Development of an integrated rehabilitation pathway for individuals recovering from COVID-19 in the community

Objective: COVID-19 is a multisystem illness with considerable long-term physical, psychological, cognitive, social and vocational sequelae in survivors. The aim of this study is to describe the development of an integrated rehabilitation pathway using tele-medicine approach to manage these sequelae in a systematic and efficient way.

Methods: A multidisciplinary team of professionals used a consensus method to define pathway referral criteria based on the COVID-19 Yorkshire Rehabilitation Screen (C19-YRS) telephone screening tool developed previously by the team. Specialists needed for the pathway to operate were also decided.

Results: A rehabilitation pathway, which spans the acute hospital trust, community trust and primary care service within the UK National Health Service (NHS) service model was developed. C19-YRS referral criteria thresholds for informing the decision making process were defined. A dedicated multidisciplinary COVID-19 rehabilitation team is responsible for dealing with the management of complex cases with needs spanning across multiple domains of the health condition.

Conclusion: An integrated COVID-19 rehabilitation pathway based on our previously published C19-YRS tool is proposed. Future research is needed for validation of the pathway. We recommend health services dealing with the pandemic to adopt such a pathway to manage the care of the COVID-19 survivors in the community.