Managing Daily Participation via Tele-rehabilitation during the Corona Pandemic Among Breast Cancer Survivors

Video-conference tele-rehabilitation for women with breast cancer. Women with breast cancer (BC) cope with decreased daily participation and quality of life (QOL)due to short and long-term physical, cognitive and emotional symptoms related to BC and medical treatments. Tele-rehabilitation offers a way to deliver rehabilitation and enhance self-management to provide strategies to reduce the impact of symptoms on daily participation and QOL. Specifically, telerehabilitation overcomes concerns regarding the vulnerable immune system, specifically in crowded places such as clinics, during pandemic. The sessions focused on identifying occupational-focused goals, identifying barriers to participation, addressed by training and providing strategies to manage and improve women's daily participation specifically during the pandemic. Materials included women’s own daily life activities ,schedules and objects available at home to promote participation as well as cognitive and physical training. The intervention was administered by a trained occupational therapist. Online treatment sessions, one individual and one small group meeting were delivered using videoconferencing (ZOOM Pro) weekly for six weeks ( a total of 12 sessions for each participant). Each online treatment session lasted about 45 minutes. Participants and the therapist were each located in their own homes, during the sessions. The content of treatment was tailored to each participant’s needs, symptoms and occupational goals. The first meeting was individual, focusing on understanding what changes occurred in the woman's daily activities and routines after BC and treatments, what are the symptoms that she faces and how these symptoms affect her performance and participation in daily activities. In addition, the first meeting included setting the functional meaningful goals to be achieved during the following sessions and planning a timeline. The following individual meetings included training self-management and meta-cognitive strategies needed to manage symptoms and minimize barriers to participate in the selected meaningful activities (e.g., self-knowledge, awareness and processing strategies, using cognitive strategies such as self-talk to enhance attention, reorganizing priorities, understanding activity demands, preparing weekly action plans, and utilizing potential environmental and social resources). Depending on the woman’s functional needs and motor abilities, the sessions also covered some aspects related to motor abilities (e.g., reducing range-of-motion limitations and strengthening the upper extremity). During the meetings ways to implement the weekly plan and to transfer the strategies trained during the sessions into other daily activities were discussed. During the group meetings women acquired more general self-management strategies and also shared their experiences using these strategies in their daily meaningful activities with the other women . These meetings enabled the women to discuss additional dilemmas they faced during the week in coping with other symptoms and daily activities. To monitor adherence to the intervention, the OT set the timeline together with the woman at the first meeting. At the end of each meeting a ZOOM link for the following meeting was sent via email, and few hours before each meeting a reminder was sent to the woman via WhatsApp. In addition, the OT and the woman agreed upon assignments to be performed between the sessions. These were discussed during the following session.