served within the institute testing positive for
COVID-19. Lessons learned and opportunities for rehabilitation
were examined using semi-structured interviews with the
COVID-19 follow-up representative and coordinating director.
At the onset of the pandemic, the board of directors selected a
group of three persons that were given authority to make decisions
and implement measures against the spread of the virus. The two
medical doctors of the institute provided the team with the latest
updates via their network. Challenges could be tackled within the
organization with the support of their medical team, including 2
medical doctors, 28 nurses, and 5 healthcare providers. Because
of the fast-shrinking supply of personal protective equipment
(PPE), residents safely produced face masks in the workshop.
Proactive actions that supported a timely response to the
pandemic was the initiative taken one year before the onset of
the COVID-19 pandemic, to sensitize employees on the
importance of hygiene (e.g., through the availability of automatic
hand disinfectants and provided instructions on the use of PPE).
Despite the lockdown, all patients received the treatments and
rehabilitation they needed while considering the well-being of both
patients and employees. Initiatives such as the Chatbus, i.e., a bus
separated in two parts by a plastic wall allowed contact between
residents and visitors. Infographics were created and distributed
to allow residents to make informed decisions about vaccination
and PPE. Through the pandemic, the team adjusted their
strategies, and in January 2022, they reduced the burden on the
staff and residents by limiting the amount of PPE to Filtering
Face Piece 2 masks. The call center “Coronafoon”allowed to
collect and monitor the number of positive cases and provide
timely information to the leadership team. The implementation
of an emergency plan with a barometer which incorporates four
main principles (1. Solidarity, 2. Contextuality, 3. Differentiation,
4. Well-being of the patients and employees) gives guidance and
trust for the future. The years of investment in solidarity and
commitment amongst employees to improve the quality of life of
persons with a disability proved its impact.
Bossuyt et al. 10.3389/fresc.2023.1173558
Frontiers in Rehabilitation Sciences 04 frontiersin.org
Success story from Japan
Similar strategies were observed in Japan, which presented low
mortality and morbidity rates in care homes (65). For example, the
long-term care insurance introduced in 2000 had been revised and
matured enough at the time of the pandemic (66). The wide range
of coverage continued to care for the needs of the elderly and people
with disabilities. Furthermore, standard operating procedures for
rapidly spreading infections, like influenza, were already in place
in nursing homes, long-term daycare facilities, and home
rehabilitation services. Hence infection control measures for
COVID-19 were akin to an extension of this service. Nursing
homes readily implemented national policies during the pandemic
through communication between residents and family members
on a virtual platform. In addition, recreational activities like
gardening, exercise, music, and other therapies were modified and
not completely halted. Finally, access to alternative rehabilitation
services was readily available in situations where a daycare center
had to be closed due to a COVID cluster; users could access
alternative services, including telehealth and home services.
Discussion
The COVID-19 pandemic offered insights into how different
countries across the globe prioritize rehabilitation. Those countries
that were not able to provide continued rehabilitation services
during the pandemic are expected to suffer from detrimental
consequences, including increased rates of chronic diseases,
growing healthcare costs, and reduced overall quality of life. To
accommodate the patient’s needs and address the challenges in the
COVID-19 pandemic, rehabilitation specialists have devised
innovative ways to deliver rehabilitation services for patients and
caregivers. Continued research of innovative interventions and
remote treatment delivery methods (including development and
evaluation of the most optimal and lasting rehabilitation
outcomes, capacity building of patients, caregivers, families, and
providers as well as eliminating barriers to infrastructure and
financing) and government support is needed to inform clinical
recommendations and rehabilitation guidelines around the globe.
Common findings from the presented success stories from LTCFs
demonstrate the importance and effectiveness of a comprehensive
approach where health care and rehabilitation are a critical part of
one another as well as preparedness and having systems that can
reduce the impacts of large-scale unexpected disruption to
services, such as the COVID-19 pandemic.
The presented stories from high-income developed countries
also align with challenges and recommendations from the low-
income countries Jordan (34) and India (46), and the low-income
under developed country Bangladesh (67). Although scarce, the
emerging literature on low-income and under developed countries
highlighted the need for multidisciplinary rehabilitation teams
with scale-up of rehabilitation services (67). A recent article from
South Africa reported how the consequences of discontinued,
restricted or disrupted rehabilitation led to a reappraisal of the
field as an essential service and highlighted the competencies of
rehabilitation specialists as paramount in managing recovery and
mental health needs (35).
The unpreparedness to react effectively and promptly to the
pandemic was presented as one of the significant public health
challenges (68). Identifying lessons learned and raising opportunities
is a crucial step to improving global preparedness and ability to
understand the multidimensional effects of the pandemic across
social, technological, economic, and health contexts. Future research
needs to identify the long-term impact of the pandemic on
rehabilitation, health, and mortality across the globe and in different
populations, including vulnerable populations. Rehabilitation
medicine has evolved in response to the health impact of
pandemics, wars, and natural disasters (69–72). On each occasion,
thepeoplearoundtheglobewereabletocometogetherto
overcome the challenges presented, and move toward advancement
of rehabilitation medicine. The COVID-19 pandemic has provided
the opportunity to continue evolving our approaches, and the
rehabilitation community is called to continue innovating in the future.
Data availability statement
The original contributions presented in the study are included
in the article, further inquiries can be directed to the corresponding
author.
Author contributions
FB, YB, KK, and FC initiated the present work. All authors
substantially contributed to the conception or design of the
work. FB contacted the Dominiek Savio Institute (Belgium). FB,
YB, KK, and FC drafted the first manuscript version. All authors
contributed to the article and approved the submitted version.
Funding
This study has been supported by the Swiss Paraplegic Research.
Acknowledgments
This publication has been established within the COVID-19
Taskforce of the International Interdisciplinary Special Interest
Group of the American Congress of Rehabilitation Medicine.
The authors wish to thank Kaat Delrue and Marnix Crevits from
the Dominiek Savio Institute in Belgium for their time and support.
Conflict of interest
The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
Bossuyt et al. 10.3389/fresc.2023.1173558
Frontiers in Rehabilitation Sciences 05 frontiersin.org
Publisher’s note
All claims expressed in this article are solely those of the
authors and do not necessarily represent those of their affiliated
organizations, or those of the publisher, the editors and the
reviewers. Any product that may be evaluated in this article, or
claim that may be made by its manufacturer, is not guaranteed
or endorsed by the publisher.
References
1. Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vos T. Global estimates
of the need for rehabilitation based on the global burden of disease study 2019: a
systematic analysis for the global burden of disease study 2019. Lancet. (2021) 396
(10267):2006–17. doi: 10.1016/S0140-6736(20)32340-0
2. Jesus TS, Landry MD, Hoenig H. Global need for physical rehabilitation:
systematic analysis from the global burden of disease study 2017. Int J Environ Res
Public Health. (2019) 16(6):980. doi: 10.3390/ijerph16060980
3. Jesus TS, Arango-Lasprilla JC, Kumar Kamalakannan S, Landry MD. Growing
physical rehabilitation needs in resource-poor world regions: secondary, cross-
regional analysis with data from the global burden of disease 2017. Disabil Rehabil.
(2022) 44(19):5429–39. doi: 10.1080/09638288.2021.1933619
4. WHO. Rehabilitation 2030 Inititative (2017). Available at: https://www.who.int/
initiatives/rehabilitation-2030 (Accessed February 24, 2023).
5. Houben S, Bonnechere B. The impact of COVID-19 infection on cognitive
function and the implication for rehabilitation: a systematic review and meta-
analysis. Int J Environ Res Public Health. (2022) 19:13. doi: 10.3390/ijerph19137748
6. CDC. Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and
Prevention. (2020). Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/
telehealth.html (Accessed February 24, 2023).
7. Croft S, Fraser S. A scoping review of barriers and facilitators affecting the lives of
people with disabilities during COVID-19. Front Rehabil Sci. (2021) 2:784450. doi: 10.
3389/fresc.2021.784450
8. Jesus TS, Bhattacharjya S, Papadimitriou C, Bogdanova Y, Bentley J, Arango-
Lasprilla JC, et al. Lockdown-Related disparities experienced by people with
disabilities during the first wave of the COVID-19 pandemic: scoping review with
thematic analysis. Int J Environ Res Public Health. (2021) 18(12):6178. doi: 10.3390/
ijerph18126178
9. Lugo-Agudelo LH, Spir Brunal MA, Posada Borrero AM, Cruz Sarmiento KM,
Velasquez Correa JC, Di Dio Castagna Iannini R, et al. Countries response for
people with disabilities during the COVID-19 pandemic. Front Rehabil Sci. (2021)
2:796074. doi: 10.3389/fresc.2021.796074
10. Kamalakannan S, Bhattacharjya S, Bogdanova Y, Papadimitriou C, Arango-
Lasprilla JC, Bentley J, et al. Health risks and consequences of a COVID-19
infection for people with disabilities: scoping review and descriptive thematic
analysis. Int J Environ Res Public Health. (2021) 18(8):4348. doi: 10.3390/
ijerph18084348
11. Allen-Ebrahimian. China’s domestic violence epidemic (2020). Available at:
https://www.axios.com/2020/03/07/china-domestic-violence-coronavirus-quarantine
(Accessed May 28, 2021).
12. COVID-19 and violence against women: What the health sector/system can do
(2020). Available at: https://apps.who.int/iris/bitstream/handle/10665/331699/WHO-
SRH-20.04-eng.pdf?ua=1 (Accessed January 6, 2023).
13. Alzueta E, Perrin P, Baker FC, Caffarra S, Ramos-Usuga D, Yuksel D, et al. How
the COVID-19 pandemic has changed our lives: a study of psychological correlates
across 59 countries. J Clin Psychol. (2021) 77(3):556–70. doi: 10.1002/jclp.23082
14. Jesus TS, Kamalakannan S, Bhattacharjya S, Bogdanova Y, Arango-Lasprilla JC,
Bentley J, et al. People with disabilities and other forms of vulnerability to the
COVID-19 pandemic: study protocol for a scoping review and thematic analysis.
Arch Rehabil Res Clin Transl. (2020) 2(4):100079. doi: 10.1016/j.arrct.2020.100079
15. Jesus TS, Kamalakannan S, Bhattacharjya S, Bogdanova Y, Arango-Lasprilla JC,
Bentley J, et al. PREparedness, REsponse and SySTemic transformation (PRE-RE-
SyST): a model for disability-inclusive pandemic responses and systemic disparities
reduction derived from a scoping review and thematic analysis. Int J Equity Health.
(2021) 20(1):204. doi: 10.1186/s12939-021-01526-y
16. Kiekens C, Duttine A, Mishra S, Sabariego C. Health systems, rehabilitation care
and COVID-19: challenges and opportunities. Front Rehabil Sci. (2023) 4:1134461.
doi: 10.3389/fresc.2023.1134461
17. Worldometer. Cornovirus Pandemic (2023). Available at: www.worldometers.
info/coronavirus (Accessed January 6, 2023).
18. Bwire GM. Coronavirus: why men are more vulnerable to COVID-19 than
women? SN Compr Clin Med. (2020) 2(7):874–6. doi: 10.1007/s42399-020-00341-w
19. Cagnacci A, Xholli A. Age-related difference in the rate of coronavirus disease
2019 mortality in women versus men. Am J Obstet Gynecol. (2020) 223(3):451–3.
doi: 10.1016/j.ajog.2020.05.035
20. Rozenberg S, Vandromme J, Martin C. Are we equal in adversity? Does COVID-
19 affect women and men differently? Maturitas. (2020) 138:62–8. doi: 10.1016/j.
maturitas.2020.05.009
21. Dangis A, De Brucker N, Heremans A, Gilis M, Frans J, Demeyere A, et al.
Impact of gender on extent of lung injury in COVID-19. Clin Radiol. (2020) 75
(7):554–6. doi: 10.1016/j.crad.2020.04.005
22. Pelà G, Goldoni M, Solinas E, Cavalli C, Tagliaferri S, Ranzieri S, et al. Sex-
Related differences in long-COVID-19 syndrome. J Womens Health. (2022) 31
(5):620–30. doi: 10.1089/jwh.2021.0411
23. Ramos-Usuga D, Perrin PB, Bogdanova Y, Olabarrieta-Landa L, Alzueta E,
Baker FC, et al. Moderate, little, or No improvements in neurobehavioral symptoms
among individuals with long COVID: a 34-country retrospective study. Int
J Environ Res Public Health. (2022) 19(19):12593. doi: 10.3390/ijerph191912593
24. Phosp. Clinical characteristics with inflammation profiling of long COVID and
association with 1-year recovery following hospitalisation in the UK: a prospective
observational study. Lancet Respir Med. (2022) 10(8):761–75. doi: 10.1016/S2213-
2600(22)00127-8
25. Bai F, Tomasoni D, Falcinella C, Barbanotti D, Castoldi R, Mule G, et al. Female
gender is associated with long COVID syndrome: a prospective cohort study. Clin
Microbiol Infect. (2022) 28(4):611 e9–611 e16. doi: 10.1016/j.cmi.2021.11.002
26. WHO. Cornovirus disease (COVID-19): Post COVID-19 condition. (2021).
Available at: https://www.who.int/news-room/questions-and-answers/item/
coronavirus-disease-(covid-19)-post-covid-19-condition?gclid=CjwKCAiAqt-dBhBcEi
wATw-ggNC6I96OGLHxFz3xpPPcm-Y0srnw6b7EGzRiXylRrDyOgGulumUvRhoCb
2EQAvD_BwE (Accessed December 16, 2021).
27. Ceban F, Ling S, Lui LMW, Lee Y, Gill H, Teopiz KM, et al. Fatigue and
cognitive impairment in post-COVID-19 syndrome: a systematic review and meta-
analysis. Brain Behav Immun. (2022) 101:93–135. doi: 10.1016/j.bbi.2021.12.020
28. Tabacof L, Tosto-Mancuso J, Wood J, Cortes M, Kontorovich A, McCarthy D,
et al. Post-acute COVID-19 syndrome negatively impacts physical function, cognitive
function, health-related quality of life, and participation. Am J Phys Med Rehabil.
(2022) 101(1):48–52. doi: 10.1097/PHM.0000000000001910
29. US Veterans, Health, and Administration. Available at: https://recovercovid.org/
(Accessed February24, 2023).
30. Fugazzaro S, Contri A, Esseroukh O, Kaleci S, Croci S, Massari M, et al.
Rehabilitation interventions for post-acute COVID-19 syndrome: a systematic
review. Int J Environ Res Public Health. (2022) 19(9):5185. doi: 10.3390/
ijerph19095185
31. Bettger JP, Thoumi A, Marquevich V, De Groote W, Battistella LR, Imamura M,
et al. COVID-19: maintaining essential rehabilitation services across the care
continuum. BMJ Glob Health. (2020) 5(5):e002670. doi: 10.1136/bmjgh-2020-002670
32. Lugo-Agudelo LH, Cruz Sarmiento KM, Spir Brunal MA, Velasquez Correa JC,
Posada Borrero AM, Fernanda Mesa Franco L, et al. Adaptations for rehabilitation
services during the COVID-19 pandemic proposed by scientific organizations and
rehabilitation professionals. J Rehabil Med. (2021) 53(9):jrm00228. doi: 10.2340/
16501977-2865
33. Bethge M, Fauser D, Zollmann P, Streibelt M. Reduced requests for medical
rehabilitation because of the SARS-CoV-2 pandemic: a difference-in-differences
analysis. Arch Phys Med Rehabil. (2022) 103(1):14–19 e2. doi: 10.1016/j.apmr.2021.
07.791
34. Almasri NA, Dunst CJ, Hadoush H, Aldaod J, Khader Y, Alrjoub A, et al. Impact
of the COVID-19 pandemic and governmental policies on rehabilitation services and
physical medicine in Jordan: a retrospective study. Int J Environ Res Public Health.
(2023) 20(3):1972. doi: 10.3390/ijerph20031972
35. van Biljon HM, van Niekerk L. Working in the time of COVID-19: rehabilitation
clinicians’reflections of working in Gauteng’s Public healthcare during the pandemic.
Afr J Disabil. (2022) 11:889. doi: 10.4102/ajod.v11i0.889
36. Negrini S, Grabljevec K, Boldrini P, Kiekens C, Moslavac S, Zampolini M, et al.
Up to 2.2 million people experiencing disability suffer collateral damage each day of
COVID-19 lockdown in Europe. Eur J Phys Rehabil Med. (2020) 56(3):361–5.
doi: 10.23736/s1973-9087.20.06361-3
37. Ghisi GLM, Xu Z, Liu X, Mola A, Gallagher R, Babu AS, et al. Impacts of the
COVID-19 pandemic on cardiac rehabilitation delivery around the world. Glob
Heart. (2021) 16(1):43. doi: 10.5334/gh.939
Bossuyt et al. 10.3389/fresc.2023.1173558
Frontiers in Rehabilitation Sciences 06 frontiersin.org
38. Tverdal C, Brunborg C, Helseth E, Andelic N, Koch M, Roe C, et al. Referrals to
early specialized rehabilitation after traumatic brain injury during the COVID-19
pandemic. J Rehabil Med. (2022) 54:jrm00334. doi: 10.2340/jrm.v54.2203
39. Japanese Association. Guidelines for infection control. Japanese Association of
Rehabilitation Medicine (2022). Available at: https://www.jarm.or.jp/document/
guideline_jarm_infection.pdf (Accessed February 21, 2022).
40. Japanese Ministry. COVID-19: Guidelines of Medical Care. The Japanese
Ministry of Health Labour and Health (2022). Available at: https://www.mhlw.go.jp/
content/000936655.pdf (Accessed July 22, 2022).
41. Ikegami N, Yoo B-K, Hashimoto H, Matsumoto M, Ogata H, Babazono A, et al.
Japanese Universal health coverage: evolution, achievements and challenges. Lancet.
(2011) 378(9796):1106–15. doi: https://doi.org/10.1016/S0140-6736(11)60828-3
42. Yamanouchi Y, Maeda K, Shinoda Y, Majima M, Lee J, Inoue I, et al. Can
outpatient rehabilitation be continued during the COVID-19 pandemic? a report
from a Japanese Regional Medical University Hospital. Arch Rehabil Res Clin
Transl. (2022) 4(3):100199. doi: 10.1016/j.arrct.2022.100199
43. Velez M, Lugo-Agudelo LH, Patino Lugo DF, Glenton C, Posada AM, Mesa
Franco LF, et al. Factors that influence the provision of home-based rehabilitation
services for people needing rehabilitation: a qualitative evidence synthesis. Cochrane
Database Syst Rev. (2023) 2(2):CD014823. doi: 10.1002/14651858.CD014823
44. US. Telehealth for behavioral health & health care providers. (2023). Available
at: https://telehealth.hhs.gov/providers/best-practice-guides/ (Accessed February 24,
2023).
45. Australian Government. MBS Telehealth Services. Department of Health &
Aged Care. (2023). Mbsonline.gov.au. Available at: http://www.mbsonline.gov.au/
internet/mbsonline/publishing.nsf/Content/Factsheet-telehealth-1July22 (Accessed
February 7, 2023).
46. Srivastava A, Swaminathan A, Chockalingam M, Srinivasan MK, Surya N, Ray P,
et al. Tele-Neurorehabilitation during the COVID-19 pandemic: implications for
practice in low- and middle-income countries. Front Neurol. (2021) 12:667925.
doi: 10.3389/fneur.2021.667925
47. Bogdanova Y, Gilbert K, Baird L, Naeser M. LED Home treatment program for
chronic TBI and PTSD: clinical program evaluation. Arch Phys Med Rehabil. (2019)
100(12):e187–8. doi: 10.1016/j.apmr.2019.10.077
48. Bogdanova Y, Sokol O, Gilbert K. Home-based photobiomodulation treatment
for cognitive and neuropsychiatric symptoms in TBI. Arch Phys Med Rehabil.
(2021) 102(10):e81–2. doi: 10.1016/j.apmr.2021.07.715
49. Mukaino M, Tatemoto T, Kumazawa N, Tanabe S, Katoh M, Saitoh E, et al. An
affordable, user-friendly telerehabilitation system assembled using existing
technologies for individuals isolated with COVID-19: development and feasibility
study. JMIR Rehabil Assist Technol. (2020) 7(2):e24960. doi: 10.2196/24960
50. Tatemoto T, Mukaino M, Kumazawa N, Tanabe S, Mizutani K, Katoh M, et al.
Overcoming language barriers to provide telerehabilitation for COVID-19 patients: a
two-case report. Disabil Rehabil Assist Technol. (2022) 17(3):275–82. doi: 10.1080/
17483107.2021.2013962
51. Kumazawa N, Koyama S, Mukaino M, Tsuchiyama K, Tatemoto T, Tanikawa H,
et al. Development and preliminary evaluation of a tele-rehabilitation exercise system
using computer-generated animation. Fujita Med J. (2022) 8(4):114–20. doi: 10.20407/
fmj.2021-020
52. Naeser MA, Martin PI, Ho MD, Krengel MH, Bogdanova Y, Knight JA, et al.
Transcranial, red/near-infrared light-emitting diode (LED) therapy for chronic,
traumatic brain injury. Photomed Laser Surg. (2016) 34(12):610–26. doi: 10.1089/
pho.2015.4037
53. Naeser MA, Martin PI, Ho MD, Krengel MH, Bogdanova Y, Knight JA, et al.
Transcranial photobiomodulation treatment: significant improvements in four ex-
football players with possible chronic traumatic encephalopathy. J Alzheimers Dis
Rep. (2023) 7(1):77–105. doi: 10.3233/adr-220022
54. Bogdanova Y, Gilbert K, Baird L. Virtual care and home-based LED treatment
for TBI during COVID-19 pandemic. Arch Phys Med Rehabil. (2021) 102:4. doi: 10.
1016/j.apmr.2021.01.058
55. Yoshioka-Maeda K, Sumikawa Y, Tanaka N, Honda C, Iwasaki-Motegi R,
Yamamoto-Mitani N. Content analysis of the free COVID-19 telephone
consultations available during the first wave of the pandemic in Japan. Healthcare
(Basel). (2021) 9:11. doi: 10.3390/healthcare9111593
56. Ministry of health Labour and Welfare. Act on the Prevention of Infectious
Diseases and Medical Care for Patients with Infectious Diseases. Law No 114 of
1998. (Accessed February 21, 2023).
57. Hiroshima City. 2020. Hiroshima City Consultation Hotline for COVID-19.
Available at: https://www.city.hiroshima.lg.jp/site/english/156336.html (Accessed
August 8, 2022).
58. ESLA. 2021. Speech-lagnuage therapy practice during COVID-19 emergency
crisis. Available at: https://eslaeurope.eu/wp-content/uploads/2021/03/CPLOL-
Covid-19-Statement.pdf (Accessed February 20, 2023).
59. Thompson DC, Barbu MG, Beiu C, Popa LG, Mihai MM, Berteanu M, et al. The
impact of COVID-19 pandemic on long-term care facilities worldwide: an overview on
international issues. Biomed Res Int. (2020) 2020:8870249. doi: 10.1155/2020/8870249
60. Chidambaram P. Over 200,000 Residents and Staff in Long-Term Care Facilities
Have Died From COVID-19. (2022). Available at: https://www.kff.org/policy-watch/
over-200000-residents-and-staff-in-long-term-care-facilities-have-died-from-covid-
19/ (Accessed February 24, 2023).
61. Cronin CJ, Evans WN. Nursing home quality, COVID-19 deaths, and excess
mortality. J Health Econ. (2022) 82:102592. doi: 10.1016/j.jhealeco.2022.102592
62. White EM, Wetle TF, Reddy A, Baier RR. Front-line nursing home staff
experiences during the COVID-19 pandemic. J Am Med Dir Assoc. (2021) 22
(1):199–203. doi: 10.1016/j.jamda.2020.11.022
63. Miralles O, Sanchez-Rodriguez D, Marco E, Annweiler C, Baztan A, Betancor E,
et al. Unmet needs, health policies, and actions during the COVID-19 pandemic: a
report from six European countries. Eur Geriatr Med. (2021) 12(1):193–204.
doi: 10.1007/s41999-020-00415-x
64. Comas-Herrera A, Zalakain J, Lemmon E, Henderson D, Litwin C, Hsu AT,
et al. Mortality associated with COVID-19 in care homes: international evidence.
International Long Term Care Policy Network. (2020). Available at: https://ltccovid.
org/wp-content/uploads/2021/02/Mortality-associated-with-COVID-among-people-
living-in-care-homes-14-October-2020.pdf (Accessed October 14, 2020).
65. Estévez-Abe M, Ide H. COVID-19 and long-term care policy for older people
in Japan. J Aging Soc Policy. (2021) 33(4–5):444–58. doi: 10.1080/08959420.2021.
1924342
66. Health and Welfare Bureau for the Elderly Ministry of Health Labour and
Welfare. Long Term Care Insurance System of Japan, November 2016.
67. Uddin T, Rahim HR, Khandaker MN. The impact of COVID-19 and the
challenges of post-COVID rehabilitation in a developing country. Front Rehabil Sci.
(2021) 2:746061. doi: 10.3389/fresc.2021.746061
68. Sacco PL, De Domenico M. Public health challenges and opportunities after
COVID-19. Bull World Health Organ. (2021) 99(7):529–35. doi: 10.2471/BLT.20.
267757
69. Linker B. The great war and modern health care. N Engl J Med. (2016) 374
(20):1907–9. doi: 10.1056/NEJMp1509034
70. Alliance EPB. White book on physical and rehabilitation medicine in
Europe. Eur J Phys Rehabil Med. (2018) 54(2):125–55. doi: 10.23736/S1973-9087.18.
05143-2
71. Bartels MN. Polio. JAMA. (2005) 294(10):1277. doi: 10.1001/jama.294.10.1277-b
72. Rogers N. Polio and its role in shaping American physical therapy. Phys Ther.
(2021) 101(6):126. doi: 10.1093/ptj/pzab126
Bossuyt et al. 10.3389/fresc.2023.1173558
Frontiers in Rehabilitation Sciences 07 frontiersin.org
