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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 70-76

Impact of the COVID-19 pandemic on physical and rehabilitation medicine in morocco: Results of a national survey


Department of Physical and Rehabilitation Medicine, Faculty of Medicine, University Hospital Mohammed VI Marrakesh, Cadi Ayyad University, Marrakesh, Morocco

Date of Submission10-Aug-2020
Date of Decision10-Oct-2020
Date of Acceptance02-Mar-2021
Date of Web Publication01-Jun-2021

Correspondence Address:
Dr. Youness Abdelfettah
Department of Physical and Rehabilitation Medicine, University Hospital Mohammed VI Marrakesh, Av. Ibn Sina Amerchich, BP 2360, Marrakech Principal
Morocco
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISPRM-000105

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  Abstract 


Background: The World Health Organization declared coronavirus disease-19 (COVID-19) as a pandemic on March 11, 2020. The impact of COVID-19 on physical and rehabilitation medicine (PRM) services is unknown. In Morocco, the spread of the COVID-19 pandemic has worried the entire healthcare system. The present study intended to assess the global impact of COVID-19 on PRM patient care and training across Morocco. Setting: We conducted a web-based anonymous survey from April 15, 2020, to May 15, 2020. A 9-item questionnaire was developed to investigate the impact of COVID-19 PRM services. Participants: Practicing PRM physicians and PRM trainees. Results: About 57.5% of PRM physicians consented to participate in the survey. They are mostly based in Casablanca and Rabat. The type of activity indicates that 36% of the respondents are associated with a public institution, 43% with private institutions, 12% with a university hospital, 3% with the military hospital, and 3% with Foundations and Associations. The impact of COVID-19 over activities and the results indicate that a majority of the activities are reduced (79%) because of the prevailing pandemic, 29% is devoted toward participating in COVID-19 patient care, 25% converted to COVID-19 department. The measures undertaken for the continuity of training indicates that several ways were used to carry on training sessions of the staff. Conclusion: Considering beyond the pandemic, rehabilitation and physical medicine should be at the forefront of discussions, carriers to infrastructure, financing as well as implementing care through telehealth along with other approaches needs to end.

Keywords: Coronavirus disease-19, impact, physical, rehabilitation medicine, survey


How to cite this article:
Abdelfettah Y. Impact of the COVID-19 pandemic on physical and rehabilitation medicine in morocco: Results of a national survey. J Int Soc Phys Rehabil Med 2021;4:70-6

How to cite this URL:
Abdelfettah Y. Impact of the COVID-19 pandemic on physical and rehabilitation medicine in morocco: Results of a national survey. J Int Soc Phys Rehabil Med [serial online] 2021 [cited 2021 Oct 24];4:70-6. Available from: https://www.jisprm.org/text.asp?2021/4/2/70/317387




  Introduction Top


In December 2019, an unidentified respiratory infection affected by a novel coronavirus referred to as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was described in the Hubei province of the People's Republic of China.[1],[2] This infection was called coronavirus disease 2019 (COVID-19), leading to temperature, coughing, and dyspnea, describing viral pneumonia.[3],[4]

Since the rapid proliferation in the records of patients infected and deaths caused by COVID-19, the World Health Organization (WHO) confirmed the situation as a Public Health Emergency of International Concern in January 2020.[5] Even with drastic actions of containment taken in China, the virus extends worldwide, and the WHO has officially declared it as a pandemic on March 11, 2020.[6],[7]

Most of the countries are now affected by COVID-19. The pandemic represents the most significant threat that humanity has faced since the Second World War. At the time, confidence in international cooperation and multilateral institutions had reached a historically low point; this is again the case today.

By June 26, 2020, >11000 people had tested positive for SARS-CoV-2 in Morocco, 8656 recovered, and 218 people had died of COVID-19.[8] In the consequences of these extraordinary medical, economic, and social challenges, the Moroccan health system has put enormous efforts in the fight against the SARS-CoV-2 pandemic. These circumstances have had an effect not only on the infectious-disease and intensive care departments providing direct treatment but also on other specialties.[9],[10],[11],[12]

Morocco has around 35.5 million inhabitants according to the projections of the High Commission for Planning. Almost 37% of the population is located in rural areas. Moreover, 62.9% are between 15 and 59 years old.[13] There is still a gap between Morocco and comparable countries in terms of health spending. There are many sources of financing for the health sector: Tax revenues (24.4%), households (50.7%), health insurance (22.4%), employers (1.2%), international cooperation, and others (1.3%). About 40% of the population had medical coverage.[13]

Morocco has 16 regions; the majority of the healthcare supply is concentrated in 5 areas, this creates a significant disparity in the healthcare supply and medical deserts. There are around 24,961 Doctors, of which 11,416 are in the public sector. The number of hospital beds in the public sector is 25,385.[14]

Physical and Rehabilitation Medicine (PRM) Physicians are few in number compared to neighboring countries. There are 80 MPR doctors registered on the medical council, divided between public, private, military, and foundation sectors. About twenty residents also follow their specialization in PRM in the different university hospitals in Morocco.[14]

The present article provides an overview of the current and upcoming impact of PRM. The aim is to give a survey on the current information in our field and make it accessible to a broader readership. Naturally, especially with the rapid development of knowledge in the current pandemic, it is an overview of the situation here in Morocco.


  Materials and Methods Top


We conducted a multicentric cross-sectional study using a web-based anonymous survey from April 15, 2020, to Mai 15, 2020. A 9-item questionnaire was developed to investigate the impact of COVID-19 on various aspects of PRM services. Target respondents were practicing PRM physicians and PRM trainees.

All members of the Moroccan Society of Physical and Rehabilitation Medicine (SOMAREF) were invited to answer a web-based survey via Google Form. It contains multiple-choice questions and open questions. The accessing link to the survey was sent via E-mail and WhatsApp with a short description of the questionnaire. A first request was sent to all members, followed by a reminder after a few days.

The survey questions aimed to address the main changes that have occurred in the PRM physicians following the COVID-19 pandemic including the practice city, activity area, types of activities, the impact of the COVID-19 on activities, the actions taken for the continuity of training, and the measures taken for the permanency of PRM care. In addition, we asked about their perceptions and encountered difficulties because of the pandemic.

Categorical variables were summarized as frequency and percentage. For all statistical analyses, we used Microsoft Excel® 2016.

We conducted a multicentric cross-sectional study using a web-based anonymous survey via Google Form from April 15, 2020, to May 15, 2020, in French because it is the language of instruction. A 9-item questionnaire was developed to investigate the impact of COVID-19 on various aspects of PRM services. Target respondents were practicing PRM physicians and PRM trainees. The survey includes multiple-choice and open-ended short answer questions [Table 1].
Table 1: The 9-item questionnaire: the impact of the coronavirus disease-19 outbreak on PMR and rehabilitation activity in morocco

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All members of the SOMAREF were invited to answer a web-based survey via Google Form. It contains multiple-choice questions and open questions. The link for accessing the survey tool was sent via E-mail and WhatsApp with a short description of the questionnaire. A first request was sent to all members, followed by a reminder after a few days.

The survey questions aimed to address the main changes that have occurred in the PRM physicians following the COVID-19 pandemic including the practice city, activity area, types of activities, the impact of the COVID-19 on activities, the actions taken for the continuity of training, and the measures taken for the permanency of PRM care. In addition, we asked about their perceptions and encountered difficulties because of the pandemic.

Categorical variables were summarized as frequency and percentage. Microsoft Excel® 2016 was used for all statistical analyses and evaluation.


  Results Top


Forty-nine out of eighty physicians responded to the survey. Three excluded responses because received twice, making 57.5% response rate, of which 3% are residents.

The first question intends to determine the geographic profile of the respondents. In the current survey, a majority of the respondents (46%) are from Casablanca, 18% from Marrakech, 9% from Rabat, 6% from Tangier, and 3% from Agadir, BeniMellal, Errachidia, Fes, Oujda, Safi, and Salé [Figure 1].
Figure 1: Geographic profile of the respondents

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The second question concerned the field of activity, and the results indicate that 36% of the respondents are associated with a public institution, 43% with private institutions, 12% with a university hospital, 3% with a military hospital, and 3% with Foundations and Associations [Figure 2].
Figure 2: Field of activity of the participants

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The distribution of the type of activity in which the respondents are involved indicates that all the physicians are involved in consultation services whereas, 64% of the respondents are associated with hospital outpatient, 44% with medical scope, 25% with hospitalization, and Day Hospital [Figure 3].
Figure 3: Distribution of the category of activity

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The amount of the rehabilitation staff, who depend on the centers surveyed, indicates that there are 215 51 caregivers, 39 speech therapists, 37 psychomotor therapists, 36 security personnel, 32 secretaries, 25 orthoptists, 11 stretcher-bearers, two occupational therapists, and no one among them is contaminated with the COVID-19 [Figure 4].
Figure 4: The amount of the rehabilitation staff

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The next question aims to determine the impact of COVID-19 over activities. It indicates that a majority of the activities are reduced (79%) because of the prevailing pandemic, 29% is devoted toward participating in COVID-19 patient care, 25% with conversion to COVID-19 department, 11% in closing down activities, 3% in everyday activities, and only 2% toward requisition to other care-related activities [Figure 5].
Figure 5: The impact of COVID-19 over activities

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The measures undertaken for the continuity of training indicate that several mediums were used to carry on training sessions of the staff. This includes WhatsApp (32%), Webinars (17%), E-mail (14%), through Zoom software (11%), through Microsoft team and meet (4%), and 3% for Facebook and face-to-face [Figure 6].
Figure 6: The measures undertaken for the continuity of training

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For continuity of patient care, respondents took several measures, including phone (46%), self-rehabilitation (35%), telemedicine (14%), and sheets distribution to patients (8%) [Figure 7].
Figure 7: Continuity of patient care

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The feelings that the respondents have developed included stress, anxiety, panic, and fears which are all contributing factors toward rehabilitation and medical facility [Figure 8].
Figure 8: Feelings expressed by the respondents

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There were several difficulties which were encountered in this process and which include lack of communication, unsuitable structure, lack of training, and communication. These difficulties will help in understanding the situation well [Figure 9].
Figure 9: Encountered difficulties

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  Discussion Top


This article aimed to give a description of the current state of PRM cares over Morocco. The prevalence of COVID-19 is overwhelming the entire healthcare facilities as well as healthcare workers on a global basis. Appropriately, the response is over the ability to provide care to those who are critically sick, protecting their careers, along with maintaining the social distancing phenomenon. In fact, this response has now experienced a shift in the process of the provision of healthcare services. PRM services are aimed toward delivering optimized cognitive and physical functioning for reducing any disability and are a crucial component of care.[14],[15] The decision related to delay, transform, shift, or discontinue rehabilitation services is very complicated as they have societal implications both for the current time as well as for future. Most of the Moroccan PRM physicians reduced their activities, either imposed or spontaneously.

The COVID-19 is causing an influx of convalescent patients in the follow-up care and PRM services, with the risk of engorgement. PRM establishments have a unique role, apart from their mission and expertise in the field of rehabilitation and care for the chronically ill, to ensure the endorsement of the other specialties. In a context of health crisis characterized by a massive influx of patients, they constitute an essential link making it possible to streamline the care pathways and thus optimize the use of reception capacities, especially during short stays.[14],[16],[17],[18] In this context, the primary objective for rehabilitation and physical medicine establishments, therefore, consists in maintaining their capacity to respond to requests from the others specialties, for COVID + patients as well as for patients from other sectors, while adapting their organizations to the setting in charge of fragile and vulnerable patients.[13],[15],[16] They must make it possible to free up beds in intensive care units, continuing care, pulmonology, infectious diseases, and medicine as quickly as possible for the hospitals of the first and second lines. In addition, they must promptly organize the return of patients to their homes, including, if necessary, the continuation of the independent rehabilitation plan at home.[18],[19]

Though there is a high level of concern for people with unmet PRM services, as we saw in our study, it is imperative that care providers be protected in pandemic response. There are several components of the rehabilitation services, which include providing treatment through mechanical ventilation, fitting a new limb after amputation, and developing balancing techniques for patients suffered from the stroke. In addition, the rehabilitation staff is being reemployed in a changed healthcare setting which is different from the usual environment. For example, in Spain, the healthcare workers represent 15% of COVID cases, and the response for this was that the country had mobilized medical residents, retirees, and health personnel.[20]

Enhanced monitoring and measurement are the need of time for the individual or national level health system. The release of the Rehabilitation Guide of the WHO, there are some countries that have undergone a complete systematic assessment related to rehabilitation situation and have drafted a strategic plan to adequately meet rehabilitative requirements in the time of the pandemic. In the current time, there is a need to align over the measurement strategy and longitudinal assessments of health, as well as functional outcomes, are required to monitor the population or individual health-related decisions-making for the allocation of scarce resources within the healthcare setting.[21]

The global significance related to the measurement of policy and practice is widely evident with the emergence of COVID-19 outcomes evaluations of the patients in the intensive care unit.[20] Additional service records should also be monitored to assure adequate quality as well as maintaining equity within constrained resources. In the aspect of long term, increased attention toward national census, as well as cohort services, are essential to track changes within the health conditions of the population that will be useful for policy-making related to rehabilitation and physical medicine services and the geographic disparities. The rehabilitation community should reunite and determine a core set of measures for the monitoring of patient recovery suffering from COVID-19, the health condition of those who have a disability or any chronic illness along with the accessibility, quality, and availability of the services today and as the world recover from the pandemic.[19]

A high number of participants in our study hosted telemedicine, which has not been used before as extensively as during the crisis.

Consulting for care over the telephone has emerged as the most feasible option in most of the regions, however; it is predominantly dependent upon the availability of trained personnel. Using different types of virtual care has a core requirement of an internet connection, the availability of the technology for both the patient and the rehabilitation provider, tech-related literacy, which refers to the ability to use the technology or device, tech support, or the availability of troubleshooting processes to remain connected.[22],[23]

Using telerehabilitation under unusual circumstances involves planning, training as well as improving iterative aspects. These approaches are limited in several developing countries, mainly because of the costs of data plans as well as limited in-home internet access. A majority of rehabilitation care provided remotely in a pandemic, telehealth strategies require infrastructure and need to be financed and resourced appropriately.

Training in COVID-19 is crucial, as they should be prepared to provide rehabilitation services. Webinars are undertaken to spread out the world and train caregivers accordingly. Besides, these webinars will guarantee continuing medical education during the pandemic.

This lockdown has been called the most extensive psychological experimentation by some psychologists. Van Hoof showed rising levels of stress from 15% to 25% during the lockdown.[24]

The potential factors leading to mental stress include loss of financial support, emotional stress, fear of falling sick, and health risks for the family.[25] Irritability, anger, acute stress disorder, and high anxiety levels have been associated with the COVID-19 of health care workers, as we saw in our study.[26]

The present study has limitations: First, the low number of respondents is because the PRM physicians in Morocco are still few compared to neighboring countries. In addition, the Moroccan PRM physicians are concentrated primarily in the big cities. Another evaluation of the impact after this pandemic is necessary, especially the financial consequences and on the patients followed in PRM.


  Conclusion Top


Nations are called by the WHO to assure continuity of essential services. In addition, the considerations for service delivery with the availability of resources for the provision of care are also vital. Considering beyond the pandemic, rehabilitation and physical medicine should be at the forefront of discussions, carriers to infrastructure, financing as well as implementing care through telehealth along with other approaches needs to end. Vital leadership inclusion related to rehabilitation in the policy-making of the healthcare department and public health is of utmost requirement to deliver the high value of care.

Even though our attention today is primarily devoted to the innumerable emergencies generated by the COVID-19, we must give serious thought to why the international community was not prepared for such an inevitable epidemic.

Acknowledgments

We would like to thank the SOMAREF members for participating in this survey.

Consent

Informed consent was obtained from all individual participants included in the study.

Financial support and sponsorship

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest

There are no conflicts of interest.



 
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