Navigating uncertainty: occupational therapists' experiences of Long COVID management in Germany, Austria and Switzerland.

PURPOSE: Long COVID presents global challenges for healthcare professionals. Occupational therapists responded by seeking effective treatment strategies. The approaches of occupational therapists supporting long-haulers in German-speaking countries remain under-explored. The purpose of this study is to explore how occupational therapists in Germany, Austria and Switzerland navigate and apply profession-specific strategies in the new clinical landscape of Long COVID care. MATERIALS AND METHODS: This study used qualitative-descriptive design and content analysis to extract insights from seven semi-structured interviews with occupational therapists in inpatient and outpatient settings from three countries. RESULTS: Four overarching themes emerged: how Long COVID was encountered within the scope of occupational therapy, the multifaceted repertoire experts used to support long haulers, triumphs and challenges that emerged in Long COVID treatment, and recommendations and opportunities for occupational therapy practice. The results underscore the complex support needed for long-haulers, achieved through a multifaceted occupational therapy repertoire, incorporating client-centred, occupation-focused, and context-referencing strategies with shared decision-making and collaborative therapy planning. CONCLUSIONS: Occupational therapy concepts, with their focus on human occupation, may offer new treatment options and strategies for managing emerging conditions such as Long COVID.

Long COVID-RehabilitationSymptom management in relation to the clients' occupational repertoire improves participation and social function in everyday life.Actively involving clients in the therapy process through shared decision-making enhances tailored rehabilitation.Contextualized interventions take into account clients' needs and concerns, as well as the requirements of their social and professional environment.Teletherapy can be a pragmatic solution to improve the accessibility of rehabilitation services for those affected by long COVID.

"Back into Life-With a Power Wheelchair": Learning from People with Severe Stroke through a Participatory Photovoice Study in a Metropolitan Area in Germany.

Severe stroke leads to permanent changes in everyday life. Many stroke survivors depend on support in community mobility (CM). This leads to restrictions and limited social participation. A power wheelchair (PWC) can enable independent CM and reduce such restrictions. This participatory study focused on how people with severe stroke experience their CM in a PWC in Berlin/Germany and what changes they want to initiate. A research team of five severe stroke survivors and two occupational therapists examined the question using photovoice. Stroke survivors took photos of their environment, presented, discussed, and analyzed them at group meetings to identify themes, and disseminated their findings at exhibitions and congresses. The photos emphasize the significance of and unique relationship to the PWC for the self-determined expression of personal freedom. As a complex, individualized construct, CM requires an accessible environment and diverse planning strategies by PWC users to arrive at their destination and overcome suddenly occurring obstacles. Desired changes stress CM independent of external help, increased social esteem, and active involvement in the provision of assistive devices. Voices of severe stroke survivors need to be heard more in healthcare and research to ensure the possibility of equal social participation.

[Potential analyses for research on occupational therapy-led training of activities of daily living in stroke patients]. / Potenzialanalyse zu ergotherapeutischem Alltagstraining nach Schlaganfall.

HEALTH PROBLEM: Every year about 200,000 people in Germany suffer from a first stroke and 65,000 persons from a recurrent stroke. Stroke is one of the major causes of acquired life-long disability. It is associated with multiple limitations in functioning, activities of daily living and social participation. People with stroke must develop and apply considerable coping and adaptation strategies to manage the consequences of disabilities in daily life. Insufficient adaptations may result in social isolation, depressive disorders, need for medical and nursing care and subsequently lead to increasing costs for care. Thus occupational therapy-led treatment addressing social participation as well as skills training, adaptation strategies and assistive technology for activities of daily living is essential for stroke patients after hospital discharge. CORPUS OF EVIDENCE: Based on nine randomised comparisons, a Cochrane review from 2006 revealed that occupational therapy-led training after stroke had positive effects on personal activities of daily living (8 studies; 961 participants; 0.18 SMD; 95 % CI [0.04 to 0.32]), on extended activities of daily living (6 studies; 847 participants; 0.21 SMD; 95 % CI [0.03 to 0.39]), and on poor outcome (7 studies; 1,065 participants; odds ratio 0.67; 95 % CI [0.51 to 0.87]). However, direct implementation into the German healthcare context is not recommendable due to (1) different settings and heterogeneity within the primary studies, (2) lack of manualisation of treatment programmes and (3) insufficient evaluation of client-oriented outcomes. IMPLICATION FOR RESEARCH: It is recommended to manualise client-centred standardised modules of a stage-specific occupational therapy-led training of activities of daily living and to pilot-test this intervention programme in a feasibility study. If this trial results in a set of reliable and valid client-oriented outcome measurements applicable within the German care context and in a feasible treatment programme well accepted by stroke patients and their treating occupational therapists, a large-scaled randomised clinical trial in terms of comparative effectiveness research may follow.