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Understanding the impact of the Covid-19 pandemic on delivery of rehabilitation in specialist palliative care services: An analysis of the CovPall-Rehab survey data

Research output: Contribution to journalArticlepeer-review

Joanne Bayly, Andy Bradshaw, Lucy Fettes, Muhammed Omarjee, Helena Talbot-Rice, Catherine Walshe, Katherine E. Sleeman, Sabrina Bajwah, Lesley Dunleavy, Mevhibe Hocaoglu, Adejoke Oluyase, Ian Garner, Rachel L. Cripps, Nancy Preston, Lorna K. Fraser, Fliss E.M. Murtagh, Irene J. Higginson, Matthew Maddocks

Original languageEnglish
JournalPalliative medicine
Issue number2
Early online date29 Dec 2021
Accepted/In press2021
E-pub ahead of print29 Dec 2021

Bibliographical note

Funding Information: IJH is the grant holder and chief investigator; KES, MM, FEM, CW, NP, LKF, SB, MBH and AO are co-applicants for funding. IJH and CW with critical input from all authors wrote the protocol for the CovPall study. JB, MM, LF and HTR amended the CovPall Survey to produce the Covpall-Rehab survey. JB co-ordinated data collection and distributed survey with input from MM and LF. JB, AB, MM and MO analysed the data. All authors discussed the interpretation of findings and take responsibility for data integrity and analysis. JB and AB drafted the manuscript. All authors provided critical revision of the manuscript for important intellectual content. IJH is the guarantor. Funding Information: This study was part of CovPall, a multi-national study, supported by the Medical Research Council, National Institute for Health Research Applied Research Collaboration South London and Cicely Saunders International. We thank all collaborators and advisors. We thank all participants, partners, PPI members and our Study Steering Group. We gratefully acknowledge technical assistance from the Precision Health Informatics Data Lab group ( ) at National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London for the use of REDCap for data capture. We thank all services for responding. The following indicated they were happy to be acknowledged: Arthur Rank Hospice Charity, Dorothy House Hospice Day Service, East Cheshire Hospice, Garden House Hospice care, Isabel Hospice, John Taylor Hospice, Kilbryde Hospice, Longfield Community Hospice, Marie Curie Hospice Cardiff and the Vale, Marie Curie Hospice West Midlands, Martlets Rehabilitation Team, Mary Ann Evans Hospice, Mountbatten Isle of Wight and Hampshire, Overgate Hospice, Peace Hospice Care, Pilgrims Hospices, Phyllis Tuckwell Hospice Care, Princess Alice Hospice, Rosemary Foundation, Salisbury Hospice, St Andrew’s Hospice, St Ann’s Hospice, St Catherine’s Scarborough, Southern Area Hospice Services Newry, St Andrew’s Hospice, St Barnabas House Hospices, St Christopher’s Hospice, St Cuthbert’s Hospice, St Elizabeth Hospice, St Joseph’s Hospice, St Luke’s Hospice, Sy Margaret’s Hospice, St Mary’s Hospice, St Michael’s Hospice, St Nicholas Hospice, St Wilfrid’s Hospice Eastbourne, Strathcarron Hospice, Sue Ryder South Oxfordshire Palliative Care Therapy Team, Sue Ryder Wheatfields Hospice, Sue Ryder, Leckhampton Court Hospice, Teesside Hospice Care Foundation., Wigan and Leigh Hospice. Publisher Copyright: © The Author(s) 2021.

King's Authors


Background: Palliative rehabilitation involves multi-professional processes and interventions aimed at optimising patients’ symptom self-management, independence and social participation throughout advanced illness. Rehabilitation services were highly disrupted during the Covid-19 pandemic. Aim: To understand rehabilitation provision in palliative care services during the Covid-19 pandemic, identifying and reflecting on adaptative and innovative practice to inform ongoing provision. Design: Cross-sectional national online survey. Setting/participants: Rehabilitation leads for specialist palliative care services across hospice, hospital, or community settings, conducted from 30/07/20 to 21/09/2020. Findings: 61 completed responses (England, n = 55; Scotland, n = 4; Wales, n = 1; and Northern Ireland, n = 1) most frequently from services based in hospices (56/61, 92%) providing adult rehabilitation. Most services (55/61, 90%) reported rehabilitation provision becoming remote during Covid-19 and half reported reduced caseloads. Rehabilitation teams frequently had staff members on sick-leave with suspected/confirmed Covid-19 (27/61, 44%), redeployed to other services/organisations (25/61, 41%) or furloughed (15/61, 26%). Free text responses were constructed into four themes: (i) fluctuating shared spaces; (ii) remote and digitised rehabilitation offer; (iii) capacity to provide and participate in rehabilitation; (iv) Covid-19 as a springboard for positive change. These represent how rehabilitation services contracted, reconfigured, and were redirected to more remote modes of delivery, and how this affected the capacity of clinicians and patients to participate in rehabilitation. Conclusion: This study demonstrates how changes in provision of rehabilitation during the pandemic could act as a springboard for positive changes. Hybrid models of rehabilitation have the potential to expand the equity of access and reach of rehabilitation within specialist palliative care.

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