To understand the impact of the pandemic on the physiotherapy needs of adults with a learning disability and explore how services are managing the changes in people’s physical and functional presentation a survey was developed. This was sent to the ACPPLD membership to complete between the 4th to the 30th November 2020. 88 people responded to the survey from across to UK. The survey was completed before the UK entered the latest lockdown therefore, a secondary aim of the results is to inform how specialist learning disability physiotherapy services manage the next phase of the pandemic.
It is evident that the COVID-19 pandemic has had a profound impact on adults with a learning disability. They had a six times higher death rate than the general population from contracting the virus in the first wave (Public Health England, 2020). They have also been severely impacted by the social measures used the control the spread of the virus. The results of the survey indicate that the latter had a greater negative impact with adults with a learning disability experiencing deterioration in their physical, function, cognitive and mental health presentation. In addition, the increased anxiety, fear, stress and load placed on networks of care has caused carer fatigue and impacted on quality of care. These are likely to be exacerbated by the third wave of the virus and the latest lockdown measures.
Specialist learning disability services have had to change their model of care to manage the increased high priority demand. They have been unable to return to ‘normal practice’ and offer the proactive management that is so critical to meeting the physiotherapy needs of adults with a learning disability. Returning to a proactive model of care as soon as possible is essential. However, the extent of the deterioration highlighted in the survey means that services are likely to be reacting to this need for some time. Worryingly, the results suggest the extent of the impact of the virus is not yet known, and will only become apparent as society returns to normal and public confidence returns. Physiotherapy services will need to plan and prepare for this demand.
Many services were under resourced prior to the pandemic and will struggle to meet the additional need whilst recovering a proactive service model without extra staffing. There is clear evidence about the benefits and potential cost savings of rehabilitation against living with long term disability. There is a growing awareness that the pandemic has caused significant rehabilitation needs across all settings of healthcare.
Specialist learning disability physiotherapy services have an essential role in managing the physiotherapy needs, health and wellbeing of adults with a learning disability during and after the pandemic. Therefore:
- Specialist learning disability physiotherapists must retained capacity to meet the physiotherapy needs of their local population.
- Services should continue to provide direct and indirect assessment, treatment and reviews to adults with a learning disability as clinically indicated.
- Service must take into consideration the indirect impact of the pandemic on the physical and functional presentation of adults with a learning disability when making decisions about service provision.
- Physiotherapists should risk assess the benefit of physiotherapy versus the risk of contracting the virus. This should take into consideration any potential impact of not offering physiotherapy; and the person’s wishes and choice. Where the person lacks capacity to contribute the risk assessment, best interest should be considered.
- Services should be proactive in identifying people at risk of deterioration during the pandemic, and offer physiotherapy to minimise decline in physical and functional presentation.
- Services should maintain capacity to offer rehabilitation for deterioration in physical and functional presentation in a timely manner to restore baseline.
- Service should contribute to monitoring of long COVID (COVID syndrome) in adults with a learning disability, and support the management of the condition either directly or by supporting access to mainstream services.
- Services should work with their local day services and community activities where and when possible to promote opportunities for physical activity, movement and health promotion.
- Service should plan for an expected surge in referrals as the social measures used to control the virus are reduced and society returns to normal.
- Services should recover back to a proactive model of care as soon as possible, whilst maintaining the ability to react quickly to high priority referrals.
- Services should monitor service demand versus capacity to meet this need. Where demand outweighs capacity this should be raised with management and commissioning to highlight gaps and request additional resources to manage this need. This includes highlighting the roles and tasks not being provided as a result of the pandemic.
It is important to take note of the findings of the survey as we more forwards into the next phases of the pandemic. It is crucial to strike a balance between the benefits of physiotherapy and the risk of contracting the virus. This is difficult, professionals need to be careful about being a vector for transmission. However, it is important to learn from the experiences during the first wave. We now have evidence of the negative impact of the pandemic on adults with a learning disability. Thus it is not appropriate to cease specialist learning disability physiotherapy; completely shift service delivery and provision to manage COVID-19, or redeploy staff into acute or vaccination services.
If we have learnt anything from the pandemic, it is that if you limit access to specialist learning disability physiotherapy and relevant healthcare services; reduced opportunities for physical activity and movement; and remove proactive management from adults with a learning disability many will experience significant deterioration. Therefore, these must remain in place wherever possible during the next and any subsequent phases of the pandemic, and be fully restored as soon as possible.
David Standley, Clinical Specialist Physiotherapist, Community Adult with Learning Disabilities Team, Guy’s and St Thomas’ NHS Foundation Trust., Research and Education Officer ACPPLD NEC
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