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COVID-19: maintaining essential rehabilitation services across the care continuum
  1. Janet Prvu Bettger1,2,
  2. Andrea Thoumi2,
  3. Victoria Marquevich3,
  4. Wouter De Groote4,
  5. Linamara Rizzo Battistella5,
  6. Marta Imamura5,
  7. Vinicius Delgado Ramos6,
  8. Ninie Wang7,
  9. Karsten E Dreinhoefer8,
  10. Ariane Mangar9,
  11. Dorcas B C Ghandi10,
  12. Yee Sien Ng11,
  13. Kheng Hock Lee12,
  14. John Tan Wei Ming13,
  15. Yong Hao Pua13,
  16. Marco Inzitari14,
  17. Blandina T Mmbaga15,
  18. Mathew J Shayo16,
  19. Darren A Brown17,
  20. Marissa Carvalho18,
  21. Mooyeon Oh-Park19,
  22. Joel Stein20
  1. 1 Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
  2. 2 Duke-Margolis Center For Health Policy, Duke University, Washington, District of Columbia, USA
  3. 3 Intensive Care Unit, Austral University Hospital, PIlar, Buenos Aires, Argentina
  4. 4 Rehabilitation Department, AZ Rivierenland, Bornem, Belgium
  5. 5 Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
  6. 6 Hospital das Clinicas, Universidade de Sao Paulo, Sao Paulo, Brazil
  7. 7 Pinetree Care Group, Beijing, P. R. China
  8. 8 Medical Park Berlin Humboldtmühle, Berlin, Germany
  9. 9 Disability and Rehabilitation, Ministry of Public Health Guyana, Georgetown, Guyana
  10. 10 Physiotherapy, Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India
  11. 11 Rehabilitation Medicine, Singapore General Hospital, Singapore
  12. 12 Bright Vision Hospital, SingHealth Community Hospitals, Singapore
  13. 13 Physiotherapy, Singapore General Hospital, Singapore
  14. 14 Intermediate Care, Research and Teaching, Parc Sanitari Pere Virgili, Barcelona, Spain
  15. 15 Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Center, Moshi, United Republic of Tanzania
  16. 16 Physiotherapy, Kilimanjaro Christian Medical Center, Moshi, United Republic of Tanzania
  17. 17 Therapies Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  18. 18 Physical Therapy and Occupational Therapy, Department, Duke University Health System, Durham, North Carolina, USA
  19. 19 Burke Rehabilitation Hospital, Montefiore Health System, New York, New York, USA
  20. 20 Rehabilitation and Regenerative Medicine Department, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
  1. Correspondence to Dr Janet Prvu Bettger; janet.bettger{at}

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Summary box

  • Rehabilitation services are essential: They need to continue during a pandemic and after as they are an essential component of high-value care offered for individuals across the lifespan to optimise physical and cognitive functioning to reduce disability.

  • Rehabilitation care is affected: Globally, the response to COVID-19 is shifting rehabilitation services provided in all settings, introducing new burden on patients, families and healthcare workers.

  • Measurement needed: A core set of measures needs to be adopted to monitor the health and functional outcomes for COVID-19 and other patients at risk for functional decline and to assess the quality, availability and accessibility of services today and as our nations recover.

  • Telerehabilitation is necessary: Remote delivery of care and the necessary rapid scale-up of telehealth could be optimised if financial, infrastructure, resource, training and cybersecurity barriers were addressed.

  • Collaboration can support needs in the home: Novel partnerships that include the rehabilitation community could enhance communication and delivery of safe and effective home-based rehabilitative strategies to mitigate the consequences of COVID-19 and reduced service capacity.

  • Direct care providers need personal protective equipment: Rehabilitation providers in all settings should be ensured personal protective equipment and training to use it effectively.


COVID-19 is overwhelming healthcare services and healthcare workers globally. The response, appropriately, is on the ability to care for people who become critically ill, protect their carers and keep people physically distanced. However, this response has shifted what is considered and how to provide essential healthcare services. Rehabilitation services, which optimise physical and cognitive functioning to reduce disability, are a core component of high-value care.1 The decisions to shift, transform, delay or discontinue rehabilitation care are complex. These decisions have societal implications for today and the future. This commentary describes adjustments to the continuum of rehabilitation services across 12 low-income, middle-income and high-income countries in …

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