Responding to COVID-19: Resilience in Occupational Therapy

Since March 2020, the number of confirmed cases of coronavirus disease 2019 (COVID-19) in the United States has climbed to more than 33 million, constituting a serious public health emergency (PHE; World Health Organization, 2021). Occupational therapists and occupational therapy assistants on the front line have demonstrated resilience and creativity while addressing the occupational needs of people with COVID-19. The case studies in this supplemental issue of the American Journal of Occupational Therapy (AJOT) highlight some of the innovative and important work accomplished by practitioners across practice settings and with different client populations. These practitioners have addressed many challenges to meet the physical, cognitive, psychological, and social needs of clients, their families, and care providers.

As the COVID-19 PHE evolved, occupational therapy practitioners found themselves in the middle of a new and unique situation. Clients presented with a complex medical profile and unknown trajectory. Evidence for interventions specific to COVID-19 did not exist, client characteristics and care needs evolved, and information about the progression of this often devastating disease was continually changing. However, nimble practitioners used their clinical decision-making skills and knowledge related to interventions for people with complex respiratory conditions to effectively address needs at the individual and population levels. During this time, practitioners returned to the roots of the profession, finding direction in the core values of occupational therapy. The case studies in this AJOT supplement demonstrate both the flexibility and the creativity of our profession in addressing occupational needs in the novel circumstances of an unprecedented PHE.

The American Occupational Therapy Association (AOTA) worked quickly to respond to practitioners’ inquiries during the PHE and, as part of that initiative, developed a Practice Resource Group consisting of occupational therapy staff at AOTA. The goal was to provide resources based on exiting best practices and evolving information received from AOTA members. In many cases, practitioners needed tools to advocate for the role of occupational therapy during the pandemic. Many decisions were new to the health care system, and there were no simple yes or no answers. Practitioners needed to synthesize novel information and use their clinical decision-making skills to determine the courses of action that were best for each situation. To assist in this process, the AOTA Practice Resource Group developed and disseminated resources, including webinars and FAQ lists, that would provide information in a quick and effective way. In addition, they have created decision guides using a checklist or flowchart format to focus practitioners’ clinical reasoning as they make practice decisions during the pandemic (AOTA, n.d.).

This supplemental issue of AJOT is a continuation of the work started by the AOTA Practice Resource Group. The issue gathers case studies from occupational therapy practitioners on the frontlines across practice settings, levels of care, age groups, client profiles, clinical courses, and goals, highlighting the versatility of the occupational therapy response across areas of practice and disease presentation.

These case studies have many elements in common. They show how occupational therapy practitioners provided care and implemented interventions for people with COVID-19 and how they adapted to the ever-changing needs of clients and health systems during the PHE. They emphasize client-centered care and a balance between acute medical needs and the return to meaningful roles, daily routines, and valued occupations. They also address socialization, caregiver needs, and family dynamics across client populations and the continuum of care. In addition, as a special area of focus, the issue includes articles on functional cognition and mental health and the valuable contributions of occupational therapy practitioners in these areas. The PHE has also elucidated other challenges for practitioners and society. Health disparities have been highlighted by the pandemic and are leading to overdue discussion about how to address these disparities. Articles addressing this topic are in development for a future issue of AJOT.

The PHE has emphasized the need for occupational therapy to address the holistic needs of clients to promote and optimize their participation in meaningful occupations. As the disease progression has continued to evolve, the special needs of “long haulers,” or people with postacute sequelae of COVID-19 (PASC) infection, have also become apparent. The National Institutes of Health has implemented an initiative to fund research related to PASC, including treatment options (Collins, 2021). Occupational therapy practitioners can contribute to the research in this area as they continue to manage change and look for opportunities to provide care to people with PASC, their families, and care providers.

The articles in this issue of AJOT reflect occupational therapy practitioners’ capacity to adapt and respond to change in challenging times. Occupational therapy is critical to COVID-19 recovery. Further evidence, using more rigorous research designs, is needed to document the substantial contributions of occupational therapy with this population. Additional research is needed to address the multiple sequelae experienced by patients with COVID-19 and PASC and to document the role of occupational therapy in their care and treatment. Occupational therapy is well suited to provide services that address the importance of purposeful activity and occupation in the lives of people affected by COVID-19. We urge practitioners to continue to advocate for the role of occupational therapy in providing services to clients with COVID-19 and PASC across the care continuum. The aim of this supplement is not only to provide practitioners with current information on occupational therapy and COVID-19 but also to present relevant, accessible, and useful case examples to guide intervention and improve outcomes for clients, their families, and care providers.

We acknowledge the contributions to this editorial of additional members of the AOTA Practice Resource Group: Hope Caracci, Elin Schold Davis, Jeremy Furniss, Varleisha Gibbs, Hillary Richardson, and Angela Warren.