Background: Palliative rehabilitation involves multi-professional processes and interventions aimed at
optimising patients’ symptom self-management, independence, and social participation throughout
advanced illness. Rehabilitation services were highly disrupted during the Covid-19 pandemic.

Aim: To understand rehabilitation provision in palliative care services during the Covid-19 pandemic,
identifying and reflecting on adaptative and innovative practice to inform ongoing provision.

Design: Cross-sectional national online survey.

Setting/participants: Rehabilitation leads for specialist palliative care services across hospice, hospital,
or community settings, conducted from 30/07/20 to 21/09/2020.

Findings: 61 completed responses (England, n=55; Scotland, n=4; Wales, n=1; and Northern Ireland,
n=1) most frequently from services based in hospices (56/61, 92%) providing adult rehabilitation. Most
services (55/61, 90%) reported rehabilitation provision becoming remote during Covid-19 and half
reported reduced caseloads. Rehabilitation teams frequently had staff members on sick-leave with
suspected/confirmed Covid-19 (27/61, 44%), redeployed to other services/organisations (25/61, 41%) or
furloughed (15/61, 26%). Free text responses were constructed into four themes: (i) fluctuating shared
spaces; (ii) remote and digitised rehabilitation offer; (iii) capacity to provide and participate in
rehabilitation; (iv) Covid-19 as a springboard for positive change. These represent how rehabilitation
services contracted, reconfigured, and were redirected to more remote modes of delivery, and how this
affected the capacity of clinicians and patients to participate in rehabilitation.
Conclusion: This study demonstrates how changes in provision of rehabilitation during the pandemic
could act as a springboard for positive changes. Hybrid models of rehabilitation have the potential to
expand the equity of access and reach of rehabilitation within specialist palliative care.