Improved clinical outcomes in response to a 12-week blended digital and community-based long-COVID-19 rehabilitation programme

Jemma L Smith; Kevin Deighton; Aidan Q Innes; Marc Holl; Laura Mould; Zhining Liao; Patrick Doherty; Greg Whyte; James A King; Davina Deniszczyc; Benjamin M Kelly

doi:10.3389/fmed.2023.1149922

Improved clinical outcomes in response to a 12-week blended digital and community-based long-COVID-19 rehabilitation programme

Front Med (Lausanne). 2023 May 24:10:1149922. doi: 10.3389/fmed.2023.1149922. eCollection 2023.

Authors

Jemma L Smith^#¹, Kevin Deighton^#¹, Aidan Q Innes¹, Marc Holl¹, Laura Mould¹, Zhining Liao¹, Patrick Doherty², Greg Whyte³, James A King^{4

5}, Davina Deniszczyc¹, Benjamin M Kelly^{1

6}

Affiliations

¹ Nuffield Health, Epsom, United Kingdom.
² Department of Health Sciences, University of York, York, United Kingdom.
³ School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom.
⁴ National Centre for Sport and Exercise Medicine, Loughborough University, Loughborough, United Kingdom.
⁵ NIHR Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust, University of Leicester, Leicester, United Kingdom.
⁶ Department of Health Professions, Faculty of Health and Education, Manchester Metropolitan University, Manchester, United Kingdom.

^# Contributed equally.

Abstract

Introduction: Two million people in the UK are experiencing long COVID (LC), which necessitates effective and scalable interventions to manage this condition. This study provides the first results from a scalable rehabilitation programme for participants presenting with LC.

Methods: 601 adult participants with symptoms of LC completed the Nuffield Health COVID-19 Rehabilitation Programme between February 2021 and March 2022 and provided written informed consent for the inclusion of outcomes data in external publications. The 12-week programme included three exercise sessions per week consisting of aerobic and strength-based exercises, and stability and mobility activities. The first 6 weeks of the programme were conducted remotely, whereas the second 6 weeks incorporated face-to-face rehabilitation sessions in a community setting. A weekly telephone call with a rehabilitation specialist was also provided to support queries and advise on exercise selection, symptom management and emotional wellbeing.

Results: The 12-week rehabilitation programme significantly improved Dyspnea-12 (D-12), Duke Activity Status Index (DASI), World Health Orginaisation-5 (WHO-5) and EQ-5D-5L utility scores (all p < 0.001), with the 95% confidence intervals (CI) for the improvement in each of these outcomes exceeding the minimum clinically important difference (MCID) for each measure (mean change [CI]: D-12: -3.4 [-3.9, -2.9]; DASI: 9.2 [8.2, 10.1]; WHO-5: 20.3 [18.6, 22.0]; EQ-5D-5L utility: 0.11 [0.10, 0.13]). Significant improvements exceeding the MCID were also observed for sit-to-stand test results (4.1 [3.5, 4.6]). On completion of the rehabilitation programme, participants also reported significantly fewer GP consultations (p < 0.001), sick days (p = 0.003) and outpatient visits (p = 0.007) during the previous 3 months compared with baseline.

Discussion: The blended and community design of this rehabilitation model makes it scalable and meets the urgent need for an effective intervention to support patients experiencing LC. This rehabilitation model is well placed to support the NHS (and other healthcare systems worldwide) in its aim of controlling the impacts of COVID-19 and delivering on its long-term plan.

Clinical trial registration: https://www.isrctn.com/ISRCTN14707226, identifier 14707226.

Keywords: SARS-CoV-2; SeaCole; coronavirus; digital health; emotional wellbeing; exercise; fatigue.

Grants and funding

This work was funded through a grant from the Manchester Metropolitan University Partnership Board, a funding source dedicated to the advancement of health and wellbeing service development that have the potential to generate significant public benefit.