Community- and Home-Based Rehabilitation of COVID-19
Upon being approved for discharge, COVID-19 patients have many physical dysfunctions, such as shortness of breath, weakness, and palpitations as well as psychological, daily life, and social participation dysfunction. Hospital rehabilitation is only a short process; after discharge, patients should be further rehabilitated in the community and family, helping them to gradually return to everyday life.
Unlike hospital rehabilitation, community rehabilitation can better integrate and utilize social resources and mobilize COVID-19 patients’ enthusiasm. Appropriate community-based rehabilitation interventions are an important part of the layered and refined management of COVID-19 patients. According to the different needs of patients, the community should be equipped with basic management, guidance, and rehabilitation intervention capabilities to improve the overall functional status of patients, promote the overall improvement of their quality of life, and finally return to the family and society.
Home-based rehabilitation means that rehabilitation and related medical personnel go to the streets or homes to provide professional and continuous comprehensive guidance, such as rehabilitation, medication, and nursing for patients with functional disorders in need. Home-based rehabilitation is mainly evaluated based on the people in need (including living environment, physical function, and mental state) to make corresponding plans and provide guidance. Patients’ self-rehabilitation management is also an essential part of home rehabilitation.
Community-Based Rehabilitation
Community-based rehabilitation, a concept put forward by the World Health Organization in 1976, is an economical, effective practical and convenient way to provide rehabilitation services. It can expand the coverage of rehabilitation services and enable disabled people in developing countries to enjoy rehabilitation services. Telemedicine and internet therapy have been gradually carried out in China, which provide convenience for the further development of community-based rehabilitation and home-based rehabilitation. As the pandemic is nearing its end, treatment of newly diagnosed COVID-19 patients is mainly focused on patient rehabilitation. Many patients left with respiratory and physical dysfunction can be treated according to their own needs. Community rehabilitation is the link between hospital rehabilitation and home-based rehabilitation, which complement and permeate each other.
Dysfunction Requiring Rehabilitation Treatment
Dysfunction of Daily Living Ability and Social Participation
The Barthel Index is used to assess daily living abilities, which includes the ability to defecate, urinate, use the toilet, eat, transfer beds and chairs, walk, dress, go upstairs and downstairs, and bathe independently. Communication with the outside world is an essential human survival ability, while social participation manifests comprehensive ability. Clinically, it has been found that some patients are unable to achieve regular interpersonal communication and return to work due to their long medical treatment, which requires a more extended period of rehabilitation and more help from society.
Respiratory Dysfunction
Respiratory dysfunction is the residual symptom after lung injury, mainly including cough, sputum, dyspnea, and shortness of breath after activity and may be accompanied by respiratory muscle weakness and impaired lung function. Currently, there are not enough statistics on the duration of patients’ respiratory dysfunction. Some patients have been discharged from the hospital for more than 2 months and their daily living ability assessed by Barthel Index has reached 100 points. However, the above respiratory dysfunction still exists, which seriously affects patients’ quality of life, so community rehabilitation should be given as soon as possible.
Physical Dysfunction
Physical dysfunction’s main symptoms are lack of power, easy fatigue, and muscle ache and can be accompanied by muscle atrophy, decreased muscle strength, etc. This is mainly due to the decreased oxygen uptake capacity of the body caused by lung tissue damage. In the early stage of treatment, especially in severe and critically severe patients, taking breaks and resting are adopted to reduce oxygen consumption, causing muscle tissue atrophy. Some hospitals carry out convalescent hospital rehabilitation, but for some patients who have not received hospital rehabilitation, physical dysfunction will be more obvious and will need attention.
Psychological Dysfunction
Most COVID-19 patients have psychological dysfunction, the duration and severity of which vary from person to person. Psychological dysfunction may cause somatization symptoms, so most of the psychological dysfunction is accompanied by physical dysfunction. Symptoms of simple mental dysfunction include emotional problems, such as fear, anger, anxiety, and depression. Short-term emotional problems are conducive to the regulation and release of pressure. After a long treatment and isolation in an unfamiliar medical environment, some patients with poor emotional regulation ability will become ill and need drug control. Even for people with psychological dysfunction who need drug control, community-based rehabilitation is more appropriate.
