Long Covid affects individuals and their ability to work in different ways. Tailored rehabilitation support can help achieve the best outcomes. Ashleigh Webber speaks to the head of PAM Physio Solutions’ long Covid rehabilitation programme to find out what a recovery plan should involve.
As a relatively new condition, our knowledge of what long Covid is, its symptoms and how best to treat it is limited. However, it is clear it can have a devastating impact on a person’s ability to work.
The Office for National Statistics estimates that 1.5 million people in the UK are living with “self-reported” long Covid, which the ONS defines as symptoms lasting four or more weeks – however, most health professionals define long Covid as a condition with symptoms lasting at least 12 weeks.
With the recent surge in Covid-19 infections following to the removal of legal requirements around self-isolation and mask-wearing, there are fears the number experiencing it could increase further. Almost half of employers are already managing staff with the condition.
Because of the complex nature and variety of potential long Covid symptoms, which range from breathlessness and muscular aches to cognitive issues and feelings of depression, rehabilitation and the return to work may be challenging for some people. Yet, it is possible with suitable support, patience and guidance.
As Claire Glynn, head of musculoskeletal services at PAM Physio Solutions, has found while working on PAM’s long Covid rehabilitation programme, not all patients undergo the same recovery process.
“The support needed by someone who ran for miles every day, but now can’t walk without getting breathless, will be very different to that of someone who is very overweight and experiencing extreme post-viral joint pain,” she tells OHW+.
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She says each individual on PAM’s rehabilitation programme has been affected by long Covid in different ways. Not only can these be direct side-effects from Covid infection, such as breathlessness, but some people may also feel mentally exhausted and anxious after their experience with Covid. Some experience problems with sleep, changes in their appetite and weight gain or loss.
Long Covid’s impact on confidence
“Concentration, mental health and physical capability to perform simple activities or complete simple tasks becomes impeded, so work attendance is not feasible, especially for those who have ‘decision making’ roles that affect other people in society. Even with reasonable adjustments in place, an individual suffering with brain fog who is expected to make instantaneous decisions is not practically able to be effective in work,” explains Glynn.
“An individual suffering with ongoing breathlessness who struggles to walk more than 100 metres without having to sit down and rest for half an hour, or experiences severe oxygen desaturation upon being upright, isn’t safe in a retail environment.
“Some people are so overwhelmed with the experience that their confidence is diminished and they need that support, guidance and reassurance, alongside the clinical tools to overcome their anxiety about being more active to be able to get back into work.”
Rehabilitation programme
Employees who are referred by their employers to PAM’s long Covid rehabilitation programme are allocated a case manager who undertakes a clinical assessment and develops a treatment plan for them.
Some people are so overwhelmed with the experience that their confidence is diminished and they need that support, guidance and reassurance, alongside the clinical tools to overcome their anxiety about being more active.” – Claire Glynn, PAM Physio Solutions
They receive up to six treatment sessions with a clinical expert to help them manage their symptoms, and managers from their organisation are given guidance on how to support their recovery, including any reasonable adjustments needed.
Where individuals struggle with a range of issues, a multi-disciplinary team is pulled together from the wider PAM Group. Glynn says some patients have seen psychotherapists to advise on managing anxiety or brain fog, while working with occupational health clinicians to address sleeplessness, loss of taste and sustaining appetite, and the physiotherapist team to overcome shortness of breath, fatigue and muscle pain.
More than 100 employees from employers ranging from government agencies to high street brands have been referred to PAM’s rehabilitation programme, Glynn says. Some individuals’ symptoms were so severe they could not work at all.
Pacing is essential
Glynn says: “Lots of people struggle with breathlessness, where they feel fine while sitting but as soon as they attempt to move about or do anything, their oxygen levels drop to dangerously low levels. Critical to helping them overcome this was encouraging them to pace themselves, in keeping with the emerging NICE guidelines. This is so they don’t push themselves past their limits to the extent that they undermine their recovery and take a backwards step.”
She says this approach is challenging for PAM’s physiotherapists, who are used to encouraging people to push themselves to do more with their bodies to drive recovery.
“Much as those struggling with long Covid would like to ‘snap out of it’, individuals who constantly push themselves past their limits will struggle to recover,” explains Glynn. “Instead, a supportive employer, adjustments to working conditions and a recovery plan is essential to retaining and rehabilitating employees.”
Many people have not fully recovered as they concluded PAM’s 12-week programme; however the aim is to give them tools and exercises to continually manage and reduce the severity of their symptoms, which may aid their return to work.
Of the people who have completed the programme so far, 82% were able to return to work or remain at work. This comprised 40% who were helped to return to work with adjustments, 20% who were able to return without any adjustments and 22% who were helped to remain in work.
Nearly three-quarters of employees affected by breathlessness; 81% experiencing fatigue, concentration or brain fog; 81% with joint or muscle pain; and 70% experiencing depression, saw an improvement in their symptoms.
Be proactive
Employers and in-house occupational health professionals should take a proactive approach to supporting staff who may have long Covid, Glynn advises.
Instead of waiting until someone has had residual Covid symptoms for over 12 weeks, invite anyone struggling to come forward for help – especially women, who might delay getting support if they mistakenly think they’re entering menopause.” – Claire Glynn, PAM Physio Solutions
“People will be concerned that admitting they have long Covid could put their job at risk, so reassure them you’re aware of the extent of the problem and want to help them recover,” she says. “Instead of waiting until someone has had residual Covid symptoms for over 12 weeks, invite anyone struggling to come forward for help – especially women, who might delay getting support if they mistakenly think they’re entering menopause, due to the similarity of some symptoms such as fatigue and brain fog.”
Managers should also be encouraged to refer anyone who they suspect has long Covid to occupational health. They should not demand employees get a formal diagnosis from their GP, because GPs are often reluctant to provide certificates for this condition, she says.
Finally, Glynn advises employers to consider referring individuals to a specialist rehabilitation service, either through the NHS or a private provider, as many will not see their symptoms improve without a treatment plan.
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“There isn’t yet enough research to give a definitive answer as to how long it takes for someone to recover from long Covid,” says Glynn.
“Our focus has been on helping people to recover enough to return to work, where possible, in a way that has also had profound benefits on their ability to function outside of work.”
