Psychometric analysis of the modified Covid-19 Yorkshire Rehabilitation Scale (C19-YRSm) in a prospective multicentre study (preprint)

BckgroundLong COVID is a novel multisystem clinical syndrome affecting millions of individuals worldwide. The modified COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) is a condition-specific patient-reported outcome measure designed for assessment and monitoring of people with Long COVID (LC). ObjectivesTo evaluate the psychometric properties of the C19-YRSm in a prospective sample of people with Long COVID. Methods1314 patients attending UK specialist Long COVID clinics completed C19-YRSm and EQ-5D-5L longitudinally. Scale characteristics were derived for C19-YRSm subscales (Symptom Severity, SS; Functional Disability, FD; and Overall Health, OH) and internal consistency (Cronbachs alpha). Convergent validity was assessed using the FACIT-Fatigue scale. Known groups validity was assessed for the Other Symptoms (OS) subscale as tertiles, hospitalisation and intensive care admission. Responsiveness and test-retest reliability was evaluated for C19-YRSm subscales and EQ-5D-5L. The minimal important difference (MID) and minimal clinically important difference (MCID) were estimated. Confirmatory factor analysis was applied to determine the instruments two-factor structure. ResultsC19-YRSm demonstrated good scale characteristic properties. Item-total correlations were between 0.37 to 0.65 (for SS and FD), with good internal reliability (Cronbachs alphas >0.8). Item correlations between subscales ranged between 0.46 to 0.72. Convergent validity with FACIT was good (-0.46 to -0.62). The three subscales discriminated between different levels of symptom burden (p<0.001), and between patients admitted to hospital and intensive care. There was moderate responsiveness for the three subscales ranging from 0.22 (OH) to 0.50 (SS) and was greater than the EQ-5D-5L. Test-retest reliability was good for both SS 0.86 and FD 0.78. MID was 2 for SS, 2 for FD, and 1 for OH; MCID was 4 for both the SS and FD. The factor analysis supported the two-factor SS and FD structure. ConclusionsThe C19-YRSm is a condition-specific, reliable, valid, and responsive patient-reported outcome measure for Long COVID. Key messagesO_ST_ABSWhat is already known on this topicC_ST_ABSLong Covid or Post-COVID-19 syndrome is a multisystem, fluctuating condition. C19-YRSm is literatures first condition-specific patient reported outcome measure which needed validation in a large population sample. What this study addsC19-YRSm is a valid, reliable, responsive and easy to administer measure which is able to show clinically meaningful change in the status of the condition in people living with Long Covid. How this study might affect research, practice or policyC19-YRSm can be used in clinical and research settings to reliably capture the condition trajectory and the effect of interventions and also help inform clinical policy.

Prevalence of orthostatic intolerance in Long Covid clinic patients - A multicentre observational study (preprint)

PurposeOrthostatic intolerance (OI), including postural orthostatic tachycardia syndrome (PoTS) and orthostatic hypotension (OH), are often reported in long covid, but published studies are small with inconsistent results. We sought to estimate the prevalence of objective OI in patients attending long covid clinics and healthy volunteers and associations with symptoms and comorbidities. MethodsParticipants were recruited from 8 UK long covid clinics, and healthy volunteers from general population. All undertook standardised National Aeronautics and Space Administration Lean Test (NLT). Participants history of typical OI symptoms (e.g. dizziness, palpitations) prior to and during the NLT were recorded. Results277 long covid patients and 50 frequency-matched healthy volunteers were tested. Healthy volunteers had no history of OI symptoms or PoTS, 10% had asymptomatic OH. 130 (47%) long covid patients had previous history of OI symptoms and 144 (52%) developed symptoms during the NLT. 41 (15%) had an abnormal NLT, 20 (7%) met criteria for PoTS and 21 (8%) had OH. Of patients with an abnormal NLT, 45% had no prior symptoms of OI. Relaxing the diagnostic thresholds for PoTS from two consecutive to one reading, resulted in 11% of long covid participants meeting criteria for PoTS, but not in healthy volunteers. ConclusionMore than half of long covid patients experienced OI symptoms during NLT and more than one in ten patients met the criteria for either PoTS or OH, half of whom did not report previous typical OI symptoms. We recommend all patients attending long covid clinics are offered an NLT and appropriate management commenced. Trial registration numbers NCT05057260, ISRCTN15022307

The adoption of smart industry 4.0 app technology and harnessing e-WOM in the wine industry caused by a global pandemic: a case study of the Yarra Valley in Australia

Purpose This exploratory study aims to examine how wine stakeholders' are adopting innovative advancements in smart industry 4.0 application technology (SI4.0AT) coupled with electronic word-of-mouth (e-WOM) techniques to increase winery visitation and wine sales, prior to and during a global pandemic in the Yarra Valley in Victoria, Australia. Design/methodology/approach A qualitative interpretivist geographical bounded case study approach was used to collect data from fifteen Victorian wine stakeholder's prior to and during the global pandemic COVID-19. A thematic analysis was applied to interpret participant responses and how they viewed, reacted to and harnessed S14.0AT and e-WOM to continue and increase wine sales. Findings The findings suggest few wine stakeholders' were actively implementing SI4.0AT prior to the global pandemic, COVID -19. With the forced closure of wineries to visitors across Australia, most small to medium-sized wineries immediately changed their business models to concentrate on domestic e-commerce wine sales and home delivery. To support these new business models, e-WOM techniques were quickly adopted or increased whereas other S14.0AT technologies were not, due to financial restraints. Research limitations/implications The number of participants used in this study is a limitation, however, this can be overcome by replicating this study in other wine regions. This research focused on the wine stakeholders' viewpoint only and may not be easily generalised. Future studies may examine the "what" aspect of SI4.0AT is being used and e-WOM content such as investigating what consumers are saying about these wineries, the method of communication and the motivations for consumers to engage with a winery. Practical implications The implications for the wine industry and overall results offer insight into the wine stakeholders' perceptions of SI4.0AT and e-WOM and consequent marketing strategy of wineries in the Yarra Valley, Victoria, both pre- and during forced face-to-face winery closures due to a global pandemic. Wineries need to continue to harness and leverage the benefits of e-WOM wine marketing in their marketing strategies and continue to explore the affordability of 4.0 app technology and Tourism 4.0 options. Originality/value This study is the first attempt at investigating how wine stakeholders' view;react to and harness SI4.0AT and e-WOM through formalised online marketing strategies which should continue to be investigated in the future.