Abstract
Background:
Following a COVID-19 infection, approximately 10-30% of people will have ongoing symptoms lasting longer than 12 weeks. This is referred to as post- COVID-19 condition or ‘long COVID’. Globally, health services have been set up with the aim of reducing the impact of long COVID and improving individuals’ function and quality of life. However, there is limited research reporting the outcomes of such services.
Purpose:
The purpose of this thesis is to:
- 1. In a narrative review, summarise the literature surrounding the nature of long COVID, as well as the literature guiding long COVID rehabilitation services to summarise best practice service structure, assessment and management approaches.
- 2. To better understand the demographic and clinical characteristics of people presenting to a long COVID clinical service, the impact of long COVID on their function, outcomes observed after targeted individualised intervention, and how people view such a service.
- 3. Informed by the above, to reflect on the delivery of long COVID rehabilitation services.
Methods:
The retrospective case notes review extracted data from a long COVID service set up to support rehabilitation of people presenting with long COVID between September 2022 and June 2023. The long COVID service included provision of funds of eight professional contact hours over a three-month period per client, with most input provided by occupational therapists (OT’s), physiotherapists and dieticians. Demographic, service, clinical and survey data were collected. Demographic and clinical data were analysed using descriptive statistics; survey data were analysed using conceptual content analysis.
Results:
The long COVID service received 113 referrals from general practitioners (GPs), and, after exclusions, data are reported for 102 clients. Two-thirds of clients were female (65.7%), and the mean age was 45.8 years (SD =13). Multiple well-recognized disorders were identified including post-exertional malaise (78.9% of the 95 clients assessed), postural orthostatic tachycardia syndrome (21% of 62 assessed), and possible breathing pattern disorders (64.3% of 70 assessed). Over the period of the service (median = 88.5 days, LQ = 47, UQ = 135) quality of life, symptom and function scores improved, and 25.5% of clients increased their work status. These findings were supported by positive ratings of a ‘global rating of change’ score (mean=2.6/5.0, SD 1.1). Survey findings were positive for goal achievement (mean=6.9/10, SD 2.4), and very positive for care received (mean=9.3/10, SD 0.9) and likelihood of recommending the long COVID service (mean=9.3/10, SD 1.4).
Conclusions:
Data collection in a dedicated long COVID service has provided valuable insights into demographic and clinical characteristics of those presenting with the condition, the impact on people’s function, outcomes of rehabilitation, and overall perceptions of the service. The data highlight the presence of multiple disorders, and the value of individualized care from a core multi-disciplinary team of occupational therapists (OT’s), physiotherapists and dietitians, with access to other health professionals as needed.
The long COVID service in this study was valuable and effective in developing a greater understanding of those presenting with the condition and how best to support their recovery. Despite being set up at a time where knowledge of long COVID was limited, the overall findings are promising. This information provides a good starting point to support existing health practices within New Zealand to more effectively manage patients with long COVID.