Early experiences of the your COVID recovery programmme for individuals with long COVID

Early experiences of the your COVID recovery programme for individuals with long COVID Background: There is a significant prolonged symptom burden for a high proportion of patients after an initial acute infection with COVID. Objective measures in large cohorts have demonstrated that exercise capacity is disrupted in a large proportion of the Long COVID population. Recommendations for rehabilitation are emerging but clinical pathways and models of rehabilitation are lacking. Your COVID Recovery (YCR) is an online 'light touch' digital recovery programme for individuals recovering from Long COVID. Aim(s): To describe the early data from the YCR phase two site and to understand the data collected from the two outcome measures. Method(s): Participants were referred on the YCR programme. Basic demographics and questionnaire (EQ5D5L and the CAT) data were extracted from the site for the period February - November 2021. Result(s): 110 patients completed the programme (68% female, 88% White British, age: 46 +/- 11 years, height: 170 +/- 10 cm, weight: 87 +/- 21 kg). 47% of patients had comorbidities. Patients were on the programme for 9 +/- 4.3 weeks. There was an increase in EQ5D5L VAS score (pre = 49 +/- 19.5;post = 60 +/- 22.1;p<0.01) and EQ5D5L Index Value pre- to post-intervention (pre = 0.52 +/- 0.25;post = 0.57 +/- 0.27;p=0.09). CAT total score improved pre- to postintervention (pre = 19.8 +/- 7.2;post = 15.6 +/- 7.6, p<0.01). Discussion(s): This early data describes the impact of the YCR programme on the first cohort of patients to complete the programme. The outcome data is promising and should promote adoption by HCPs. Future research should focus on the comparing the YCR programme versus best usual care.

Exploring the impact of comorbidities in individuals after a Covid hospital admission or community infection in those referred to a rehabilitation programme

Introduction: Following a SARS-CoV-2(COVID)infection,individuals often present with complex needs and multiple comorbidities. However, it is currently unknown if comorbidities differ between those who were hospitalised or remained in the community during their covid infection. Aim(s): To explore the baseline characteristics and impact of comorbidities in individuals who were hospitalised or managed their covid infection at home and referred into a Covid Rehabilitation programme (CoR). Method(s): An observational cohort analysis of individuals who attended a CoR assessment between July 2020 and November 2021. Routine characteristics including age, gender, BMI, ethnicity and significant comorbidities were collected. Result(s): 466 individuals (age: 54 +/- 14 yrs;BMI:7.4 +/-30kg/m ;Female: 271[58%],White British: 296[64%], South Asian:111[26%],Other Ethnic groups:36[9.1%])were assessed. Those who were hospitalised had more comorbidities than those in the community;Median IQR1(1-2) vs 2 (1-4);p<0.05. The top 5 comorbidities were different in each group;Hospital: Total 544;Respiratory (n=101;18.6%), Metabolic (100;18.4%), Vascular (79;14.5%), MSK (72;13.2%), Psychiatric (71;19%) and Community: Total: 391;Psychiatric (97;25%), MSK (72;19.5%), Respiratory (74;19%), Metabolic (38;9.7%), Gastroenterology (38;9.7%). Conclusion(s): Patients who were hospitalised had more comorbidities than the community referrals. It will be important to consider these comorbidities when assessing for and delivering CoR.

Predicting those that require rehabilitation following hospitalisation of COVID19

Introduction: It is estimated that 25% of all individuals hospitalised with COVID-19 will require rehabilitation for lasting symptoms following infection. Aim(s): The aim of this study is to predict those that will require rehabilitation. Method(s): An observational cohort study exploring ongoing symptoms and rehabilitation needs for COVID-19 patients after 3 months of hospital admission. The FACIT and HADS were used to determine fatigue and anxiety/depression respectively and categorised using known cut offs (<30 FACIT severe, >10 HADS). Patients selfidentified whether they required rehabilitation based on if they perceived they had returned to baseline. Univariate and multivariable logistic regression models were used to identify factors that influence rehabilitation needs. Result(s): 363 patients were identified (186(51%) male, mean[SD] age 57[14], length of stay 10[14]). Univariate analysis determined respiratory comorbidities, fatigue, anxiety and depression were significant predictors in determining the need for rehabilitation with an odds ratio of 1.40, 3.12, 4.20 and 14.27 respectively. Age, sex and length of stay were not significant predictors of recovery. Significant predictors identified from univariate analyses (p<0.01) were entered into a multivariable regression model. Severe depression and fatigue lead to an increase in requiring rehabilitation with an odds ratio of 7.11 and 2.75 respectively. Conclusion(s): Patients that display severe depression and fatigue should be referred for rehabilitation. Patients with a pre-existing respiratory comorbidity should be considered for referral to a rehabilitation programme.

The impact of comorbidities on recovery following hospitalisation from COVID-19

Introduction: It is unknown how pre-existing comorbidities affect recovery after a hospital admission for COVID-19. Aim(s): To explore the impact of comorbidities on symptoms, exercise capacity and QoL 5 months after a hospital admission for COVID-19. Method(s): Patients hospitalised with COVID-19 were recruited to an observational longitudinal cohort study (PHOSPCOVID). Patients were categorised into three comorbid categories (0, 1, >=2). The Incremental Shuttle Walking Test (ISWT), FACIT, Dyspnoea-12 and the EQ5D-VAS were assessed 5 months post-discharge. Patient perceived preadmission EQ5D-VAS scores were collected retrospectively. One-way ANOVA were used to compare groups. Result(s): 1516 patients completed the assessment: 61% male, mean[SD];age 58[12], length of stay 14[19] days, BMI 32[7], number of comorbidities 2[2] with 813(53%) patients having >=2 comorbidities. The EQ5D was reduced pre admission to 5 months for all groups (p<0.01), however the difference between pre EQ5D-VAS and at 5 months was similar between groups (p=0.18). There was a significant difference in ISWT (m, %), FACIT and EQ5D between those that had >=2 comorbidities compared to no, and 1 comorbidity (p<0.01)(table 1). Conclusion(s): Although patients with more co-morbidities have a greater symptom burden and lower exercise capacity at five months post-discharge, important morbidity also persists in adults without pre-existing co-morbidity.

The effect of COVID rehabilitation on fatigue and postexertional symptom exacerbation

Background: Fatigue is a common symptom after a COVID-19 infection. There is evidence to support COVID-19 rehabilitation (CoR) improving symptoms. However, there is concern that exercise therapies may increase postexertional symptom exacerbation (PESE). Aim(s): To determine the effect of 6 weeks of CoR on fatigue and symptoms of PESE. Method(s): 148 patients (55 +/- 13 y;56 [38%] male) completed 6 weeks of CoR including symptom-titrated exercise and education. Fatigue was assessed pre- and post-CoR using the Functional Assessment Chronic Illness TherapyFatigue questionnaire (FACIT). Patients with a FACIT score <30 were defined as having severe fatigue. PESE symptoms were assessed in a sub-group of patients (n=44) using a subscale of the DePaul Symptom Questionnaire (DSQ). A mean composite score was calculated for DSQ symptom questions. Result(s): FACIT score reduced pre- to post-CoR with a mean change of -5 +/- 9;p<0.01. The DSQ composite score improved by 20 +/- 21 (p<0.01, n=44). The magnitude of change in the DSQ composite score pre- to post-CoR was not different in those with (26 +/- 22) and without (19 +/- 21) severe fatigue (p=0.44). Conclusion(s): CoR has demonstrated improvements in fatigue and symptoms associated with PESE. The improvement in PESE symptoms pre- to post-CoR was similar in patients with and without severe fatigue, advocating the use of CoR in both cohorts.

Exercise tolerance and limiting symptoms 5 and 12 months after hospital discharge from COVID-19

Introduction: Exercise tolerance, a strong predictor of morbidity and mortality, is reduced 2-3 months after a COVID19 hospitalisation. However, the long-term effects of COVID-19 on exercise tolerance in this population remain largely unknown. Aim(s): This study aimed to assess exercise tolerance 5 and 12 months after hospital discharge for COVID-19 and compare groups according to the limiting symptom. Method(s): Patients discharged from hospital after COVID-19 were invited to a multicentre long-term follow up study (PHOSP-COVID). 378 participants (58 +/- 12 y;BMI: 32.2 +/- 7.4 kg/m2;143 [38%] female;106 [28%] had received mechanical ventilation) performed an incremental shuttle walk test (ISWT) to intolerance 5 and 12 months after hospital discharge. Self-reported reason for intolerance was recorded. Result(s): ISWT distance 5 months post-discharge was 465 +/- 263 m (63 +/- 29% predicted;heart rate: 66 +/- 17% agepredicted max). At exercise intolerance, modified Borg ratings of perceived exertion and breathlessness were 3 +/- 2 and 4 +/- 2, respectively. Participants terminated the test due to breathlessness (n = 107;28%), leg fatigue (38;10%), breathlessness and leg fatigue (85;23%) or other reason (148;39%). There was no increase in ISWT distance 5 to 12 months post-hospital discharge (12 months;476 +/- 264 m;64 +/- 29% predicted;p = 0.09), with no differences between participants based on their reason for exercise intolerance at 5 months (p = 0.29). Conclusion(s): Between 5 and 12 months after hospital discharge, exercise tolerance did not increase, irrespective of patient reported exercise limitations, underscoring the need for effective rehabilitation strategies in this population.

Exploring the Impact of Fatigue on Exercise Tolerance in Post-COVID Individuals

Introduction: After acute COVID infection, individuals experience fatigue and a reduced exercise tolerance, however the relationship between these variables has not been established. Aim(s): This study explored the impact of fatigue severity on exercise tolerance in individuals post-COVID infection. Method(s): This observational cohort analysis of individuals attending COVID-rehabilitation was assessed using the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F) questionnaire and Incremental Shuttle Walk Test (ISWT) pre- to post- rehabilitation. Individuals were split into mild and severe fatigue (FACIT-F</>=30) groups. Result(s): 295 individuals were assessed (64% male, mean[SD] age 54[15] years, BMI 30.1[8.7] kg/m ). 193 (65%) individuals were in the severe fatigue group. Baseline ISWT distance was reduced in the severe fatigue group (287[181]m) compared to the mild fatigue group (396[217]m, p<0.05). There was a weak positive correlation between Pre-FACIT-F and baseline ISWT (r=0.28). There was a significant improvement in ISWT following rehabilitation of 90[114]m and 62[77]m for severe and mild fatigue groups respectively but there was no differences between groups (p=0.13)Conclusion: Those with severe fatigue had reduced exercise tolerance compared to those with mild fatigue prior to rehabilitation. Rehabilitation improves exercise tolerance in those with mild and severe fatigue, and there are no differences between groups.

The impact of a 6-week COVID-19 rehabilitation programme on dyspnoea post COVID-19

IntroductionDyspnoea is one of several ongoing symptoms experienced by those recovering from COVID-19 (Arnold et al, 2021). It can impact people for numerous weeks and months following the initial infection. Post COVID-19 rehabilitation may help;however, little is known about the effects of rehabilitation on dyspnoea and the related emotional response. This study aims to explore the impact of an outpatient hospital-based rehabilitation programme on dyspnoea and its emotional burden in those recovering from COVID-19.MethodPeople experiencing ongoing symptoms of COVID-19, both post-hospitalisation and community managed, were referred for assessment of their rehabilitation needs prior to commencing the programme. Consent and ethical approval was gained to allow data collection and analysis for a longitudinal cohort study. The COVID-19 hospital-based programme was twice weekly for 6-weeks. The Multidimensional Dyspnoea Profile (MDP) (Banzett et al, 2015) was completed pre and post-rehabilitation. Data was analysed using a paired t-test. For the MDP, data was explored to understand the most prevalent sensation of dyspnoea. Data is presented as the immediate perception (A1+SQ) and emotional domain (A2).ResultsNineteen people completed the MDP pre-rehabilitation (74% female, mean [SD] age 53.21 [9.99] years). Hospital admissions were 5 (26.3%) and the mean [SD] length of hospital stay was 8.8 [12.66] days. The mean [SD] unpleasantness (A1) score was 5.21 [1.69]. Chest tightness was the most severe and prevalent sensation (SQ). Frustrated was the most severe emotion (A2).Fourteen people completed the MDP Post-rehabilitation. The mean [SD] unpleasantness (A1) score was 4.29 [2.46]. Hyperventilating was the most severe and prevalent sensation (SQ). Frustrated was the most severe emotion (A2). There was no statistically significant difference between the immediate perception pre and post-rehabilitation (-3.37 [10.40]), p=0.22). There was a statistically significant difference between the emotional domain pre and post-rehabilitation (4.36 [5.32]), p< 0.01.ConclusionThese results demonstrate rehabilitation did improve the immediate perception of dyspnoea but this was not statistically significant. Unpleasantness of dyspnoea reduced following rehabilitation. Furthermore, the sensation of dyspnoea changed following the rehabilitation programme. The emotional domain statistically significantly increased following rehabilitation. Further research is required due to the multifactorial nature of dyspnoea.

Using the Sit to Stand tests to assess functional status and oxygen desaturations following COVID-19

IntroductionCOVID-19 leads to persistent symptoms and in some instances oxygen desaturation (>3%) (Greenhalgh et al, 2020). Field walking tests are used in respiratory diseases to assess oxygen desaturation and exercise capacity due to their high reliability (Hernandes et al, 2014). However, under COVID-19 restrictions these tests became problematic to perform due to limitations of space, time, and equipment. This project aims to investigate sit to stand test’s (1STS & 5STS) in comparison to the Incremental shuttle walk test (ISWT) to assess function and oxygen desaturation (SpO2) in patients following COVID19 infection. In addition, to investigate if there is a difference in results to patients who received hospital care during the acute stage of COVID-19, to those who were managed in the community.MethodsPatients attending out-patient COVID-19 rehabilitation comprised of those hospitalised for acute COVID-19 and community managed referrals. Oxygen saturation was recorded directly before and after the tests. An independent T- test was used to measure group means for statistical difference and Pearson’s correlation was used to compare 5STS, 1STS and ISWT performance outcomes.ResultsTwenty-nine patients were eligible for analysis, mean (SD) age 54 (7.8) years (65.5% female and 69% White British) 7 (24%) participants had hospital admissions with a mean time from discharge to assessment of 347 days. There were desaturations of >3% in 3 (10%) participants during the 1STS and 9 (38%) in the ISWT and no desaturations of >3% during the 5STS. The difference between patient groups and SPO2 desaturations are non-significant at 0.559 for ISWT, 0.447 for 1STS and 0.447 5STS. There was no significant difference between SpO2, RPE and BORG for patient groups in each test condition. There was a strong correlation (R=-0.88) between the 1STS repetitions and 5STS time. There was a moderate correlation between ISWT and both STS tests (5STS R=-0.53 and 1STSR=-0.66).ConclusionsThe 5STS does not detect desaturation, whilst the ISWT detected meaningful desaturation in 38% of the population. There was a strong correlation with respect to performance on both STS tests, but not with the ISWT.

The impact of post COVID-19 rehabilitation on hospital and non-hospitalised participant- is there a difference?

P70 Table 1 All Hospitalised Mean difference (SD) Non-Hospitalised Mean difference (SD) Between group Difference Mean difference (95% CI) ISWT(m) 100.1(95.6)** 95.5(90.0)** 114.4(112.8)** 18.9(70.7,-32.9) ESWT(secs) 332.0(636.9)** 308.0 (686.4)** 417.2(422.2)** 109.1 (470.0, -251.7) QMVC (kg) 5.2(4.8)** 5.6(4.7)** 3.7(5.5) 1.9 (2.2,-6.0) FACIT 3.8(7.8)** 3.4 (7.4)* 5.1(9.2)* 1.8 (-2.6,6.2) CAT 2.6(6.0)** 2.8(5.6)** 0.7(7.2) 2.1 (5.4,-1.1) EQ-5D (thermometer) 7.7(20.1)** 11.0(19.4)** 3.9(19.0) 14.9 (3.2, 26.6)* MoCA 0.8(3.8) 0.8(4.2) 0.7(1.9) 0.08(2.2,-2.4) HAD-A 0.6(3.1) 0.6(3.0) 0.4(3.3) 0.2 (1.5,-2.0) HAD-D 1.1(3.5)* 1.3(3.4)* 0.5(3.8) 0.8(1.2,-2.7) *<0.05 **<0.01ConclusionEarly data suggests that those who have prolonged and significant symptoms post COVID-19 improve after a supervised rehabilitation programme. The response to the intervention is similar in both hospitalised and non-hospitalised groups. This is early cohort data and therefore must be treated with caution, nevertheless is encouraging.

‘It gives you that hope, knowing that you are not alone’ – the journey of COVID-19 recovery and the rehabilitation boat

P143 Figure 1The over-arching themes, sub-themes and illustrative quotes[Figure omitted. See PDF]ConclusionsAttending rehabilitation for COVID-19 was considered acceptable and important part of recovery and a positive experience. The opportunity to share the experience with others in the same boat was highly valued in the context of an unexpected and potentially lonely COVID-19 recovery.ReferencesPHOSP-COVID Collaborative Group, Evans R, McAuley H. Physical, cognitive and mental health impacts of COVID-19 following hospitilisation - a multi-centre prospective cohort study. MedRxiv. 2021.Daynes E, Gerlis C, Chaplin E, Gardiner N, S Singh. Early experiences of rehabilitations for patients post-COVID to improve fatigue, breathlessness, exercise capacity and cognition. CRD. 2021.

Using the multidimensional dyspnoea profile in COVID-19- the different sensations of breathlessness and their impact

P72 Figure 1Immediate and emotional domains of the Multidimensional Dyspnoea Profile[Figure omitted. See PDF]Conclusion63% of patients following COVID-19 identified at least one sensation of breathlessness that persisted after discharge. The severity and emotional response to breathlessness was not influenced by length of stay, ventilatory status during admission or pre-existing respiratory condition.

The need for rehabilitation programme after an episode of COVID-19

P27 Figure 1Preferred rehabilitation programme[Figure omitted. See PDF]ConclusionThe survey responses indicate a significant need for a support package of care. The majority preferred a face-to-face intervention;although a significant minority would prefer a digital intervention, regardless of mode there will be a substantial burden on services.ReferenceDaynes E, Gerlis C, Chaplin E, Gardiner N, Singh SJ. Early experiences of rehabilitation for individuals post-COVID to improve fatigue, breathlessness exercise capacity and cognition-A cohort study. Chronic Respiratory Disease. 2021;18:14799731211015691.

A Simple Sit-to-Stand Test to Detect Exercise-Induced Oxygen Desaturation in Patients Being Discharged from Hospital with COVID-19

Introduction: Patients with COVID-19 with normal oxygen levels at rest may desaturate on exertion which could predict adverse outcomes (1). A 3% drop in oxygen saturation (SpO2) has been suggested as cause for concern in COVID-19 (2). Field walking tests are often used in respiratory disease to assess desaturation. However these tests can be impractical to perform as an inpatient due to space, equipment and technical skill requirements. The aim of this project was to use a simple sit-to-stand test to evaluate exercise-induced oxygen desaturation to inform home oxygen prescription. Methods: Patients were invited to perform a 1 minute sit-to stand test (1minSTS). Tests were performed at the bedside, around the time of hospital discharge, by the inpatient therapy team at a large teaching hospital (Leicester, UK). All but 2 patients were normoxive at rest (87 and 89%). SpO2 was recorded before, during and after each test. A standard height chair and stopwatch were required. Results: 64 patients performed the STS test. 7 COPD (1 existing oxygen prescription). 72% male, 42% white British, 28% Indian, 13% Asian, 17% other. Mean (Standard Deviation: SD) age 59.2 (14.7) years, BMI 29.1 (5.7), length of stay 13.8 (13.7 days). Median (Inter Quartile Range) Medical Research Council Dyspnoea Scale 2 (1-4), Clinical Frailty Scale 2 (2-3). During admission, 7 patients were ventilated. Pre and post/during STS test SpO2 are shown in table 1 for 57 subjects with complete data. There was a change of -3.1% (p=0.000).32% of patients desaturated by >3% and 30% were discharged with oxygen.Conclusion: This quick and simple to perform sit-to-stand test identified statistically (and possibly clinically) relevant oxygen desaturation following exercise, in 30% of patients being discharged from hospital with COVID-19. This is important to inform oxygen prescription and when considering patients returning to or starting exercise/physical activity.