Description of the publications
After deduplication, 5,106 records identified from the online database underwent title/abstract screening. This was followed by the full-text screening of 95 records, which yielded 26 included articles for review. Supplemental search strategy yielded 25 articles from citation searches and five records from field experts for screening. Seven articles met the inclusion criteria, which brought the total number of included articles to 33. Figure 1 illustrates the PRISMA flowchart detailing the selection process for this review.
The included papers were produced by authors from the following countries: United Kingdom (n = 5), United States of America (n = 5), Multiple Countries (n = 4), Canada (n = 3), Germany (n = 3), Sweden (n = 2), Switzerland (n = 2), Austria (n = 1), Belgium (n = 1), Denmark (n = 1), India (n = 1), Iran (n = 1), Ireland (n = 1), Japan (n = 1), Netherlands (n = 1), and Slovenia (n = 1). The papers were also framed using different research designs including case study (n = 7), review or evidence synthesis (n = 6), qualitative (n = 6), quantitative (n = 6), mixed method (n = 3), conference paper (n = 1), evaluation (n = 1), opinion piece (n = 1), short report (n = 1), and randomized control trial (n = 1).
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The occupational therapy process and outcomes in RTW
This scoping review also aimed to identify the specific assessment tools or protocols, interventions, and outcomes utilized by occupational therapists when servicing working adults with PCC our practice context (see Table 5).
Assessments. We found a wide range of assessments used within the evaluation process within this setting. The assessment tools identified by the scoping review either informed occupational therapy evaluation to a certain extent but are not necessarily conducted by occupational therapists themselves or are directly conducted by occupational therapists towards planning and implementing occupational therapy services. There are assessments that assess COVID-19 symptoms and functional status before and after COVID-19 infection (13, 16–23), physical and mental health status (13, 15–17, 20–22, 24–26), health in relation to well-being and quality of life (13, 21, 22, 25), specific performance skills (13, 15, 27–31), and patient needs including health insurance needs (6, 17, 24, 32, 33). Since our research question focuses on understanding the role of occupational therapists in this practice context, we outline here the assessment tools that assess constructs related to occupations and activities, including those that are associated to work ability and RTW (6, 16, 18, 21, 26, 34–36). We call these assessment tools and protocols “occupation-based assessments”, which are used to assess or measure a person’s engagement in an occupation or activity through performance and task analyses (37) and identify priority occupations in their everyday living. For this review, we grouped the occupation-based assessments according to their focus: one group is focused on assessing occupations in general, and another group is focused on assessing work performance and ability more specifically.
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Interventions. After the evaluation process comes the intervention process, which consists of the services provided by occupational therapists in collaboration with clients towards achieving improved health, wellbeing, and other goals related to occupational engagement and participation (38). In our scoping review, we found a wide range of interventions and services provided to working adults with PCC (refer to Table 5). They were provided either by occupational therapists or a team of health or social care professionals involved in the intervention process. Arrangements varied including in-person, on-line, and a combination of both (hybrid). Moreover, in terms of care delivery context, the interventions were delivered in different ways including in-patient (i.e., a patient is confined in the hospital), out-patient (i.e., a patient visits the health care facility but then leaves after the health service is rendered), and remote services (i.e., telerehabilitation). There was also a diversity in the target of the interventions. There were interventions and services that intended to manage COVID-related (20, 35, 39) and fatigue symptoms (11, 13, 14, 16, 20, 22, 25, 29, 30, 40), train specific skills to alleviate functional deficits (13, 15, 16, 20, 22, 23, 27, 29, 31–34, 36, 41), facilitate activities of daily living (11, 12, 25, 27–29, 32, 33, 36, 40, 42) and work-related training (13, 17, 23, 29, 34–36, 40, 42), educate patients on self-management techniques (14, 16, 18–20, 24, 28, 31–33, 35, 40, 43), and adapt the physical and social environments (11, 13, 15, 16, 23, 33, 34). However, we must disclaim that occupational therapists were involved in some, and not in all, interventions and services for clients with PCC and RTW needs.
Provided by occupational therapists, “occupation-based interventions” are services that use occupation as a therapeutic agent to address clients’ health and wellbeing, identify and realize aspirations, satisfy needs, and change or cope with contextual factors (37, 44). In line with our research objective, we wanted to be specific in identifying occupation-based interventions that were provided primarily by occupational therapists for working adults with PCC resuming work. We categorized occupation-based interventions use in the practice context under study according to their focus: using activities (occupations) as a therapeutic agent, adapting the environment and context, and improving work ability and reintegration (refer to Table 5). It is also important to note that these occupation-based interventions were provided alongside other specialized and interprofessional services.
Outcomes. The all-encompassing outcome of occupational therapy is to achieve health, well-being, and participation in life through engagement in occupation (38). In the practice context of PCC among working adults, outcomes encapsulate the different components of the International Classification of Functioning, Disability, and Health (ICF): health condition, activity participation, and contextual factors (45). We categorize the health-related outcomes identified from the included studies into the three components abovementioned (refer to Table 5). Most of the studies included have focused on work resumption and other work-related outcomes (6, 12, 16–18, 20–24, 26, 27, 32, 34–36, 39–41), while some studies centered on rehabilitation outcomes based on overall health status and bodily functions (14, 19, 25, 28–31, 33). There were also few studies that focused on contextual and environmental outcomes, specifically on service delivery satisfaction (43) and workplace adaptations (17, 35).
The findings of this scoping review revealed that years after the outbreak of the COVID-19 pandemic (years 2021–2024), a reasonable amount of research has been published related to PCC of working adults who are having concerns about going back to or staying in their work. These papers allowed us to address our two research objectives. The first objective aimed to investigate the extent of literature pertaining to the RTW process in relation to people with PCC. While we initially described that RTW is a process, our findings revealed that 19 out of 33 included records perceive RTW as a rehabilitation outcome. This denotes that RTW is seen as part of intervention planning, goal setting, and the intervention itself. As an outcome, RTW is measured quantitatively and is an indicator of recovery. Nine studies considered RTW as a process that encompasses health, socio-economic, and environmental dimensions of life beyond rehabilitation. As a process, RTW entails the involvement of an interprofessional team, inter-sectoral coordination (including insurance, social welfare, and community support), and continuity of care beyond the healthcare system. Four considered RTW both as outcome and process, whereas only one record did not specify any.
In other words, the demonstration of returning to work after rehabilitation is perceived as a sign of “successful” outcome, largely measured through assessment tools and rehabilitation goals by means of performance improvements. Alternatively, the series of events forming the evaluation and intervention programs that aim to facilitate this “successful” outcome constitute the complex process of RTW. Additionally, the RTW process is characterized by the intertwined services, under a holistic rehabilitation program, provided by an interprofessional team of health and social care professionals, ensuring a system of follow up, support, and care for the clients beyond rehabilitation and discharge.
The second objective aimed to identify the role of occupational therapists in the practice area of RTW for people with PCC. Our findings revealed that the RTW process was either led by a team or by any of the following professionals who are recognized to be closely working in this practice area: occupational therapists, physiotherapists, physiatrists, or occupational health/medicine specialists. Put simply, occupational therapists are considered important team members that co-facilitate the RTW process and support clients achieve RTW outcomes. Specifically, occupational therapists were not only providing one-on-one evaluation and/or intervention sessions for individual clients but were also highly involved in co-leading virtual courses to coach and educate patients, individually or in groups, on self-management skills, activity management, and symptoms management. They also provide consultation for clients and their family members with specific assistive technology needs and psychosocial support needs. When occupational therapists find their scope of work limiting, considering the complex needs of clients, they refer them to other professionals with specialized services including medical, rehabilitation, social security, and insurance services. Apart from these statutory services that occupational therapists provide, the role of occupational therapists is to hear clients’ concerns and experiences about their work and life dimensions, and as a result, support clients’ life goals and the whole recovery process.