Occupational therapy productions in times of pandemic: a systematic review of occupational therapeutic actions against the new coronavirus (COVID-19) epidemic [version 1; peer review: 2 approved with reservations]

Background: In March 2020, the World Health Organization classified infection and contagion of coronavirus disease 2019 (COVID-19) as a worldwide pandemic. Since then, health professionals have been tirelessly researching the symptoms and consequences of this disease in people's daily lives. Occupational therapists have also been mobilized to implement effective actions in order to guarantee the functionality and quality of life of individuals and groups. The aim of this article was to investigate what available resources there are regarding occupational therapy during the pandemic, and thus support and enrich professional practice during this time. Methods: A search for was carried out for materials such as technical notes, guidelines for working with COVID-19 patients, clinical trials, and reflections and debates on occupational therapeutic practice during the COVID-19 pandemic. Articles in English, Portuguese and Spanish were included. The search was carried out in the Virtual Health Library (VHL), Google Scholar, Latin American & Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SCIELO) databases, Medical Literature Analysis and Retrieval System Online (MEDLINE), Pubmed, and the websites of occupational therapy


Introduction
The coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, impacts the daily lives of people, families and communities, as well as having an emergency impact on public health worldwide.In view of this, challenges arise for the multidisciplinary teams working on the front line to fight the virus, to adopt patient-centered approaches and care during the acute phase of the disease and after-care 1 .
COVID-19 spreads through contact with droplets on contaminated surfaces followed by direct contact with eyes, nose or mouth.The main symptoms of the disease are high temperature, continuous cough, and loss or change to sense of smell or taste 2 .Emergency measures have been adopted to slow down the contagion curve and prevent health systems from being overloaded.Social distancing has been the main measure used to reduce the spread of the virus; however, social distance and isolation has had a negative impact on people's daily lives 2 .
According to the World Federation of Occupational Therapists 3 , there are several changes to and consequences of the way people perform their occupations in times of isolation, including access to resources in terms of activities of daily living (ADLs), mobility, communication, social interaction and wellbeing.The COVID-19 pandemic has had a devastating impact on the occupations of millions of people around the world.In this sense, occupational therapy, as part of the multidisciplinary team on the front line to face the crisis, presents itself as a fundamental specialty in reducing the repercussions of symptoms, hospitalization and social isolation 4 .
Throughout history, occupational therapy has been important when dealing with social emergency scenarios, starting after the first world war, when thousands of people had physical and / or mental disabilities.In the current situation, all knowledge accumulated over the years must be accessed, mainly because in the beginning of the pandemic, health professionals did not know which strategies would be better for treating the symptoms and consequences of COVID-19.It is worth noting that occupational therapists use evidence-based practices to ensure effective treatment and improve the quality of life of their patients 5 .
Following this, the aim of this article was to perform a systematic review of scientific publications that make reference to occupational therapy during the COVID-19 pandemic.This was in order to provide guidance for the clinical practice of occupational therapy professionals and students.

Search strategy
This systematic review was carried out according to the PRISMA recommendations 6 using the following electronic databases: Virtual Health Library (VHL), Google Scholar, Latin American & Caribbean Health Sciences Literature (LILACS), Scientific Electronic Library Online (SCIELO) databases, Medical Literature Analysis and Retrieval System Online (MEDLINE), Pubmed, and the websites of occupational therapy entities and organizations.
The databases were searched between May and September 2020.The terms and combinations used for the search were derived from the Health Sciences / DeCS Descriptors, which were: Occupational Therapy, Coronavirus, Pandemic and COVID-19, and their equivalents in Spanish and Portugese.The complete strategy consisted of searching the entry terms in the MeSH, referring to the research question based on PICO (population, intervention, comparison and outcomes): what are the actions taken by occupational therapists during the pandemic period caused by the new coronavirus?The terms were searched using the Boolean operators AND and OR.No filters were used (neither time nor language) so that the results were as comprehensive as possible.

Inclusion and exclusion criteria
Articles were included if they were written in English, Spanish and Portuguese, written by occupational therapists and / or representative entities, and published in late 2019 until September 2020, consistent with the first documentation of the virus in December 2019.For this review, randomized clinical trials, reflective articles, performance guides and normative articles from professional associations were included.Experimental studies in animals, systematic reviews and letters to the editor were excluded.

Data collection and analysis
The data collection was carried out by two independent researchers.The articles from the search were first judged on: the title of the study, the type of study, and the summary.Articles that did not meet the eligibility criteria were excluded.After the first filter, a complete reading of the studies was performed to judge and list the information relevant to the research.
For the analysis, a synthesis matrix was prepared for the presentation and qualitative organization of information.For each identified category, the matrix contained the title, authors, study objective, results and the type of study.We simplified the main guidelines and results of the studies in order to provide a quick overview of the included articles.

Results and discussion
Of an initial 733 articles found, 44 were included in the analysis (Figure 1), of which 21 were in Portuguese, 19 in English and two in Spanish.These were categorized into three categories, being scientific articles in journals (19), performance guides (18) and technical notes published by entities representing occupational therapy (7) (Figure 1).The 19 scientific articles were divided into experience reports and original articles.
The 18 performance guides found were produced by associations and official entities of occupational therapy around the world.They address guidelines for the performance and operation of occupational therapy services during the pandemic.The main texts found were from the American Occupational Therapy Association (AOTA).
The technical notes found are responsible for clarifying doubts of occupational therapists in matters regarding COVID-19.They aim at being a quick communication channel between representative entities and professionals, in addition to demonstrating their position on governmental decisions.
The articles were separated into five thematic axes, namely: guidelines for occupational therapy services; quality of life during isolation; telehealth; social context; and possibilities of occupational therapy.
The publications of the guidelines for occupational therapy services (Table 1) have an important documentary role in assisting therapists in understanding measures to deal with the pandemic, addressing the main strategies implemented to treat the symptoms and consequences of COVID-19.The publications on occupational therapy are also important to stimulate reflections and decision making of professionals about the consequences of COVID-19 and social isolation in carrying out daily activities.From this theoretical framework, the concern of the representative entities is to provide information to offer several possibilities of how professionals should perform hospital, outpatient and home care for the treatment of the physical and psychological health of people with COVID-19.
Occupational therapy aims to weave support networks in the fight against COVID-19 that go beyond the hospital context in order to achieve balance and occupational justice in a harmonious way that promotes social and family satisfaction, and reduces stressful environments that provide panic, anxiety, and other distressing emotions.The current scenario offers occupational therapists the opportunity to contribute their knowledge through governmental and non-governmental programs that aim to mitigate the side effects of social isolation that directly affect people's occupational performance 7 .
Regarding quality of life (Table 2), the studies found show the negative effects of the routine change in the subjects' lives, mainly due to the abrupt break and modification in their daily routine.This shows the need for reflection on and adaptation of habits to prevent social isolation.The English-language texts address aspects such as low quality of life due to decreased income, lack of sleep and unstructured routine.The authors allow us to observe financial losses, which part of the population are facing, as well as repercussions on mental health, work activities and physical health.Guidelines and reflections about a quality routine are the main points addressed which may help populations that are experiencing occupational disorders.The main suggestions for enhancing quality of life focus on structuring a good routine, including personal care, home care, work (in person or online), leisure activities, exercise, developing new hobbies, and receiving psychological support with professionals online.There is an emphasis on structuring a routine with schedules, pleasurable activities, exercise and home maintenance, for physical, mental and emotional health.
The articles in Portuguese deal with the issue of quality of life and isolation, emphasizing issues such as the professional identity of occupational therapists regarding their role in the pandemic, and discuss different isolation processes that may vary according to socioeconomic class and other contextual factors.They also point out the challenges of the academic community in developing strategies to continue undergraduate teaching of occupational therapy, in addition to providing psychosocial support to students.
The construction of the thematic axis of quality of life during isolation, made it possible to reaffirm the competence of the occupational therapist in identifying impairments in patient independence, setting treatment goals, increasing autonomy and performance capacities in the activities of daily life 8 .Finally, the articles compile actions taken by occupational therapists in order to promote a better quality of life during social isolation, such as reorganizing daily routine, promoting self-care, and providing support networks to help maintain mental and physical health.
Given the high degree of infection by COVID-19, telehealth, which is shown in Table 3, was one of the main strategies adopted to continue remote treatments to guarantee the safety of professionals and patients.The Canadian Association Of Occupational Therapy defines telehealth as the provision of health services through telecommunications, which may vary according to the user's skills 9 .The articles addressing this theme involved occupational therapists' reflections on the introduction of telehealth in their practice.When using remote means of communication, therapists need to improve their skills in order to identify patient needs in distant care.This might be achieved by the therapist paying greater attention to the tone of the patient's voice and their way of communicating for example.The use of telehealth in occupational therapy impacts the way therapists interact with their patients for appointments regarding a range of issues including mental health, hand and upper limb therapy, group therapy, the use of sensory diet as a form of intervention, and assessing elderly people with cancer.
The advantages of telehealth have the potential to optimize the time and costs of services, the possibility of expanding the reach of the health team in remote areas and the increased potential for rehabilitation.In addition to being more practical for the patient, call centers enables the care and monitoring of a greater number of patients.Telehealth could also be used in an educational program through daily dialogues that expand

Type
Reflections from the Latin American Confederation of Occupational Therapistsclato, en tiempos de covid19 Agudelo et al. 16 .Promote a reflection to occupational therapists, regarding their performance during the pandemic: how interventions should occur, how representative bodies can contribute to the training of students and can contribute to this process.It reports the importance of the representative entities of occupational therapy in Latin America, and their support with professional practice such as the call center during the pandemic, raising some reflections on how to continue the process of monitoring and assisting the subjects in this process of social isolation.

Reflections and actions
from Occupational Therapy against the covid-19 during social confinement.
Encourage a reflection on the assistance level of OT during emergency periods, taking into account the different contexts in which the subjects are inserted.Reflects on the role of occupational therapy in health emergencies, highlighting its importance in the process of confinement, as strengthening agents of support networks, through actions such as the call center to guide biological risks in home visits and assistance to those who are in situations of social fragility.on teaching and research in occupational therapy.It is a position, which is described as the opposite of the substitution of practical disciplines, for remote ones, taking into account some factors such as access to technologies and quality internet, which is unequal among students, disruption of family life that was established during isolation, and among other issues that make remote education unviable and highlight support for policies that support teaching and research in public universities.

Telehealth position statement
WFOT 21 Present the translated position of the World Federation of Occupational Therapists on telehealth care.It brings the speech of the World Federation of occupational therapy, reports on the use of telehealth, its importance in providing assistance to users, describes strategies to be used with this tool for its best effectiveness, such as the selection of clients to be assisted, taking into account its uniqueness, collaboration with local professionals, and affirms the effectiveness of using this method for the provision of services in occupational therapy during the pandemic.

Communication by occupational therapists during the Covid-19 Academy Cordeiro 22
List the pandemic's reflexes on occupational therapy in Brazil and considerations for effective and dignified communication of the principles that govern professional practice during the pandemic and for the postpandemic period.It instigates a reflection on occupational therapists, regarding communication before society through social media, as well as encouraging a consensus among professionals in the area on concepts, guidelines and the future of the profession, after the pandemic.

Scientific Article
Learning

Type
Does social distancing during the lockdown due to covid-19 outbreak affect quality of life?
Understand the effect of lockdown during the coronavirus outbreak on the quality of life of individuals in Mumbai, India.In the study, the WHOQOL scale was applied, referring to quality of life.The applied scale was analyzed in the 832 research participants.
It was observed that the main complaints regarding changes in the participants' quality of life were related to physical and psychological aspects, without observing significant differences between genders.
It was concluded that the social isolation caused by COVID-19, directly affects the quality of life of the subjects. .
To problematize issues involving the occupational therapist's professional practice in everyday life -in daily life in the face of the COVID-19 Pandemic phenomenon.It questions the professional practice of occupational therapists in the face of the pandemic, relating terminologies of our professional practice to everyday life, with the moment of social isolation we are facing, as well as mentioning some actions taken by professionals, such as reorganizing the routine, telemoniotoring, technologies, such as personal protective equipment.

Social isolation and occupations
Corrêa et al. 29 Open reflection on social isolation, occupations and other themes that touch the repercussions experienced with the moment.Describes how social isolation affected the subjects' occupations and brings caveats that the subjects must reinvent themselves and resinify their occupations, highlights the importance of the occupational therapist in this process of occupational resignification during isolation and in the evaluation of the same pre, during and post pandemic.

Scientific Article
Recreating possible daily lives: building support strategies between professors and undergraduate students in Occupational Therapy in times of pandemic Teixeira & Dahl 30 . Report challenges to the academic community due to the social distance and to outline possible support strategies among teachers, occupational therapists and students of an undergraduate course in occupational therapy.Reports strategies adopted by students and professors at a university during the period of social isolation, with the main objective of providing a psychosocial support network, some strategies adopted were the reorganization of the routine, mapping the situation of students, self-care actions, support and monitoring of students in distress during isolation.

Scientific Article
WHOQOL: World Health Organization Quality of Life.
Table 3.Studies that provided information about telehealth in occupational therapy.

Tipo
Occupational Therapy Telehealth decision guide AOTA 31 .
Offer a flowchart of decisions about the occupational therapeutic approach on call centers The offered flowchart shows AOTA's position regarding the recommendations and obligations that occupational therapists must adopt to start and continue the call center services.The flowchart demands a series of requirements to be fulfilled in order to perform the legal call center service, these being the position of the State and service management on this modality, as well as the familiarity of patients and therapists with the tools to be used.

Guide
Practical considerations for occupational therapists who are considering telehealth CAOT 9 Create reflection points for occupational therapists who consider the inclusion of telehealth actions in their care It has provided some telehealth resources and platforms for the safe and effective provision of telehealth to occupational therapists today according to their / practice environments. .Describe the role of the occupational therapist in telemonitoring through the use of the sensory diet.It highlights the importance of professional reinvention, describes in detail the process of building an occupational therapeutic plan with children with ASD, using the call center because of social isolation.

Scientific Article
AOTA: American Occupational Therapy Association; CAOT: Canadian Association of Occupational Therapy; ASD: Autistic Spectrum Disorder.
the understanding of patient's health conditions and encourage them to make changes in their lives to make them healthier and more independent 36 .
The articles in Table 4 show occupational therapy actions in the social context, pointing out the inequalities observed in vulnerable populations in coping with COVID-19 due to the pre-existence of disadvantages in social and economic factors 37 .
One of the groups cited is the LGBTQIA+ community.This community has faced daily situations of stigma, prejudice, social isolation, and increased mental health problems, due to the interruption of support groups and therapy aimed at mental health during the COVID-19 pandemic 38 .People living in the suburbs and with low incomes are also more affected, due to the lack of resources to obtain individual protective items and hand and object hygiene 39 .Many people have lost their jobs during the pandemic, which has compromised the basic livelihood of many families 39 .Also highlighted are the elderly, who are at risk of having severe symptoms and requiring hospitalisation.Although they are in this high risk group, many elderly people in Brazil have not obeyed the isolation guidelines and have continued to frequent places with crowds of people during the pandemic, such as markets and shopping centers 39 .
The study by Pereira et al. 40 describes a strategy created by students and professionals in occupational therapy during the pandemic, which aimed to provide social support for these groups, not only in this moment of social isolation, but also for after the pandemic.This involved socio-educational support for children and youth in communities via distance learning, promoting the strengthening of socio-community ties and assisting the organization of collecting and donating basic supplies to poor communities in various regions of Brazil.
For possibilities of occupational therapy during the pandemic (Table 5), 12 papers were found divided into scientific articles, performance guides and technical notes that discuss mental health, assistive technology, hospital care, primary health care, worker health, and rehabilitation, written in all three languages.
Primarily, articles that dealt with hospital care included strategies that are being applied in the institutions, including training for the correct use of personal protective equipment (PPE), remote work strategies, reorganization of the units, individualized care, interventions with the patient's family, priority screening and construction of informative booklets on the disease and protective measures for non-contamination.Some papers provided resources more directed to care in bed, such as postural information, how to communicate during therapy, and attention to clinical conditions, especially the respiratory system 1 .
With regard to mental health, contents were found that dealt with the impact of the pandemic and social isolation in particular.Some articles commented on changes in the mental health of professionals who are on the front lines.These studies pointed out ways to support health professionals since many of them have had to leave their homes and isolate themselves to avoid contaminating their families.In addition there has been an intensification in working hours due to the very high demand for health services worldwide for a small number of professionals on the front line.These variables were observed as potentially stressful factors for professionals 41 .
The assistive technology addressed in the publications refers to adaptations in the masks and respirators used to prevent the spread of COVID-19, focusing on the low cost and availability of equipment, guaranteeing the population's access to these tools 2 .As far as rehabilitation is concerned, the action guide found seeks to guide occupational therapy for patients discharged from the ICU after infection, prioritizing sequelae in the respiratory and musculoskeletal system that can affect occupational performance.The guide was based on the Person-Environment-Occupation (PEO) model to promote better patient follow-up and rehabilitation 42 .
As for the performance of professionals in primary health care, the study by Falcão, et al. carried out remote work at a family health unit (USF) and at a family health support center (NASF) with the objective of continuing the monitoring of mildly symptomatic patients.Health education groups, assessment and guidance in carrying out ADLs, and monitoring of mental health were created.In remote service, through the internet, they carried out environmental organization, listening and solving problems that patients reported, assistance in triage, urgency classification and order of care, including emergencies due to mental illness 43 .
The article by Barroso et al. discusses the teaching of occupational therapy students and reflects on the safety and health of workers during the pandemic period, addressing issues regarding legislation and worker rights.Work is considered a potential source of spreading the virus due to workplaces often not providing self-protection resources, such as protective masks, gloves and alcohol gel.There are also often shifts with large numbers of workers and inadequate distance between staff.In addition, many workers use public transport to get to work, and this is also a potential source of contagion.Therefore, for workers to guarantee their rights in having protection against catching COVID-19 at work, it is necessary to discuss the regulations and organizational measures of each active job, according to its level of exposure, thus guaranteeing the safety of workers 44 .
Since this review searched for papers in three languages, the number of papers found was small compared to the initial expectation of the study.This can be considered a negative and aggravating point for the recognition of the profession, since occupational therapists are part of the essential team on the front line of the COVID-19 pandemic.Studies about the work and contributions of occupational therapy for the affected public are of great use to support discussions, and enable students and professionals to access information about what actions can be taken by therapists, as well as drawing attention to the profession, which as shown in this review, is important in the face of health emergencies.

Type
Occupational therapy in times of pandemic: Social security and guarantees of a possible daily life for all Malfitano et al. 37 .Point out the main contributions in the scope of health and social security to the confrontation of COVID-19.It describes the importance of the occupational therapist on the front line of COVID-19, as well as portraying some strategies to be adopted by them, as organization guides for routine and leisure, which contribute to the maintenance of physical and mental health in times of isolation.

It reflects on the importance of social actions in marginalized
populations during the pandemic, and reports some actions developed, such as the "corona map in the peripheries" that is organized for the propagation of information, as well as the distribution of personal protective equipment, and the action " network "that aims to maintain and stimulate the critical reading of young people, who are away from school, due to isolation.

Type
Adapting reusable elastomeric respirators to utilise anaesthesia circuit filters using a 3D-printed adaptor; a potential alternative to address N95 shortages during the COVID-19 pandemia.
The objective of the study is to offer a strategy to prolong the life of the masks with respirators, making modifications to the elastomers, applying rapid prototyping technology.This study demonstrated that the interface of an anesthesia circuit filter with reusable elastomeric respirators made in 3D printing can be a viable alternative to disposable N95 respirators for healthcare professionals who perform aerosol generation procedures in patients with COVID-19.

Scientific Article
Exploring

Type
Therapeutic-occupational interventions for patients with COVID-19 in the ICU Do Carmo et al. 1 .Discuss possibilities of occupational therapist intervention with the patient diagnosed with COVID-19 in the ICU.She reports on some possibilities for occupational therapists to intervene in ICUs during the COVID-19 pandemic, such as the organization of the intervention in order to avoid unnecessary leaving the bed, the use of disposable materials in therapy, the use of alternative communication and attention to the clinical condition of the patient, especially the respiratory system so that there is no complication in the therapy session.

Scientific Article
Brazilian pediatric occupational therapy in the face of the COVID-

Scientific Article
Everyday life against the coronavirus in a health resiliency: possibilities built with occupational therapists Miranda et al 49 .
To report the experience of occupational therapy Residents in the context of the coronavirus pandemic.It describes the inequality in the pandemic, emphasizes the importance of the occupational therapist to this public that is on the margin of isolation, and as a support strategy, a booklet was built with a structured routine for the whole family that is in isolation, in a broad way to supplying the demand of the various subjects, taking into account their uniqueness, the primer with the routine was designed to warn about the positive and negative points of disorderly productivity and occupational balance.

Scientific Article
The dizzying access in the acquisition of facial masks and their repercussions on public health and vulnerable populations Da Conceição et al. 44 .Describe the development of a low-cost resource for socially vulnerable groups in the ABC Paulista region of Greater São Paulo, Brazil.It describes the process of creating the low-cost face mask, the most widely used individual protection equipment in the pandemic, for distribution to vulnerable groups, in order to reduce the spread of the virus and protect this population.

Scientific Article
Occupational health in times of covid-19: reflections on health, safety and Occupational Therapy Barroso et al. 43 .

Discuss and reflect on worker health in times
of COVID-19.It brings several reflections on the current situation of workers, whether they are informal or not and describes some measures adopted by the government to minimize the impact of the pandemic on this population, such as emergency aid, however it brings a criticism regarding the need for effective humanization policies.and assistance to the working class.

Conclusion
This review found that both professionals and professional associations showed the concern to report and scientifically disseminate the experiences and guidelines of occupational therapists during the COVID-19 pandemic.The resulting 44 papers demonstrate the quick response of the profession to the challenges and barriers that have been imposed during this time, promoting scientifically based strategies to provide the best assistance to patients within the pandemic.The contributions addressed include positioning in bed, the humanization of care, and the restructuring of a daily routine after recovery of the infected person or just for those who are at home due to social distancing measures.
There were some limitations of the review such as the low number of papers found, the high concentration of papers from magazines and specific organizations, as well as the lack of preparation and visibility of the profession in public health emergency contexts.Further, this review had structural limitations due to the lack of qualitative and quantitative analysis.These analyses were not done due to the types of study included (technical notes, performance guides and reflection articles) which do not work for meta-analysis or qualitative evaluation.Another limitation is that we did not see any risk of bias, due to the lack of qualitative and quantitative analyses.Finally, the search time was short; we are aware that there was an accelerated production of new articles published after the end of the survey carried out by the authors.
We believe that this review serves as a basis for further research in this area, instigating students, researchers, professionals and other agents of occupational therapy to produce and discuss the profession's practices in public health emergencies with a focus on infectious agents like COVID-19.I applaud for the authors' efforts in conducting such an important topic regarding the effectiveness of occupational therapy during the era of COVID-19 pandemic.In general, the systematic review is well written and followed by the standard (i.e., the PRISMA guideline).The Results section is meaningful and have clear information that demonstrates the synthesized results.However, I believe that the systematic review can be improved with three minor comments from my side:

Reporting guidelines
In the Introduction, I would like the authors to mention that occupational therapy can be applied to different aspects of human daily livings, including their sleep (Fan & Drumheller, 2021 1 ).This can strengthen the rationale of conducting this meaningful systematic review. 1.
I would suggest changing the title from "the new coronavirus (COVID-19) epidemic" to "COVID-19 pandemic".Given that the COVID-19 is spread over the world, epidemic cannot reflect the true situation of the severity of COVID-19.

2.
I would like to see a clear PICO in the present systematic review, especially I would like to see the outcomes in the authors' mind.It seems that the authors have several outcomes and quality of life is the most important one that the authors want to assess.However, this is not clearly stated in the systematic review.

Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes
Are sufficient details of the methods and analysis provided to allow replication by others?Partly Is the statistical analysis and its interpretation appropriate?Not applicable

Are the conclusions drawn adequately supported by the results presented in the review? Yes
Competing Interests: No competing interests were disclosed.
Reviewer Expertise: Occupational therapy; psychosocial aspects I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
occupational therapy during the pandemic).

Introduction
The introduction is clear and demonstrated the importance of the study.I suggest you write more about the different consequences of COVID-19 in the health, for example, in the memory, lost muscle strength, fatigue and tiredness, in moderate and severe cases, and the impact of this in the activities of daily living during and after hospitalization.
○ Methods I suggest that you include a topic with criteria of exclusion that were showed in the Figure 1.

○ strategy section
First paragraph -What are the websites of occupational therapy entities and organizations?It is necessary to describe where they are found.

○
In the second paragraph, I suggest you cite the reference of use PICO strategy.

○
In the last paragraph, I suggest you inform that neither time nor language was used in the FIRST TIME.

Data collection and analysis section
What type of analysis is used?Simple?Descriptive?

Results and discussion
You have a lot of results.I suggest that you create topics for presentation and discussion of the results.

○
All legends of the tables and figures need to indicate the number of articles.

○
In the second paragraph, it is necessary to indicate the number of studies of American Occupational Therapy Association (AOTA).It is important to present the references of the articles in the text.It is too important that you describe these performance guides.

○
In the third paragraph, it is necessary to present the number of studies.It is interesting that you describe some results of the technical notes here.

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In the fourth paragraph, it is necessary to present the number of each type of study founded.

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In the fifth paragraph it is necessary to present the number of publications about guidelines for occupational therapy services.Is too important to presents the main information of these articles and after discusses them.Where are from these articles?There are differences between the places?

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In the seventh paragraph it is necessary to present the number of publications about quality of life during isolation.How many articles were writing in English?Where are from these articles?There are differences between the places?It is important to present the references of the articles in the text.

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Eight paragraph -How many articles were written in Portuguese?Where are from these articles?There are differences between the places?It is important to present the references of the articles in the text.

○
The tenth paragraph has similar information of the eighth.It is possible put this information together.

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In the eleven paragraph, it is necessary to present the number of publications about telehealth.Where are from these articles?There are differences between the places?It is important to present the references of the articles in the text.

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Twelfth paragraph -Where are from these articles?There are differences between the places?It is important to present the references of the articles in the text.

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In the thirteenth paragraph, it is important to discuss the possible negative impacts of telehealth.

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In the fourteenth paragraph, it is necessary to present the number of publications about occupational therapy actions in the social context.Where are from these articles?There are differences between the places?It is important to present the references of the articles in the text.

○
Fifteenth paragraph: Where are the articles about LGBTQIA+ community from?It is import to discuss the articles in terms of differences between countries.

Figure 1 .
Figure 1.Research flowchart as recommended by PRISMA.

18 . 19 .
Therapy against the coronavirus: Reflections on what Occupational Therapy should not do in times of pandemic Bregalda et al. 17 .Present a position on the current context of the pandemic and present the supplement that the Brazilian Interinstitutional Journal of Occupational Therapy developed as a technical-scientific contribution to the demands and crises arising from the coronavirus.Briefly describes a position on the current context, bringing reflections on the different social contexts and their respective impacts during the pandemic, in addition to fostering a discussion on the role of occupational therapy in the pandemic.Present in a translated way the Portuguese positioning WFOT.It is a translation of the world federation of occupational therapy (WFOT) that reports on the importance of the profession in this new context and ways of contributing today, namely, telemonitoring, environmental adaptation and mental health monitoring of individuals Present three positioning notes released by ABRATO It brings possible behaviors to be adopted by occupational therapists, some of them, the stimulation of the creation of support networks, acting in the propagation of information of the real situation, mobilizing protected income campaigns for informal workers, as well as guiding, and stimulating games and games for families who are in isolation with children.RENETO's positioning in the face of the impacts of the COVID-19 pandemic

19 pandemic: reformulating professional practice da Silva et al. 48 .
To report the experience of occupational therapy professionals before the national scenario of COVID-19 and their interventions with children in three different contexts.It describes actions taken by professionals during the pandemic, such as training, publication of technical notes, call center, adaptations of governmental health unit in Brazil and reorganization of the flow of users, to continue the assistance, and Highlights the need to decentralize total attention to COVID-19, and assisting people with other health needs who are currently neglected.

○
In the seventeenth paragraph, it is necessary to present the number of articles in each classification.Is it a new classification?This classification is different of the presented in the first paragraph of Results and Discussion Section? ○ Eighteenth to Twenty-second paragraph -Where are these articles from?There are differences between the places?It is important to present the references of the articles in the text.○ Twenty-third paragraph: This paragraph must be in the Conclusion section.

○
Are the rationale for, and objectives of, the Systematic Review clearly stated?YesAre sufficient details of the methods and analysis provided to allow replication by others?PartlyIs the statistical analysis and its interpretation appropriate?Not applicableAre the conclusions drawn adequately supported by the results presented in the review?PartlyCompeting Interests: No competing interests were disclosed.Reviewer Expertise: Occupational therapist graduated from UFSCarMaster and PhD in Occupational Therapy from PPGTO-UFSCarSpecialist in Neuroscience and Rehabilitation by FAMERP I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

Table 1 . Studies that provided guidelines for occupational therapy services. Title Authors Objective Results Type
It brings together guidelines on how to behave in the face of social isolation, in different contexts, and reinvent itself to continue the occupations that make up the subjects' routine, resulting in selfcontrol, maintenance of mental health and other innumerable benefits than a healthy routine can provide.
to deal with routine changes due to Covid-19: Practical Guidelines for Healthy Routines da Silva et al. 23 Translation and dissemination of information material with guidance and contributions from occupational therapy on essential care for the development of healthy routines.AOTA: American Occupational Therapy Association; OT: Occupational Therapy; WFOT: World Federation of Therapists Occupational; RENETO: National Occupational Therapy Teaching and Research in Occupational Therapy.

Table 2 . Studies that provided information about quality of life during isolation.
Lorrae Mynard's extensive production in conjunction with the Australian Association of occupational therapists favors a reflective discussion of the effects of quarantine and social isolation on productivity, self-care, leisure, individual time, routines and roles.In addition, it offers professionals ways to guide and intervene in the needs of patients with routine regulation caused by the pandemic.
The implementation of the geriatric oncology assessment in telehealth is promising, it is expected to further modify the delivery of this tool in response to the challenges observed, specifically, the lack of visual contact and non-verbal cues during telephone visits, which can make exploration difficult.and explanation of complex topics.However, as telehealth becomes more used, it offers an important opportunity to expand care for rural patients or for those who may have transportation or mobility limitations.

Table 4 . Studies that provided information about period of social isolation due to the COVID-19 pandemic.
It brings reflections about the social inequality that was intensified in the pandemic process, together with these reflections reinforce the need for the occupational therapists to act in the construction of multi and intersectoral actions, which can reach and meet the demand of the entire population that suffers from the impacts of social inequality.