Delivering physical rehabilitation services during the COVID-19 pandemic in Iran: Common challenges and potential solutions for future pandemics

The COVID-19 pandemic affected people with disabilities in different aspects, including their access to physical rehabilitation (PR). Despite a significant global surge in the need for PR, it has not been prioritized and is under-resourced, even in the non-COVID era, in many countries. This study aimed to explore the challenges of delivering PR services during the COVID-19 pandemic in Iran and potential solutions to these challenges. This qualitative study was done using a thematic approach from November 2023 to March 2024 in Iran. 45 PR professionals and faculty members from three fields-physiotherapy, occupational therapy, and orthotics and prosthetics-were interviewed in a semi-structured approach. Data analysis was done using Braun and Clarke's thematic analysis approach. The five control knobs (organization, regulation, financing, payment, and behavior) were used to study the challenges and proposed solutions. The main identified challenges included Iran's healthcare system's lack of preparedness, deficient infrastructure, limited remote rehabilitation options, restriction of in-person visits, lack of clinical guidelines, ambiguous pricing for telerehabilitation, financial hardships stemming from the pandemic, insufficient government support, reliance on out-of-pocket (OOP), patients' reluctance to pay for online services, delayed compensation for PR professionals, mental distress experienced by patients and service providers, resistance to new service modalities, and inadequate digital literacy. The key solutions included strengthening telerehabilitation infrastructure, developing clear clinical guidelines, increasing government financial support, improving payment structures, and fostering behavioral changes through increased awareness. The findings of this study underscore the importance of proactive planning, intersectoral collaboration, and the integration of PR services within the healthcare framework. The suggested solutions can inform policymakers to enhance the preparedness and responsiveness of health systems to future crises.