A Mixed-Methods Evaluation of a Virtual Rehabilitation Program for Self-Management in Post-COVID-19 Syndrome (Long COVID)
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Setting
2.3. Recruitment
2.4. Data Collection
2.5. Analysis
2.6. Inclusion
2.7. Exclusion
2.8. Ethics
3. Results
3.1. Quantitative Data Analysis
3.2. Qualitative Data Analysis
3.2.1. Main Theme 1: Attendance and Accessibility
3.2.2. Main Theme 2: Content
3.2.3. Main Theme 3: Use of Digital Technology
3.2.4. Main Theme 4: Group Dynamics
3.2.5. Main Theme 5: Individual Factors
3.2.6. Main Theme 6: Internal Change
4. Discussion
4.1. Impact of the VRP Evaluation
- At the start of ‘Session 1’, five to ten minutes are spent familiarizing participants with ‘Microsoft Teams’ software
- A section about pain has been added and the mental well-being session condensed. All presentations are now capped at 30 min to support engagement and allow extra time for peer reflection.
- A two minute ‘pause’ in each session re-enforces advice given from the HCPs about taking a break from activity, regular movement and hydration.
- Sessions 3 and 9 (Causes of Breathlessness and Breathing Retraining) are now more practical and interactive, this has resulted in better discussions between participants at the end of the sessions
- Video recordings for each session are now sent to participants instead of Microsoft PowerPoint presentations so they can re-watch at times that suit.
4.2. Strengths
4.3. Limitations
4.4. Recommendations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Coronavirus Disease (COVID-19): Post COVID-19 Condition. Available online: https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-(covid-19)-post-covid-19-condition (accessed on 7 June 2022).
- National Guidance for Post-COVID Syndrome Assessment Clinics. Available online: https://c19-yrs.com/nhs-england-national-guidance-for-post-covid-syndrome-assessment-clinics-version-2-april-2021/ (accessed on 7 July 2022).
- The Health Foundation. COVID-19 Impact Inquiry Exploring the Pandemic’s Implications for Health and Health Inequalities. 2022. Available online: https://www.health.org.uk/what-we-do/a-healthier-uk-population/mobilising-action-for-healthy-lives/covid-19-impact-inquiry?gclid=CjwKCAjw46CVBhB1EiwAgy6M4mE09i8hYBq2nzCRlyledHuHv7aVX3yhmhTejAlGNmYBwVDbzimcohoCZT8QAvD_BwE (accessed on 14 June 2022).
- Office of National Statistics (ONS). Prevalence of Ongoing Symptoms following Coronavirus (COVID-19) Infection in the UK–Office for National Statistics. June 2022. Available online: https://www.ons.gov.uk/news/statementsandletters/theprevalenceoflongcovidsymptomsandcovid19complications (accessed on 18 July 2022).
- NICE. COVID-19 Rapid Guideline: Managing the Long-Term Effects of COVID-19. Available online: https://www.nice.org.uk/guidance/ng188 (accessed on 6 July 2022).
- Hutchings, R. The Impact of COVID-19 on the Use of Digital Technology in the NHS. 2020. Available online: https://www.nuffieldtrust.org.uk/files/2020-08/the-impact-of-covid-19-on-the-use-of-digital-technology-in-the-nhs-web-2.pdf (accessed on 14 June 2022).
- Dhoonmoon, L. Self-management for patients with suspected ‘long COVID’. Indep. Nurse 2021, 2, 22–24. [Google Scholar] [CrossRef]
- Chan, C.; Yamabayashi, C.; Syed, N.; Kirkham, A.; Camp, P.G. Exercise Telemonitoring and Telerehabilitation Compared with Traditional Cardiac and Pulmonary Rehabilitation: A Systematic Review and Meta-Analysis. Physiother. Can. 2016, 68, 242–251. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hwang, R.; Bruning, J.; Morris, N.R.; Mandrusiak, A.; Russell, T. Home-based telerehabilitation is not inferior to a centre-based program in patients with chronic heart failure: A randomised trial. J. Physioth. 2017, 63, 101–107. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chaplin, E.; Hewitt, S.; Apps, L.; Bankart, J.; Pulikottil-Jacob, R.; Boyce, S.; Morgan, M.; Williams, J.; Singh, S. Interactive web-based pulmonary rehabilitation programme: A randomised controlled feasibility trial. BMJ Open 2017, 7, e013682. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chen, J.; Jin, W.; Zhang, X.X.; Xu, W.; Liu, X.N.; Ren, C.C. Telerehabilitation approaches for stroke patients: Systematic review and meta-analysis of randomized controlled trials. J. Stroke Cerebrov. Dis. 2015, 24, 2660–2668. [Google Scholar] [CrossRef] [PubMed]
- Marquis, N.; Larive’e, P.; Saey, D.; Dubois, M.; Tousignant, M. In-Home Pulmonary telerehabilitation for patients with chronic obstructive pulmonary disease: A pre-experimental study on effectiveness, satisfaction, and adherence. Telemed. J. e Health 2015, 21, 870–879. [Google Scholar] [CrossRef]
- Munoz Esquivel, K.; Nevala, E.; Alamaki, A.; Condell, J.; Kelly, D.; Davies, R.J.; Heaney, D.; Nordstorm, A.; Larsson, M.A.; Nillson, D.; et al. Remote Rehabilitation: A Solution to Overloaded & Scarce Health Care Systems. Trends Telem. E Health 2018, 1, 1–19. [Google Scholar]
- Russell, T.G. Physical rehabilitation using telemedicine. J. Telemed. Telecare 2007, 13, 217–220. [Google Scholar] [CrossRef]
- Nolan, C.M.; Kaliaraju, D.; Jones, S.E.; Patel, S.; Barker, R.; Walsh, J.A.; Wynne, S.; Man, W. Home versus outpatient pulmonary rehabilitation in COPD: A propensity-matched cohort study. Thorax 2019, 74, 996–998. [Google Scholar] [CrossRef]
- Andritoi, D.; Luca, C.; Onu, I.; Corciova, C.; Fuior, R.; Salceanu, A.; Iordan, D.A. The Use of Modern Technologies in Post-COVID-19 Cardiopulmonary Rehabilitation. Appl. Sci. 2022, 12, 7471. [Google Scholar] [CrossRef]
- Cox, N.S.; Scrivener, K.; Holland, A.E.; Jolliffe, L.; Wighton, A.; Nelson, S.; McCredie, L.; Lannin, N.A. A brief intervention to support implementation of telerehabilitation by community rehabilitation services during COVID-19: A feasibility study. Arch. Phys. Med. Rehabil. 2021, 102, 789–795. [Google Scholar] [CrossRef] [PubMed]
- Dalbosco-Salas, M.; Torres-Castro, R.; Rojas Leyton, A.; Morales Zapata, F.; Hen-ríquez Salazar, E.; Espinoza Bastías, G.; Beltrán Díaz, M.E.; Tapia Allers, K.; Mornhinweg Fonseca, D.; Vilaró, J. Effectiveness of a Primary Care telerehabilitation Program for Post-COVID-19 Patients: A Feasibility Study. J. Clin. Med. 2021, 10, 4428. [Google Scholar] [CrossRef] [PubMed]
- Pinto, M.; Gimigliano, F.; De simone, S.; Costa, M.; Bianchi, A.A.M.; Iolascon, G. Post-Acute COVID-19 Rehabilitation Network Proposal: From Intensive to Extensive and Home-Based IT Supported Services. Int. J. Environ. Res. Public Health 2020, 17, 9335. [Google Scholar] [CrossRef] [PubMed]
- Sivan, M.; Halpin, S.; Hollingworth, L.; Snook, N.; Hickman, K.; Clifton, I.J. Development of an integrated rehabilitation pathway for individuals recovering from COVID-19 in the community. J. Rehabil. Med. 2020, 52, jrm00089. [Google Scholar] [CrossRef] [PubMed]
- Parkin, A.; Davison, J.; Tarrant, R.; Ross, D.; Halpin, S.; Simms, A.; Salman, R.; Sivan, M. A multidisciplinary COVID-19 service to manage post-COVID-19 syndrome in the community. J. Prim. Care Community Health 2021, 12, 21501327211010994. [Google Scholar] [CrossRef]
- Sivan, M.; Halpin, S.; Gee, J.; Makower, S.; Parkin, A.; Ross, D.; Horton, D.; O’Connor, R. The self-report version and digital format of the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) for Long Covid or Post-COVID syndrome assessment and monitoring. Adv. Clin. Neurosci. Rehabil. 2021; online ahead of print. [Google Scholar]
- National Health Service (NHS) England. Supported Self-Management: Summary Guide. 2020. Available online: https://www.england.nhs.uk/wp-content/uploads/2020/03/supported-self-management-summary-guide.pdf (accessed on 20 June 2022).
- Salawu, A.; Green, A.; Crooks, M.G.; Brixey, N.; Ross, D.H.; Sivan, M. A proposal for multidisciplinary tele-rehabilitation in the assessment and rehabilitation of COVID-19 survivors. Int. J. Environ. Res. Public Health 2020, 17, 4890. [Google Scholar] [CrossRef]
- Laver, K.E.; Adey-Wakeling, Z.; Crotty, M.; Lannin, N.A.; George, S.; Sherrington, C. Telerehabilitation services for stroke. Cochrane Database Syst. Rev. 2020. [Google Scholar] [CrossRef]
- Doyle, L.; Brady, A.M.; Byrne, G. An overview of mixed methods research. J. Res. Nurs. 2009, 14, 175. [Google Scholar] [CrossRef]
- King, N. Using Templates in the Thematic Analysis of Text. In Essential Guide to Qualitative Methods in Organizational Research; SAGE Publications: Thousand Oaks, CA, USA, 2014; pp. 256–270. [Google Scholar]
- Rayner, C.; Lokugamage, A.U.; Molokhia, M. COVID-19: Prolonged and Relapsing Course of Illness has Implications for Returning Workers. Available online: https://blogs.bmj.com/bmj/2020/06/23/covid-19-prolonged-and-relapsing-course-of-illness-has-implications-for-returning-workers/ (accessed on 7 July 2022).
- Vaes, A.; Goertz, Y.M.J.; Van Herck, M.; Machado, F.V.C.; Meys, R.; Delbressine, J.M.; Houben-Wilke, S.; Gaffron, S.; Maier, D.; Burtin, C.; et al. Recovery from COVID-19: A sprint or marathon? 6-month follow-up data from online long COVID-19 support group members. Eur. Respir. J. 2021, 7, 00141-2021. [Google Scholar] [CrossRef]
- Sivan, M.; Wright, S.; Calvertt, M. Using condition specific patient reported outcome measures for long covid. BMJ 2022, 376, o257. [Google Scholar] [CrossRef]
- Hutchings, R.; Sherlaw-Johnson, C. Supporting Patient Engagement with Digital Health Innovations. Lessons for the Care City Test Bed. 2022. Available online: https://www.nuffieldtrust.org.uk/research/supporting-patient-engagement-with-digital-health-care-innovations-lessons-from-the-care-city-test-bed (accessed on 7 July 2022).
- Rehab Program Gives Hope to ‘Long COVID’ Sufferers|CBC News. Available online: https://www.cbc.ca (accessed on 19 July 2022).
- Whitehouse, C.L.; Tinkler, L.; Jackson, C.; Hall, H.; Webster, J.; Hardy, S.; Copping, J.; Morris, P.; Manley, K. Embedding Research (ER) led by nurses, midwives and allied health professionals (NMAHP’s): The NMAHP model. BMJ Lead. 2021. [Google Scholar] [CrossRef]
- Saving and Improving Lives: The Future of UK Clinical Research Delivery-GOV.UK. Available online: https://www.gov.uk (accessed on 19 July 2022).
Session | Topic | Lead Facilitator |
---|---|---|
1 | Understanding LC | Medical Doctor, Occupational Therapist, Physiotherapist (Clinical co-ordinators) |
2 | Fatigue Management Part 1 | Occupational Therapist |
3 | Causes of Breathlessness | Physiotherapist |
4 | Sleep and Relaxation | Occupational Therapist |
5 | Mental Wellbeing | CBT Therapist, Occupational Therapist. |
6 | Diet | Dietician |
7 | Exercises and Activity | Physiotherapist |
8 | Fatigue Management Part 2 | Occupational Therapist |
9 | Breathing Retraining | Physiotherapist |
10 | Progressing Exercise and Activity | Physiotherapist |
Demographic Data | N = 38 |
---|---|
Gender | F 26 (68.42%) |
M 12 (31.57%) | |
Age (years) | 25–34 5 (16%) |
35–44 7 (19%) | |
45–54 9 (22%) | |
55–64 8 (19%) | |
65–74 6 (13%) | |
Not Known 3 (11%) | |
Ethnicity | White: 31 (78.94%) |
Asian Indian: 3 (7.89%) | |
Asian Pakistani: 2 (5.26%) | |
Black African: 1 (2.63%) | |
Mixed White and Black Caribbean: 1 (2.63%) | |
Duration of LC symptoms | 3–6 months 0 |
6–12 months 0 | |
12–18months 20 | |
18–24 months 18 |
Theme | Recommendation |
---|---|
1. Attendance and Accessibility |
|
2. Content |
|
3. Use of Digital Technology |
|
4. Group Dynamics |
|
5. Individual Dynamics |
|
6. Self-management |
|
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Flannery, T.; Brady-Sawant, H.; Tarrant, R.; Davison, J.; Shardha, J.; Halpin, S.; Sivan, M.; Ross, D. A Mixed-Methods Evaluation of a Virtual Rehabilitation Program for Self-Management in Post-COVID-19 Syndrome (Long COVID). Int. J. Environ. Res. Public Health 2022, 19, 12680. https://doi.org/10.3390/ijerph191912680
Flannery T, Brady-Sawant H, Tarrant R, Davison J, Shardha J, Halpin S, Sivan M, Ross D. A Mixed-Methods Evaluation of a Virtual Rehabilitation Program for Self-Management in Post-COVID-19 Syndrome (Long COVID). International Journal of Environmental Research and Public Health. 2022; 19(19):12680. https://doi.org/10.3390/ijerph191912680
Chicago/Turabian StyleFlannery, Thuvia, Hannah Brady-Sawant, Rachel Tarrant, Jennifer Davison, Jenna Shardha, Stephen Halpin, Manoj Sivan, and Denise Ross. 2022. "A Mixed-Methods Evaluation of a Virtual Rehabilitation Program for Self-Management in Post-COVID-19 Syndrome (Long COVID)" International Journal of Environmental Research and Public Health 19, no. 19: 12680. https://doi.org/10.3390/ijerph191912680