Introduction

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) responsible for coronavirus disease 2019 (COVID-19), which began with a few cases of flu-like disease in Wuhan, China, has now evolved into a pandemic that has affected millions of people worldwide and forced unprecedented changes in every field of life (Sifuentes-Rodríguez and Palacios-Reyes 2020).

The COVID-19 pandemic had led to mental health concerns. Among those at high risk and potentially neglected were those receiving mental health rehabilitation (“Coronavirus Protocol for Rehab,” n.d.; Gandhi et al. 2022). The impact of the COVID -19 pandemic on mentally ill patients was significant compared to the rest of the population. This can be due to pre-existing depression and anxiety disorders in such individuals that can be exacerbated in times of crisis and shake the foundations of stability or recovery for them (“Coronavirus Protocol for Rehab,” n.d.). The social distancing, home quarantine, and day-care facility closing might have negatively impacted their clinical outcome. Having to stay at home not only slow down social skills development progress but also reduces their self-reliance and self-confidence and affects their vocational potential (Chaturvedi and Sharma 2020).

Occupational therapy services typically include: an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals; customized intervention to improve the person’s ability to perform daily activities and reach the goals, and an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan (American Occupational Therapy Association 2021). Consequently, the occupational therapy process had to be modified due to COVID-19 circumstances and the COVID-19 pandemic lockdown measures caused a great impact on occupational therapy service delivery. Rehabilitation and other services delivering occupational therapy had to quickly change the way occupational therapy services has been delivered so far. Telehealth has been a known possible medium in providing service, but it hasn't been implemented as much in a period before the worldwide COVID-19 pandemic (Kamalakannan and Chakraborty 2020; Smith et al. 2020).

Background and Need for the Review

As per the 2011 census, 2.21% of the Indian population consists of people with disabilities (PWDs), among whom 6% have an intellectual disability and 3% have mental illnesses. The National Mental Health Survey (NMHS) of India reported the current and lifetime weighted prevalence of morbidity due to mental illness to be 10.6% and 13.7%, respectively (Murthy 2017).

As the healthcare system transitioned to virtual platforms during the pandemic, healthcare providers needed to help their patients embrace and get used to tele-health or mobile health technology. Maintaining regular contact with patients suffering from severe mental illness (SMI) was critical for maintaining a sense of social connection and preventing symptom relapse and hospitalization (Hamada and Fan 2020).

During the pandemic, occupational therapy has heightened the importance of enabling engagement in activities that provide meaning in life when participation in regular routines and activities is particularly challenging (Hoel et al. 2021). However, contrary to this situation, many occupational therapists have switched to telehealth practice while continuing to serve a diverse population, which has negatively affected their mental health (Ito and Ishioka 2020).

Rumrill et al. (2021) conducted a study in the USA, and noted that rehabilitation professionals and other service providers found it difficult to pivot to entirely virtual services during the COVID-19 pandemic. There's no evidence that telehealth platforms can substitute for in-person treatment, especially for people with complex disability-related needs.

An online cross-sectional survey conducted by Ganesan et al. (2021) revealed that the worldwide lockdown due to the COVID-19 pandemic had significantly affected occupational therapy and rehabilitation practice in developing and developed countries. The repetition of the occupational therapy intervention are essential for patients to achieve maximum functional capabilities and for a high level of satisfaction among rehabilitation professionals (physical therapists, occupational therapists, speech therapists), neurodevelopmental therapists and psychologists. In this survey, 40.4% of the therapists (out of 99 responses), reported that tele-rehabilitation is as effective as face-to-face therapy intervention (Ganesan et al. 2021).

Health and care staff experienced increased workloads, reallocation of duties, a necessity to adapt to changing needs (such as the use of personal protective equipment) and concerns about personal and family risk of infection (Gemine et al. 2021), all of which has the potential to impact negatively on staff wellbeing. Ward and Cuasterton (2020) conducted a survey on impact of COVID-19 on occupational therapist, respondents reported positive changes including opportunities to work in new and innovative ways (64.2%) and learning new skills (51.3%), and negative changes including the impact on work–life balance (49.6%) and reduced access to support/supervision or mentorship (32.9%).

Occupational therapist faced the challenge of providing online services to people with disabilities. This review aimed to find the best available evidence on the experiences and challenges of occupational therapist during the COVID-19 pandemic.

Aim of the Review

The review aimed to identify and synthesize the best available evidence on the experience of occupational therapists in psychiatric rehabilitation settings during the COVID-19 pandemic. Additionally, the challenges posed by changes in the mode of training were examined.

Objectives of the Review

  • To understand the complexities of experience faced by Occupational therapist during the COVID-19 pandemic

  • To identify the studies describing the challenges faced by occupational therapists in conducting training sessions in the wake of the COVID-19 pandemic

  • To identify various recommendations given by different researchers

Method

A scoping review was utilized, incorporating summaries, explanations and interpretations from available quantitative and qualitative studies to address review objectives. This method allows a review to extract different data and develop them in a way that is meaningful, transparent and systematic (Grant and Booth 2009). Reporting followed the PRISMA checklist in the manner indicated by Moher et al. (2009).

The review search for all study which explore the experiences of occupational therapist’s during the COVID-19 were published from 2020 to 2022 was included to encompass a wide range of literature. After identifying the needs and objectives for the current review, inclusion and exclusion criteria for the selection of literature were prepared, based on which the review was carried out by using different search strategies and various databases. Qualitative research articles, quantitative, and mixed studies were considered for inclusion in the review. The collected articles were checked for clarity and content and then used for the review. Data were extracted from included research articles, categorized based on similarity of meaning, and aggregated to produce a comprehensive set of synthesized findings.

Eligibility Criteria

The review identified studies that focused on the experience of occupational therapist in psychiatric rehabilitation settings during the COVID -19 pandemic.

Inclusion Criteria

  • Studies describing the experience of the occupational therapists during the COVID-19 pandemic in psychiatric rehabilitation settings

  • Literature published in the English language

  • Literature published between the years 2020 and 2022

Exclusion Criteria

  • Studies conducted other than in a psychiatric setting

  • Studies with insufficient data, such as inadequate information on research methodology

  • Systematic review, unpublished studies and abstracts

GR screened titles and abstracts and selected articles that met the inclusion criteria. Two independent reviewer (SG & TS) reviewed the full texts of these articles and excluded papers that did not meet the inclusion criteria.

Electronic Database Searching

The published literature was obtained from databases such as PubMed, PsycINFO, PsycNET, Cochrane Library, Ovid, MEDLINE, CINAHL.

Keywords/phrases used were as follows: “COVID-19 pandemic, Psychiatric Rehabilitation, Occupational therapist, psychiatric rehabilitation professionals, Vocational education & training, People with mental illness, Psychiatric day-care, Life experiences, Attitude, Impact, Experience, Perception and Effects”.

Electronic journal searching: The electronic journals assessed were SAGE Journals, Elsevier Science Direct, Springer, Wiley Online Library, JAMA Psychiatry, Society E- Journals, Karger, and Access Medicine.

Web-based searching: Web-based resources were identified by Internet searches using Google and Google scholar advanced search.

Data Extraction and Quality Assessment

The extracted data were assessed based on eligibility criteria. The literature search identified 45 references from different database. The articles were evaluated based on relevance, appropriateness, clarity, and methodology. Selection of reviewed articles were done using the PRISMA flow diagram (see Fig. 1).

Fig. 1
figure 1

PRISMA flow diagram showing the selection of studies for the review

Full size image

A total of 45 articles (2020–2022) were identified as relevant. The included studies had varying designs, reporting styles, research methodology, systematic review and abstract. The researcher screened each article and excluded unrelated studies (n = 30), systematic review (n = 4) and abstract (n = 3) based on the eligibility. Finally, eight studies were included in this review.

Data Analysis

The steps followed in the analysis of studies were:

Step 1: Preliminary Organization of Studies

The following data were tabulated from the relevant articles: Author, Journal, Year, Country, Research design, Population and sample size, data collection method, and Themes derived from the study.

Step 2: Categorizing Studies Based on Review Objectives

The studies were explored to gather data based on objectives. The gathered data were categorized under review objectives.

Step 3: Summarizing the Major Findings

  • Data analysis: Descriptive statistics were used to analyze and summarize the data.

  • Synthesis of data: Synthesis of data from major findings was done to identify the most common themes in the studies describing the experiences of occupational therapists at psychiatric rehabilitation services during the COVID-19 pandemic.

Results

Overview of Studies

A total of 8 studies conducted between 2020 and 2022 were included in this review. The studies included quantitative, qualitative & mixed methodology. The details of the studies are listed in Table 1.

Table 1 Details of the articles reviewed (n = 8)
Full size table

Summary of the Findings

The current review findings are as follows:

  • The studies included in the review came from many countries. Most of the studies were conducted in the United Kingdom (37.5%) (see Table 2)

  • All qualitative studies used phenomenological research designs (37.5%) and three studies used a quantitative methodology with cross-sectional survey design (37.5%). Two studies used a mixed methodology (see Table 3)

  • The majority of the studies had a sample size of more than 200 (50%) (see Table 4)

  • The majority of the studies used structured web-based (online) interviews to collect data (37.5%) (see Table 5)

  • The Quantitative findings in the review comprising of:

    1. (a)

      Greater decrease in the therapeutic quality of occupational therapy, increase the workload, decrease the working hours and difficulty in adaptation to the situation (Sawamura D).

    2. (b)

      40% therapist respond to to continue the tele-rehabilitation is as effective as face-face therapy (Ganesan B).

    3. (c)

      Higher feeling of safety and positive work morale (Hoel V)

  • Based on the reviewed article some themes have been found are; Challenges in vocational training, coping strategies used by rehabilitation instructors, Concern about training, and Experience of rehabilitation trainers (see Table 6).

Table 2 Frequency distribution and percentage of countries that conducted studies (n = 8)
Full size table
Table 3 Frequency distribution and percentage of research design among the reviewed studies (n = 8)
Full size table
Table 4 Frequency distribution and percentage of sample size (n = 8)
Full size table
Table 5 Frequency distribution and percentage of data collection method used among the reviewed studies (n = 8)
Full size table
Table 6 Synthesis of data
Full size table

Discussion

Through this scoping review, relevant articles related to the impact of the COVID-19 pandemic on occupational therapist were studied. The included studies focused on the impact of the COVID-19 pandemic on the working and mental health of occupational therapists and innovative practices implemented in psychiatric care settings. In this context, it is important to note that limited articles have been published on the experiences of occupational therapist in the Psychiatric Rehabilitation Service in the wake of the COVID-19 pandemic.

Discussion of Major Findings

In the wake of the COVID-19 advisory on social distancing, day boarding and day-care center for people with mental health problems had been closed for some time.

The COVID-19 pandemic has certainly caused rapid changes in methods of providing health care. Occupational therapists, however, are frustrated by the lack of service readiness in providing telehealth support, especially for participants without access to technical infrastructure. Both occupational therapist and service users had limited access. Access to smartphones, tablets, Wi-Fi, laptops and high-quality IT infrastructure is an issue in many service areas. People with mental illness often struggle with disadvantages caused by the lack of devices and resources that most people in society are accustomed to. Supporting transitions is an invaluable role within the profession (Culleton 2021).

Telehealth played an important role in facilitating continuity of occupational therapy services during the pandemic, although the resources of many occupational therapy professional associations were not available at the beginning of COVID-19. The transition to telehealth services and limitations in the community was very new to many occupational therapists. On the other hand, for the integration of telehealth, guidelines and evidence supporting the use of the technology are crucial together with appropriate guidelines to support the transition to virtual models (Hoel et al. 2021).

Additional responsibilities and increased workload accompanied the rapid development of new services and treatment pathways. Although many professionals welcomed new challenges, embraced opportunities, and motivated their colleagues, there were many who also acknowledged that this way of working was not sustainable. The rapid requirement to step into new areas and establish new services in the absence of prior experience with, and an established evidence base for, treating front-line workers created anxiety and uncertainty, resulting in wide variation in service provision (Billings et al. 2022).

A study of Fillipino Occupational Therapists conducted by Sy et al. (2020) reported feelings of isolation, an increased awareness of alternative service delivery options and creative ideas for the future; however, they did not explore explicitly the support mechanisms for reducing the psychological impact of the pandemic on Occupational Therapists.

Among rehabilitation professionals, healthcare providers, and disability advocates, it is well established that people with disabilities require significant supports to navigate the risks and complexities of the COVID-19 pandemic. Rehabilitation professionals and other service providers have found it difficult to transition entirely to virtual services, because there is not enough evidence supporting tele-health platforms as an alternative for in-person treatment, especially for people with complex disability-related needs.

The psychiatric rehabilitation professionals experienced organizational, professional, and personal challenges during the COVID-19 pandemic. Limited research has been carried out on the experience of vocational instructors in psychiatric rehabilitation settings globally. Rehabilitation professionals had to seek alternative methods in carrying out their professional duties with fundamental changes and new ways of working. Therefore, it is necessary to evaluate novel approaches comparison to traditional methods.

Implications

This literature review has the following implications for occupational therapy practice, education, and research:

Findings derived from this review can be used to support the change in occupational therapy service delivery. Occupational therapy is the health profession that can use the advantage of pandemic situation for professional development to satisfy the needs of the people with mental illness who cannot attend face- to -face intervention.

The professionals must understand the pandemic impact on rehabilitation service, and based on that finding plan and conduct an orientation and induction program related to how to handle disaster in the future, tele-rehabilitation, technology-friendly education for newly joined rehabilitation professionals. Professionals should provide supportive care and computer training for the patient so that future patients can avail the service without fail.

In Occupational therapy, curriculum should include telerehabilitation, technical competence and respect for humanity. The trained occupational therapist/ psychiatric rehabilitation professionals must understand the difficulties faced by the therapist during the crisis and should be able to empower the OT in the future.

Further research in this area is recommended since new research is emerging all the time.

Limitations

  • Only a few national and international qualitative studies on the experience of occupational therapist during the COVID-19 pandemic were found.

  • Grey literature could not be reviewed

Recommendations

Future reviews on the current topic are therefore recommended. Reviewing the following aspects in the future might be useful:

  • Experience of vocational instructors in Psychiatric Rehabilitation Settings during the COVID-19 pandemic

  • Experience of all mental health professionals in Psychiatric Rehabilitation Settings during the COVID-19 pandemic

  • In-service education for vocational instructors in tele-rehabilitation.

Conclusion

The findings from the review have revealed the complexities and challenges faced by occupational therapists during the COVID-19 pandemic (professional and personal). The study findings indicate that the experience of rehabilitation instructors during COVID-19 was not pleasant or easy. The review gives a holistic view of issues, challenges and new implications in rehabilitation. Enhancing the training of occupational therapist will help in easing the access and know-how of using telerehabilitation services for patients and coping with COVID-19 like situations in the future. This will help the occupational therapists increase their work efficiency, knowledge and motivation.