Occupational Medicine & Health Affairs
Open Access

The COVID-19 pandemic has changed lives for many individuals across the world during its reign. The pandemic has involved around 107,838,255 confirmed cases worldwide along with 2,373,398 confirmed deaths across the world (World Health Organization, 2021). The COVID-19 pandemic has affected individuals from many different groups throughout the world [1]. One aspect of society that has changed extensively during this pandemic has been the healthcare system. One of the many healthcare providers that have experienced the many different effects from COVID-19 is occupational therapists [2]. Occupational therapists have suffered throughout the COVID-19 pandemic through setbacks in their mental health and how they provide OT services. Due to these same factors, there has been a dramatic change in the healthcare system due to the COVID-19 pandemic.

Healthcare workers are under an increased amount of stress when compared to their norm, as it would be with any other pandemic [2]. Because of an increased workload and increased amount of stress, healthcare workers are subject to many different types of stress including health-, psychological-, and financial-related stress [2]. Occupational therapists are not necessarily the first line-of-defense for COVID-19 treatment, there are many negative effects experienced by not only the therapists themselves but also their patients [2]. Not all occupational therapists have experienced negative effects; however, it is important to note that all occupational therapists have either had their life or practice affected in some way [2]. Some negative effects that have been reported include mental health disorders such as anxiety, depression, and suicidal ideation [3]. Some other negative effects include occupational therapists working longer shifts, increased risk of exposure to COVID-19, and decreased resources to use for therapy [3]. The COVID-19 pandemic has also required occupational therapists to change the way that they provide their services [2]. The purpose of this literature is to research and examine how occupational therapy has been affected by the COVID-19 pandemic and how this has expanded into declines in mental health of occupational therapists.

Methodology

Participants

The participants included a wide range of health care professionals to include nursing staff, physicians, and rehabilitation staff that include occupational therapists and physical therapists. In the research analyzed, occupational therapy settings included both inpatient and outpatient settings. Nursing staff and physicians in the research examined by this study were employed in a hospital setting. Physical therapists from the research examined in this study were employed in an outpatient setting. Nursing staff, physicians, and physical therapists are reviewed to examine how occupational therapy services were affected by the COVID-19 pandemic compared to other similar healthcare services.

Interventions

Generally, occupational therapy was forced to come to a near halt due to the COVID-19 pandemic [4]. Individuals were forced to stay home and become isolated from their everyday lives [4]. The COVID-19 pandemic forced individuals to be unable to attend occupational therapy sessions due to restrictions or becoming sick themselves [4]. The inability to attend these sessions negatively affected these individuals because it did not allow these individuals to receive services and decreased their ability to engage in activities that would provide meaning in their lives [5]. Some individuals have shown an increased need for occupational therapy due to implications from COVID-19 that included individuals with advanced age, multiple chronic diseases, and organ failure [6]. Individuals who required intensive care due to the COVID-19 infection will face long-term physical, cognitive, and emotional issues which will increase need for occupational therapy services long-term [7]. There may also be individuals with no health conditions that utilize occupational therapy services for mental health because of increased issues related to conditions obtained because of the pandemic.

Occupational therapy services changed dramatically during the apex of the COVID-19 pandemic based on the setting an occupational therapist worked in. Due to many strict COVID-19 guidelines, outpatient clients were forced to almost close or have limited/no patients within the clinic. Occupational therapy within the school systems and pediatric clinics were forced to do the same. Occupational therapy in the hospital has had the opposite effect. Occupational therapists have had an increased workload within the hospital setting and have even been drawn to operate in areas of the hospital that they wouldn’t normally work. Therefore, in outpatient-type settings, telehealth has become a normal treatment setting for occupational therapists and their patients. Telehealth has had great success for both occupational therapists and their patients during the COVID-19 pandemic because of its ability to connect the therapist to the patient through remote means [4]. However, there is increasing evidence that telehealth can improve access to occupational therapy along with other rehabilitation services beyond the days of the COVID-19 pandemic.

Occupational therapy is the answer to an equation with occupational therapists and patients as the integers. Therefore, the patient demographic and related information to include the number of patients that occupational therapists have seen, the number of new patients compared to old patients regarding the start of the COVID-19 pandemic, and if old patients have seen a need for increased treatment hours now compared to the start of the COVID-19 pandemic.

Occupational therapists, like many other healthcare providers, found them affected both mentally and physically by the COVID-19 pandemic in terms of increased stress at the workplace. One of the most debilitating impacts of the COVID-19 pandemic is the increased stress and mental health risk for healthcare providers [2]. Outcome measures used for determining mental health for occupational therapists included Masloch Burnout Scale, Job Stress Scale, and selfreporting questionnaires (Ornell et al., 2020). They’re often associated with psychological pressure and feelings of loneliness and helplessness and can produce stress, irritability, physical and mental fatigue, and despair (Ornell et al., 2020). Additional outcome measures included occupational therapists’ feelings of loneliness, anxiety/depression, and stress measured by DSM-5 Cross-Level Symptom Scale 1, World Health Organization Quality of Life - short version, and the Hamilton Scale [3]. Additional outcome measures included increase in work hours assessed by surveys conducted on occupational therapists [4].

Search strategies

The search strategies for this literature involved research on Google Scholar and using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for analysis and categorization. A collection of key terms that were searched included occupational therapy, healthcare providers, COVID-19, pandemic, anxiety, depression, increase, decrease, telehealth, changes, and effects. Google Scholar was the only search engine used for this literature review.

Research articles were included when they met the guidelines as follows: within the date relative to the COVID-19 pandemic (2019- 2021) and included occupational therapy and/or related healthcare providers. Research articles were excluded if they did not refer to the COVID-19 pandemic unless they were relative to telehealth and the history of telehealth. Articles that were before the year 2019 were excluded due to COVID-19 starting in that year unless the article was pertaining to telehealth and the history of telehealth. The articles that involved telehealth were the only articles that were written before the period of the COVID-19 pandemic. Healthcare providers worked in both hospital and outpatient settings. Inclusion criteria for healthcare providers included the ability of the healthcare provider to provide hands-on care and to have worked in the same settings as occupational therapists.

Data Collection and Analysis

Data was collected through researching research articles related to how occupational therapy services and mental health of occupational therapists have changed because of the COVID-19 pandemic. All articles are either primary research articles or meta-analyses that include summations of many research articles. Of the 11 articles selected for this study, nine studies were systematic reviews or metaanalyses, and two articles were primary research studies. Data analysis was conducted by collecting research subjects from all systematic reviews and meta-analyses and studying the results collected from the primary research studies. Nine studies were characterized as level I evidence. Two articles were characterized as level II evidence.

Overall, nine studies with level one evidence showed that the COVID-19 pandemic had a negative effect on the mental health of health care workers including occupational therapists [8]. The research also showed that the future of OT is changing in a positive way [9].

Three studies looked at how the COVID-19 pandemic had a negative effect on the mental health of health care workers, and how to improve mental health [1, 3, 8]. Braquehais et al. found that many health care workers felt an increase in anxiety and depressive symptoms that ranged from personal factors, decreased resources, and exposure to COVID-19. Braquehais et al. discusses how individuals should communicate better with their employers about their mental health. The Ornell et al. study found that health care workers who have direct contact with COVID-19 patients had an increase in anxiety, depression, and suicidal ideation. Ornell et al. discussed how employers should make sure to check on their workers' mental health during this pandemic. Verma and Prakash found that mental health, education, and family life were affected by the COVID-19 pandemic. Verma and Prakash discussed how yoga can be extremely beneficial in improving individuals’ immune system and mental health. The best part is that individuals can participate in online yoga classes, so they can follow social distancing guidelines.

Three studies looked at how COVID-19 impacted the delivery of occupational therapy [4, 5, 10]. Dirette discussed how occupational therapists are working hard in the ICU and acute care setting. With different settings closed, occupational therapists are getting part time jobs to help with the overflow of patients in different settings. Hoel et al. found that OTs had difficulty in many areas of practice since the COVID-19 pandemic including accessibility, sustainability, appropriative service, efficiency, effectiveness, client-centered, and safety. Scott discussed how COVID-19 has changed the traditional methods of delivering OT services, which included new approaches and methodologies [10]. Scott also discusses how many OTs relocated from their current jobs to help assist in the front lines fighting COVID-19 [10].

Three studies looked at the current change that is occurring in occupational therapy due to COVID-19 (Simpson & Robinson, 2020; Dirnberger & Waisbren, 2020; Ceravolo et al., 2020). Simpson & Robinson (2020) showed that COVID-19 associated critical illness will have dramatic implications for patients, families, and healthcare workers around the world. Healthcare services will have to adapt rapidly to an anticipated surge of cases, and this will place enormous strain on acute services. Dirnberger & Wasisbren found an increased satisfaction score for individuals using telehealth that involved cost savings of an average of $51.94 per patient and decreased travel time by an average of 99.4 minutes per day. Ceravolo et al. study found that early rehabilitation is needed for COVID-19 patients that are in acute care, telehealth should be regarded as the best option for individuals at home, and individuals who have restricted mobility should be given an exercise program to reduce functional decline.

Discussion

The data suggests that COVID-19 has affected the mental health of health care professionals including occupational therapists, and occupational therapy as a profession. In addition, the data suggests that COVID-19 has impacted how occupational therapy services are delivered. Studies found that healthcare workers felt an increase in anxiety and depressive symptoms during the COVID-19 pandemic [8]. Occupational therapists were healthcare providers that were affected by the pandemic. Occupational therapists reported difficulty in many different areas of practices that included accessibility, sustainability, appropriate services, and effectiveness of occupational therapy practice [5].

This research reviewed literature that analyzed how occupational therapy has changed because of the COVID-19 pandemic. The results of the analyses of the articles showed that occupational therapy has changed greatly during the COVID-19 pandemic. There have been new physical and mental health conditions that have been related to the pandemic that occupational therapists will help treat in individuals that have had COVID-19 infection [11]. Occupational therapists are experiencing new levels of anxiety, depression, and loneliness along with other mental health and physical conditions related to the COVID-19 pandemic [3]. Lastly, the process of occupational therapy treatment has changed with decreased ability for in-person treatment and increased participation in telehealth sessions [4].

Implications for Occupational Therapy Practice

Occupational therapy as a practice can expand and grow due to the COVID-19 pandemic. Since some individuals who have contracted the COVID-19 infection have been shown to have an increase in prolonged symptoms, this provides a sliver of an increase in occupational therapy needs for these individuals. The need for these individuals still needs to be examined in the future; however, this study analyzed research that determined increased aspects of the COVID-19 pandemic, such as social distancing guidelines, have decreased the ability for individuals to receive occupational therapy. In this case, occupational therapy needs have increased because individuals have been unable to receive appropriate occupational therapy treatment. Therefore,these implications are relevant because it shows increases in need for occupational therapy which weighs great implications for occupational therapy as a profession.

Implications for Education

The research can also have implications for occupational therapy education. For the same reason, there can be advancement in education, such as new guidelines and occupational needs, for caring for individuals with these prolonged symptoms of the COVID-19 infection. Also, there can be improvements in education that result in increased importance for occupational therapy practitioners to gain healthy mental health strategies while delivering occupational therapy services. The research will provide important implications for future education for occupational therapy students and practicing occupational therapists. This is relevant because it shows that occupational therapy education is evolving due to the COVID-19 pandemic.

Implications for Research

Implications for other research may include examining the future of healthcare guidelines for a future pandemic and how it relates to occupational therapy. Implications for other research also may include how the future of prolonged COVID-19 symptoms will affect future and existing occupational therapy clientele. The research observes and identifies different mental health effects on healthcare workers, and specifically mental health effects on occupational therapists. Also, this research identifies several factors of occupational therapy care that have been affected during the pandemic. The research provided discusses how the occupational therapy community, as well as the health community, was unprepared for a pandemic. The occupational therapy community needs to better prepare for future pandemics. The research also explains that we do not fully understand this virus, and the long-term effects that it may cause. Therefore, this research provides implications for future research to be performed on the future of occupational therapy related to the effects of the COVID-19 pandemic. These implications are relevant to the future research of occupational therapy because it shows new needs for continued research related to occupational therapy and the COVID-19 pandemic.

Conclusion

The COVID-19 pandemic continues to change lives all over the world. Individuals all over the globe have been affected by this infectious disease in many ways. Individuals have been affected physically with signs and symptoms of the infection and affected mentally with mental health issues related to the pandemic. Specifically, healthcare workers have been affected the most during the COVID-19 pandemic. Occupational therapists are a group of healthcare workers that have been affected significantly both physically and mentally. Constant change and uncertainty looms over the occupational therapy profession and the settings they work bringing about physical and mental detriments only healed by time and the advancement of the profession itself[12].

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