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Aims and objectives: This study aimed to explore stroke rehabilitation staff's experiences, challenges and adaptations in their work during the first two waves of the COVID-19 pandemic in Sweden.

Methods: A web survey was conducted from September to December 2020 with staff involved in stroke rehabilitation. It covered participant characteristics, experiences, COVID-19 management, patient safety, organisation, information allocation and information and communication technologies (ICT). Quantitative data was presented with descriptive statistics. Free-text responses were used to illuminate the findings.

Results: Three hundred and forty stroke rehabilitation staff answered the survey. No stroke rehabilitation organisation was closed entirely, but services had been paused or altered in several regions. Adaptations included prioritising patients with COVID-19 and thereby reducing the capacity to supply rehabilitation for stroke survivors. The participants experienced a shortage of personal protective equipment (PPE) and patient safety had been compromised. The pandemic restricted opportunities to provide ordinary rehabilitation, often resulting in ethical dilemmas and stress. The rapid transition to using ICT was primarily experienced positively.

Conclusions: Staff reported working under complex, constantly changing and stressful conditions during the first two waves of the COVID-19 pandemic. Disruptions in ordinary practice led to compromised patient safety and increased stress among staff, intensified by limited access to PPE. Ethical guidelines, as well as regular debriefing protocols, should be put in place to prevent adverse health outcomes among staff and to prepare healthcare systems for future crises and disruptions. ICT offers a potential pathway for more flexible and accessible care in the future.