Mapping the occupational therapy process in response to COVID-19 and long COVID: A scoping review.
Daniel Cezar da Cruz, Kristine Haertl, George S Tomlin and 3 others
PMID 42371512WHAT IT FOUND
Across 25 studies of OT for COVID and long COVID, most were single-patient case reports.
Only one controlled trial tested a specific OT approach. The evidence base is too thin to recommend any particular intervention over another.
Key findings
01Of the 25 included studies, 11 were individual case studies, 2 were case series, and only 4 were randomised controlled trials. Just one controlled study (Jung et al., 2023) specifically tested the effect of a named OT approach, time-use therapy, and found significantly better performance in the experimental group.
02The most common therapeutic goals across the 25 studies were activities of daily living (18 studies, 72%), performance skills such as bed mobility and transfers (10 studies, 40%), and client factors including strength and endurance (9 studies, 36%). Mental health concerns were addressed in 7 studies (28%).
03Two RCTs that added robotics to standard rehabilitation protocols (one for COVID, one for long COVID) found no statistically significant difference between the experimental and control groups, although both groups showed significant improvement in rehabilitation outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Eleven of the 25 included studies were single-patient case reports; the 25 individuals across all case studies combined make a very small sample, especially spread across 8 different settings. Only one controlled study specifically tested the effect of a named OT approach; the other three RCTs tested adjunctive technologies (robotics, virtual reality) rather than OT-specific interventions. Most included studies were in English despite a multilingual search strategy (Portuguese, Spanish, German, Mandarin were attempted). No critical appraisal of included studies was performed, which is standard for scoping reviews but means the quality of the underlying evidence is unassessed. The four-category intervention framework (educational, compensatory, restorative, acquisitional) may not capture the full range of OT practice, including interpersonal and caring dimensions. Case studies varied widely in how much detail they provided about what the OT actually did, making it hard to compare interventions across studies. No qualitative studies involving patients undergoing OT for COVID or long COVID were identified, so the patient experience is absent from the evidence base. The majority of included studies originated from the United States, limiting generalisability to other healthcare systems.
Declared interests
The authors declared no conflicts of interest and no financial support for the research, authorship, or publication.
The easy way to misread this
Do not read the positive case-study outcomes as evidence that specific OT interventions work for COVID or long COVID. Eleven of the 25 included studies were single-patient reports with no control group, and the authors themselves note that without controls the effects of natural recovery cannot be separated from the effects of treatment. The only controlled test of a named OT approach was a single RCT of time-use therapy, and the two RCTs testing robotics as an add-on to standard rehab found no between-group difference.