Rehabilitation is not a cost, but an investment. It is premature to withdraw from the provision of specialized rehabilitation for patients who have undergone COVID-19. Despite the fact that the number of infections is falling, the complications will not disappear – Maciej Krawczyk, president of the National Council of Physiotherapists, told PAP.
The President of the KRF said in an interview with PAP that at the moment patients who have undergone COVID-19 will no longer be able to benefit from a specially designed rehabilitation. Such a service was created a year ago so that, thanks to specialized treatments, such people could regain strength and recover faster. In his opinion, such a decision is premature, because the complications will not disappear, even if the number of patients decreases.
PAP: After COVID-19, the patient is treated like any other patient, because from April 5, the doctor will not issue him a referral for postovid rehabilitation, but only for therapeutic rehabilitation under the standard agreement with the National Health Fund. Simply put, it can be said that the rehabilitation specially tailored to this disease a year ago – which was to eliminate the really serious effects of COVID-19 – has disappeared. What does this actually mean for patients?
President of KRF Maciej Krawczyk: This means standing in line with all other patients for rehabilitation, which will translate into the fact that the availability of rehabilitation will actually decrease. It will no longer be available in centers specially designed for this type of rehabilitation, and we had queues in some of them even until August. These are several dozen centers offering stationary rehabilitation throughout Poland. Postovid rehabilitation was also carried out in outpatient and home conditions, or in health resorts. It is true that the number of COVID-19 infections has decreased, but it must be remembered that the complications from this disease have not disappeared and will not disappear. These are largely disabled people. Systemically, it seems that such postovid rehabilitation should be maintained. In my opinion, the decision is premature and should be consulted with the centers that provided such a service.
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Will patients with serious complications after COVID-19 be able to count on the same treatments as before?
Not necessarily, because the requirements of pocovid rehabilitation are different than the requirements of standard rehabilitation. In inpatient medicine, you need a different type of apparatus. Staff requirements are also different. It’s not a one-to-one relationship. Of course, the number of centers that can carry out such specific rehabilitation – respiratory does not change, but other patients will also appear there. After all, we have 5 million people suffering from asthma in Poland, 2,5 million people suffering from Chronic Obstructive Lung Disease (COPD), who require rehabilitation in closed conditions, mainly physiotherapy. Patients from Ukraine will also come. This cork is getting bigger. It must be said straightforwardly: many COVID-19 patients will simply be deprived of rehabilitation.
Widespread testing and treatment in covid wards and hospitals has ended, but there is no rehabilitation specially prepared for such patients. Why was it decided to take such a step now?
This is probably dictated by finances. The state purse is empty at the moment. It has been reduced – and it is a phenomenon – by 30 percent. home rehabilitation appraisal. The number of patients who receive this benefit has decreased because it is not profitable to do so. It is money that is the cause and – in my opinion – the decision, as I said before, is premature. It should be preceded by an analysis of the situation, i.e. finding out how long the queues are, what is the profile of patients reporting, whether they are new patients or people who re-use such services. If the majority of these are the first time they come in, the problem still exists.
Pocovid rehabilitation by January this year consumed about PLN 75 million, which in combination with additional revenues to the National Health Fund this year in the amount of over PLN 9 billion – resulting from the change in the health insurance contribution – seems to be a small amount?
Indeed, this is not a huge amount, considering the fact that the indirect costs in the next one or two years that may arise as a result of not doing such rehabilitation may be many times higher than the direct costs. When we look at the fact that these people in a moment may be dependent on the environment, unable to work, in such a case rehabilitation actually becomes an investment, not a cost. We should view public health as a long-term investment.
What are the most common complications faced by people who have had COVID-19 and required rehabilitation?
These are mainly complications of the circulatory system – low efficiency of the respiratory system. On the part of the nervous system – paresis, paralysis, sensory disturbances. Many patients also have cognitive and emotional disorders: concentration, balance, short-term and long-term memory. These are the elements that limit the proper functioning of these people in the environment. They even make it impossible to perform professional work.
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Proper treatments and exercises can really help you recover effectively and reduce complications in practice?
The practice of many physiotherapists with whom I have contact and look after COVID patients shows that – thanks to exercise and treatments – there is an unimaginable improvement in physical and mental health. Patients often come to the center completely dependent on the environment and not only leave them on their own feet, but also intellectually fit. I am very impressed by my professional group and not only because I am also talking about psychologists and doctors. These patients could die, and they certainly would not have returned to the social roles they played before the disease without rehabilitation.
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Do you see in practice a correlation between the course, complications of the disease and, for example, age, gender, burden of other diseases?
These complications are most correlated with primary diseases. These are chronic diseases. These are, for example, hypertension, obesity, previous lung diseases, diabetes, myocardial ischemia, heart attacks, but also neurological diseases, blood diseases. It was these people who were at risk of severe disease and the greatest complications. And, of course, the severity of complications is influenced by whether or not a person is vaccinated. Most of the patients in rehabilitation departments are unvaccinated patients.
Author: Klaudia Torchała
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