COVID-19 Impact on Delivery of Rehabilitation For Persons With Traumatic Brain Injury

RESEARCH OBJECTIVES: To describe how the COVID-19 pandemic influenced treatment practices for chronic pain in persons with traumatic brain injury (TBI) and facilitators and barriers to rehabilitation care. DESIGN: A descriptive, qualitative study. SETTING: Traumatic brain injury model systems (TBIMS) civilian and Veterans facilities. PARTICIPANTS: The secondary analysis included providers consisting of rehabilitation therapists (physical therapists, speech language pathologists, and occupational therapists), medical doctors, nurses, clinical and neuro psychologists, and resource managers (n=63) for persons with TBI and chronic pain. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: A semi-structured qualitative telephone interview consisted of 13 questions asking about treatment practices and facilitators and barriers to rehabilitation for people with TBI and chronic pain during the COVID-19 pandemic. RESULTS: The COVID-19 pandemic impacted treatment practice across civilian and VA TBIMS facilities. Thematic analysis revealed that the main changes to treatment practices were switching to virtual visits, the impact of COVID-19 precautions such as social distancing and wearing masks had on providing treatment, and in some cases, treatment was halted. Facilitators to care included improved communication between providers and their patients, the increase in use of telehealth to provide care, and increased access to providers. Barriers to rehabilitation care identified by mainly civilian providers included COVID-19 visitor restrictions on family involvement, and the lack of access patients had to their providers during this time, specifically with cancelled appointments or wait lists. Both civilian and VA providers described how COVID-19 logistics for cleaning and social distance impacted scheduling and the number of patients who could be seen. CONCLUSIONS: The global COVID-19 pandemic served as a major disruptor to provision of healthcare. The switch from mainly in person care to the use of telehealth to deliver care was a major transition for providers and patients. Future research on the impact of telehealth on patient outcomes and when to use telehealth versus in person is needed. AUTHOR(S) DISCLOSURES: This work is supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (90DPTB0017 and 90DPTB0008) and General Dynamics Health Solutions (W91YTZ-13-C-0015; HT0014-19-C-0004).