Expert consensus for in-hospital neurorehabilitation during the COVID-19 pandemic in low- and middle-income countries.

Dorcas B C Gandhi,Stuti Chakraborty,Ivy A Sebastian,Mohammed Alim,John M Solomon,Sureshkumar Kamalakannan,Manigandan Chockalingam,Gerard Urimubenshi,Himani Khatter

doi:10.12688/wellcomeopenres.16715.1

Abstract

Background:Peoplewith neurological dysfunction have been significantly affected by the ongoing coronavirus disease 2019 (COVID-19) crisis in receiving adequate and quality rehabilitation services. There are no clear guidelines or recommendations for rehabilitation providers in dealing with patients with neurological dysfunction during a pandemic situation especially in low- and middle-incomecountries.The objective of this paper was to develop consensus-based expert recommendations for in-hospital based neurorehabilitation during the COVID-19 pandemic forlow- and middle-incomecountries based on available evidence. Methods: Agroup of experts in neurorehabilitation consisting of neurologists, physiotherapists and occupational therapists were identified forthe consensus groups. Ascoping review was conducted to identify existing evidence and recommendations for neurorehabilitation during COVID-19. Specific statements with level 2b evidence from studies identified were developed. These statements were circulated to 13 experts for consensus. The statements that received ≥80% agreementwere grouped in different themes and the recommendations were developed. Results:75 statements for expert consensus were generated.72 statements received consensus from 13 experts. These statements were thematically grouped as recommendations for neurorehabilitation service providers, patients, formal and informal caregivers of affected individuals, rehabilitation service organizations, and administrators. Conclusions:Thedevelopment of thisconsensusstatementis offundamental significance toneurological rehabilitation service providers and people living with neurological disabilities. It is crucial that governments, health systems, clinicians and stakeholders involved in upholding the standard of neurorehabilitation practice in low- and middle-incomecountries consider conversion of the consensus statement to minimum standard requirements within the context of the pandemic as well as for the future.

Highlights

Neurological disorders remain one of the major contributors to death and disability globally[1]
It is crucial that governments, health systems, clinicians and stakeholders involved in upholding the standard of neurorehabilitation practice in low- and middle-income countries consider conversion of the consensus statement to minimum standard requirements within the context of the pandemic as well as for the future
We aimed to develop the recommendations for in-hospital neurorehabilitation during and after the COVID-19 pandemic which could be a potential basis of reference and guidance for other similar conditions

Summary

Introduction

Neurological disorders remain one of the major contributors to death and disability globally[1]. Neurological disorders are the leading cause of disabilityadjusted life years (DALY) contributing 276 million DALYs and the second leading cause of mortality with about 9 million deaths in 2016 globally[1]. Neurological disorders such as stroke, headache disorders, epilepsy, dementia, Parkinson’s disease, traumatic brain injury and motor neuron disease amongst others can cause motor, sensory, cognitive, and emotional impairments, leading to disability and poor quality of life among those affected[3]. There are no clear guidelines or recommendations for rehabilitation providers in dealing with patients with neurological dysfunction during a pandemic situation especially in low- and middleincome countries. The objective of this paper was to develop consensus-based expert recommendations for in-hospital based neurorehabilitation during the COVID-19 pandemic for low- and middle-income countries based on available evidence

Objectives

Methods

Results

Conclusion