Results
The majority of the 783 responses were submitted from Europe and North America (30.4% and 28.1%, respectively), though six continents were represented (South America 17.3%; Asia 14.3%; Australia 6.3%; Africa 3.6%). In the Spanish language survey, 17.5% were from Central America and 7.6% were from the Caribbean. Sixty-seven percent of participants were rehabilitation physicians, 13.1% were therapists, 8.0% were nurses, and 5.7% were researchers, with the remaining 7.4% identifying as “primary care physicians/general practitioners,” “other physicians,” or “psychologists/mental health professionals.” Respondents worked in nations with a variety of economies (developed 46.5%; transitional 19.5%; developing 34.1%) and health care systems (universal coverage 52.3%; tiered system 28.9%; not universal 15.8%; self pay 3%), and 73.1% provided direct patient care.
When participants were asked if they live in a country in which COVID-19 testing is/has been widely available, 57.4% responded, “yes,” 27.4% responded, “no,” and the remaining 15.2% responded, “I’m not certain.” Only 5.8% of participants had ordered COVID-19 testing for one or more of their outpatients with SCI/D. Among this group, 22% reported that they had not used formal screening guidelines, 9.8% that they had screened “all outpatients,” and 65.9% that they had used guidelines published by their government. Only 4.4% of respondents reported that they had had a patient with SCI/D diagnosed with COVID-19 (70.3% had not and 25.3% were not certain). The most commonly listed presenting symptoms were fever (86.2%), shortness of breath (62.1%), body aches/worsening pain (20.7%), sweats (20.7%), and chest pain (13.8%). However, 10.3% reported their patients with SCI/D and COVID-19 had had increased spasticity, 6.9% that they had had rigors, and 6.9% that they had been asymptomatic. When asked which treatments their patients with SCI/D and COVID had been offered, 82.8% replied, “strict isolation/quarantine,” 58.6% “emergency room level care/hospitalization,” 20.7% “over the counter medications for symptom relief,” and 27.6% “hydroxychloroquine and/or azithromycin.” Two respondents reported that they had referred their patients to a centralized COVID-19 hospital.
Four hundred and forty-three (64% of the 692 who answered this question) worked in an inpatient rehabilitation facility. When asked on which of their inpatients with SCI/D they were performing COVID-19 screening, 53.3% reported “only patients with symptoms,” 5.3% “all patients at time of admission,” 1.2% “all patients currently in the facility,” and 4.3% “all new admissions AND all patients currently in the facility.” Ten percent reported that they did not know if patients were being screened, and 25.9% reported that patients in their facility were not being screened.
We asked participants which changes to their practices they were planning or implementing as a result of the COVID-19 pandemic. Forty seven percent reported increased use of telemedicine, 49% limiting use of therapies, 50.4% promoting the use of home care, and 7.7% were not planning any changes. Just less than 60% (58.4%) felt they had been given enough information about COVID-19 to appropriately counsel and screen people with SCI/D; only 38.8% felt that their patients with SCI/D had been given enough information about COVID-19. When asked whether their patients with SCI/D had contacted them with concerns about COVID-19, 34.1% said they had. Specific concerns that had been relayed included increased vulnerability to infection (76.9%), fragility of caretaker supply (42%), inability to obtain necessary routine supplies (40.2%), inability to be appropriately tested (28.5%), inability to obtain transportation to health care appointments (21.3%), and inability to self-quarantine (20.7%).
The Spanish language survey asked two questions not included in the English version. When asked about changes in outpatient rehabilitation services, 125 of 223 (56.1%) respondents reported that those services had been discontinued, 18.4% that treatment hours had been reduced, 16.1% that services had been discontinued but replaced with telemedicine, and 9.4% that work had continued without modification. Those respondents whose outpatient facilities had closed were asked at which point that had occurred. Thirty-nine percent responded that it had happened within 1 week of the first reported case in their country, 30.2% within two weeks, and 16.6% after three weeks or more.
The availability of COVID-19 testing was not related to the state of economic development, χ2 (2, N = 625) = 0.249, p = 0.883, but was related to the continent of origin, χ2 (5, N = 622) = 30.794, p < .001 (Table 1). However, those living in nations with universal health care were significantly more likely than those living in countries without guaranteed health care to report availability of testing, χ2 (3, N = 625) = 46.259, p < 0.001 (Table 2).
Table 1 Continent versus availability of COVID-19 testing.
Continent Has/is COVID testing widely available? N (%)
Asia Yes 56 (64.4)
No 31 (35.6)
Africa Yes 17 (70.8)
No 7 (29.2)
South America Yes 77 (81.9)
No 17 (18.1)
Europe Yes 142 (68.6)
No 65 (31.4)
North America Yes 91 (55.2)
No 74 (44.8)
Australia Yes 39 (88.6)
No 5 (11.4)
Table 2 Health care system versus availability of COVID-19 testing.
Nation’s health care system Is/has COVID-19 testing been widely available? N (%)
Universal/government funded health care Yes 253 (75.5)
No 82 (24.5)
Tiered system, basic health care with available private insurance Yes 117 (68.8)
No 53 (31.2)
Public/private insurance Yes 49 (49.0)
No 51 (51.0)
Self pay for care Yes 4 (20.0)
No 16 (80.0)