Rehabilitation after critical illness: vocational rehabilitation can begin in critical care

Dear Editor

I welcome the recent articles on the need for rehabilitation after critical illness and the lack of appropriate resources to provide what is needed [1, 2]. The deficiencies in rehabilitation services have been long recognised [3]. In my personal experience, it is quite possible for a consultant in rehabilitation medicine to have beds to receive patients from intensive care, discharge them into the community and continue to support them from a community team that may be an extension of the hospital rehabilitation service, or may be from a community-based team. Regrettably such community-based rehabilitation teams are also in short supply [4].

White et al comment on the ability to return to work (RTW) after critical illness [1]. Delayed RTW or even job loss can be catastrophic for individuals and their families, but also costly for employers and the state [5]. Intensive care teams can influence this situation by ascertaining (through talking to the patient or their family) whether or not their patient was working prior to their illness. For those uncertain how to discuss work issues with patients or relatives, advice is now available [6]. For those who were working, the following advice should be given:

• It is important to remain in contact with your employer [7-9]

• That there are many ways of supporting individuals back into work after severe illness [10]. Such measures, singly or in combination, may include:
o A phased RTW which might start by working only a few hours per week initially
o Working from home
o Modifications to the tasks and/or responsibilities at work
o Allowing time off work for health-related activities e.g. appointments and rehabilitation
o Utilising the Access to Work Scheme or other advice from the Department for Work & Pensions

The technical aspects of how this is achieved by vocational rehabilitation professionals has been described elsewhere [11]. Thus critical care teams can, by these simple means, reduce unnecessary worry about future job prospects. Facilitating a successful RTW helps not only the disadvantaged individuals and their families but also their employers and the government.

These views are personal and do not necessarily reflect those of the Vocational Rehabilitation Association.

1. White C, Connolly B and Rowland MJ. Rehabilitation after critical illness. BMJ (Clinical research ed.) 2021; 373: p. n910.
2. Iacobucci G. All intensive care patients must have access to community rehabilitation, leaders urge. BMJ 2021; 373: n137
3. Royal College of Physicians of London. Physical Disability Services in 1986 and Beyond. J R Coll Phys (London). 1986; 20(3): 160-194.
4. Collective of 20 Charities. Manifesto for community rehabilitation. Manifesto for community rehabilitation | The Chartered Society of Physiotherapy (csp.org.uk), 2019.
5. Black, Dame Carol. Working for a healthier tomorrow. London: TSO. 2008
6. Council for Work and Health. Talking Work: A guide for Doctors discussing work and work modifications with patients. London (UK), Council for Work and health 2019: 1-20.
7. Society of Occupational Medicine. COVID-19 return to work guide for recovering workers. 2021 [cited 2021]; Available from: https://www.som.org.uk/COVID-19_return_to_work_guide_for_recovering_work….
8. NICE. Managing long-term sickness absence and capability to work overview. 2019 [cited 2020 18/06/20]; Available from: https://pathways.nice.org.uk/pathways/managing-long-term-sickness-absenc…
file:///C:/Users/andre/Downloads/workplace-health-longterm-sickness-absence-and-capability-to-work-pdf-66141783176389.pdf.
9. Mikkelsen M and Rosholm M. Systematic review and meta-analysis of interventions aimed at enhancing return to work for sick-listed workers with common mental disorders, stress-related disorders, somatoform disorders and personality disorders. Occupational and Environmental Medicine, 2018. 75(9): 675-686.
10. Frank A. Rehabilitation after COVID-19: supporting those in employment back to work (letter). Clin Med, 2020. 20(6 ): 2.
11. Frank A. Vocational rehabilitation: supporting ill or disabled individuals in(to) work: a UK perspective. Healthcare, 2016. 4(46).
Healthcare | Free Full-Text | Vocational Rehabilitation: Supporting Ill or Disabled Individuals in (to) Work: A UK Perspective | HTML (mdpi.com)

Competing interests: No competing interests

Andrew O Frank is a retired consultant physician in rehabilitation medicine and trustee and past chair of the Vocational Rehabilitation Association.

This is a copy of a rapid response published in the British Medical Journal (BMJ) in response to their article on Rehabilitation after Critical Illness BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n910 (Published 15 April 2021)