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Geng LN, Bonilla H, Hedlin H, Jacobson KB, Tian L, Jagannathan P, Yang PC, Subramanian AK, Liang JW, Shen S, Deng Y, Shaw BJ, Botzheim B, Desai M, Pathak D, Jazayeri Y, Thai D, O’Donnell A, Mohaptra S, Leang Z, Reynolds GZM, Brooks EF, Bhatt AS, Shafer RW, Miglis MG, Quach T, Tiwari A, Banerjee A, Lopez RN, De Jesus M, Charnas LR, Utz PJ, Singh U. Nirmatrelvir-Ritonavir and Symptoms in Adults With Postacute Sequelae of SARS-CoV-2 Infection: The STOP-PASC Randomized Clinical Trial. JAMA Intern Med 2024; 184:1024-1034. [PMID: 38848477 PMCID: PMC11161857 DOI: 10.1001/jamainternmed.2024.2007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/30/2024] [Indexed: 06/09/2024]
Abstract
Importance There is an urgent need to identify treatments for postacute sequelae of SARS-CoV-2 infection (PASC). Objective To assess the efficacy of a 15-day course of nirmatrelvir-ritonavir in reducing the severity of select PASC symptoms. Design, Setting, and Participants This was a 15-week blinded, placebo-controlled, randomized clinical trial conducted from November 2022 to September 2023 at Stanford University (California). The participants were adults with moderate to severe PASC symptoms of 3 months or longer duration. Interventions Participants were randomized 2:1 to treatment with oral nirmatrelvir-ritonavir (NMV/r, 300 mg and 100 mg) or with placebo-ritonavir (PBO/r) twice daily for 15 days. Main Outcomes and Measures Primary outcome was a pooled severity of 6 PASC symptoms (fatigue, brain fog, shortness of breath, body aches, gastrointestinal symptoms, and cardiovascular symptoms) based on a Likert scale score at 10 weeks. Secondary outcomes included symptom severity at different time points, symptom burden and relief, patient global measures, Patient-Reported Outcomes Measurement Information System (PROMIS) measures, orthostatic vital signs, and sit-to-stand test change from baseline. Results Of the 155 participants (median [IQR] age, 43 [34-54] years; 92 [59%] females), 102 were randomized to the NMV/r group and 53 to the PBO/r group. Nearly all participants (n = 153) had received the primary series for COVID-19 vaccination. Mean (SD) time between index SARS-CoV-2 infection and randomization was 17.5 (9.1) months. There was no statistically significant difference in the model-derived severity outcome pooled across the 6 core symptoms at 10 weeks between the NMV/r and PBO/r groups. No statistically significant between-group differences were found at 10 weeks in the Patient Global Impression of Severity or Patient Global Impression of Change scores, summative symptom scores, and change from baseline to 10 weeks in PROMIS fatigue, dyspnea, cognitive function, and physical function measures. Adverse event rates were similar in NMV/r and PBO/r groups and mostly of low grade. Conclusions and Relevance The results of this randomized clinical trial showed that a 15-day course of NMV/r in a population of patients with PASC was generally safe but did not demonstrate a significant benefit for improving select PASC symptoms in a mostly vaccinated cohort with protracted symptom duration. Further studies are needed to determine the role of antivirals in the treatment of PASC. Trial Registration ClinicalTrials.gov Identifier: NCT05576662.
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Affiliation(s)
- Linda N. Geng
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Hector Bonilla
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Haley Hedlin
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Karen B. Jacobson
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- Kaiser Permanente Northern California Division of Research, Oakland
| | - Lu Tian
- Department of Biomedical Data Science, Stanford School of Medicine, Stanford, California
| | - Prasanna Jagannathan
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Phillip C. Yang
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Aruna K. Subramanian
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jane W. Liang
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Sa Shen
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Yaowei Deng
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Blake J. Shaw
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Bren Botzheim
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Manisha Desai
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Divya Pathak
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Yasmin Jazayeri
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Daniel Thai
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Andrew O’Donnell
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Sukanya Mohaptra
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Zenita Leang
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | | | - Erin F. Brooks
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Ami S. Bhatt
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Robert W. Shafer
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Mitchell G. Miglis
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California
| | - Tom Quach
- Stanford University, Stanford, California
| | | | - Anindita Banerjee
- Pfizer Research and Development, Pfizer Inc, Cambridge, Massachusetts
| | - Rene N. Lopez
- Clinical Research Collaborations COE, Worldwide Medical and Safety, Pfizer Inc, Groton, Connecticut
| | - Magdia De Jesus
- Strategic Planning, Worldwide Medical and Safety, Pfizer Inc, New York, New York
| | - Lawrence R. Charnas
- Clinical Research Collaborations COE, Worldwide Medical and Safety, Pfizer Inc, Groton, Connecticut
| | - Paul J. Utz
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, California
| | - Upinder Singh
- Department of Medicine, Stanford University School of Medicine, Stanford, California
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, California
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Al-Aly Z, Davis H, McCorkell L, Soares L, Wulf-Hanson S, Iwasaki A, Topol EJ. Long COVID science, research and policy. Nat Med 2024; 30:2148-2164. [PMID: 39122965 DOI: 10.1038/s41591-024-03173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 07/02/2024] [Indexed: 08/12/2024]
Abstract
Long COVID represents the constellation of post-acute and long-term health effects caused by SARS-CoV-2 infection; it is a complex, multisystem disorder that can affect nearly every organ system and can be severely disabling. The cumulative global incidence of long COVID is around 400 million individuals, which is estimated to have an annual economic impact of approximately $1 trillion-equivalent to about 1% of the global economy. Several mechanistic pathways are implicated in long COVID, including viral persistence, immune dysregulation, mitochondrial dysfunction, complement dysregulation, endothelial inflammation and microbiome dysbiosis. Long COVID can have devastating impacts on individual lives and, due to its complexity and prevalence, it also has major ramifications for health systems and economies, even threatening progress toward achieving the Sustainable Development Goals. Addressing the challenge of long COVID requires an ambitious and coordinated-but so far absent-global research and policy response strategy. In this interdisciplinary review, we provide a synthesis of the state of scientific evidence on long COVID, assess the impacts of long COVID on human health, health systems, the economy and global health metrics, and provide a forward-looking research and policy roadmap.
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Affiliation(s)
- Ziyad Al-Aly
- VA St. Louis Health Care System, Saint Louis, MO, USA.
- Washington University in St. Louis, Saint Louis, MO, USA.
| | - Hannah Davis
- Patient-led Research Collaborative, Calabasas, CA, USA
| | | | | | | | - Akiko Iwasaki
- Yale University, New Haven, CT, USA
- Howard Hughes Medical Institute, Chevy Chase, MD, USA
| | - Eric J Topol
- Scripps Institute, San Diego, California, CA, USA
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Davenport TE, Blitshteyn S, Clague-Baker N, Davies-Payne D, Treisman GJ, Tyson SF. Long COVID Is Not a Functional Neurologic Disorder. J Pers Med 2024; 14:799. [PMID: 39201991 PMCID: PMC11355889 DOI: 10.3390/jpm14080799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 09/03/2024] Open
Abstract
Long COVID is a common sequela of SARS-CoV-2 infection. Data from numerous scientific studies indicate that long COVID involves a complex interaction between pathophysiological processes. Long COVID may involve the development of new diagnosable health conditions and exacerbation of pre-existing health conditions. However, despite this rapidly accumulating body of evidence regarding the pathobiology of long COVID, psychogenic and functional interpretations of the illness presentation continue to be endorsed by some healthcare professionals, creating confusion and inappropriate diagnostic and therapeutic pathways for people living with long COVID. The purpose of this perspective is to present a clinical and scientific rationale for why long COVID should not be considered as a functional neurologic disorder. It will begin by discussing the parallel historical development of pathobiological and psychosomatic/sociogenic diagnostic constructs arising from a common root in neurasthenia, which has resulted in the collective understandings of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and functional neurologic disorder (FND), respectively. We will also review the case definition criteria for FND and the distinguishing clinical and neuroimaging findings in FND vs. long COVID. We conclude that considering long COVID as FND is inappropriate based on differentiating pathophysiologic mechanisms and distinguishing clinical findings.
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Affiliation(s)
- Todd E. Davenport
- Department of Physical Therapy, University of the Pacific, Stockton, CA 95211, USA
- Workwell Foundation, Santa Rosa, CA 95403, USA
| | - Svetlana Blitshteyn
- Department of Neurology, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY 14203, USA
- Dysautonomia Clinic, Williamsville, NY 14221, USA
| | - Nicola Clague-Baker
- School of Allied Health Professions and Nursing, Institute of Population Health, University of Liverpool, Liverpool L69 7ZX, UK
| | - David Davies-Payne
- Department of Radiology, Starship Children’s Hospital, Auckland 1023, New Zealand
| | - Glenn J. Treisman
- Department of Psychiatry, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA;
| | - Sarah F. Tyson
- School of Health Sciences, University of Manchester, Manchester M14 4PX, UK;
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O'Brien KK, McDuff K, Chattu VK, Churchill K, Colantonio A, Davenport TE, Gross DP, Jaglal S, Kho M, Leighton J, Premnazeer M, Rendely A, Scali O, Skoretz S, Wasilewski M, Cameron JI. A framework of research priorities in COVID rehabilitation from the Rehabilitation Science Research Network for COVID: an international consultation involving qualitative and quantitative research. Disabil Rehabil 2024:1-10. [PMID: 39049529 DOI: 10.1080/09638288.2024.2382904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE To identify research priorities related to COVID rehabilitation from the perspectives of persons with lived experiences, clinicians, researchers, community organization and policy representatives. MATERIALS & METHODS We conducted five international consultations to identify key issues and research priorities in COVID rehabilitation using (i) web-based questionnaires, (ii) synchronous discussions, and (iii) content analysis of COVID rehabilitation research conference presentations. We collated responses and notes and then analyzed data using content analytical techniques. RESULTS The Framework of Research Priorities in COVID Rehabilitation includes five priorities that span health and disability across COVID-19 and Long COVID illness trajectories: (1) understanding experiences of episodic disability; (2) assessing episodic disability; (3) identifying and examining safe approaches to rehabilitation; (4) examining the role, implementation, and impact of models of rehabilitation care; and (5) examining access to safe, timely and appropriate rehabilitation and other health care provider services. The Framework identifies target populations, methodological considerations, and highlights the importance of integrated knowledge translation and exchange in advancing scientific evidence, clinical education, practice, and COVID rehabilitation policy. CONCLUSIONS This Framework provides a foundation to advance COVID, disability and rehabilitation research to advance the health and well-being of persons with COVID-19, Long COVID, and their caregivers.Implications for rehabilitationPersons with COVID-19 or Long COVID and their caregivers may experience multi-dimensional forms of disability spanning physical, cognitive, emotional health challenges, difficulties with daily function, and social inclusion, which individually and/or collectively may be unpredictable, episodic and/or chronic in nature.Rehabilitation has a role in preventing or mitigating disability and enhancing health outcomes for persons with COVID-19, Long COVID and their caregivers.The Framework of Research Priorities COVID Rehabilitation includes five overlapping research priorities spanning health and disability across COVID trajectories: (1) understanding experiences of episodic disability; (2) assessing episodic disability; (3) identifying and examining safe approaches to rehabilitation; (4) examining the role, implementation, and impact of models of rehabilitation care; and (5) examining access to safe, timely and appropriate rehabilitation and other health care provider services.The research priorities in the Framework represent a comprehensive approach to examine disability and rehabilitation across COVID illness trajectories and the broad continuums of rehabilitation care to provide a coordinated and collaborative approach to advancing evidence in COVID disability and rehabilitation.This Framework provides a foundation for international and interdisciplinary collaborations, to advance COVID disability and rehabilitation research to enhance health outcomes of persons with COVID-19, Long COVID, and their caregivers.
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Affiliation(s)
- Kelly K O'Brien
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kiera McDuff
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vijay Kumar Chattu
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Katie Churchill
- Rehabilitative Care Alliance, Ottawa, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Angela Colantonio
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Rehab Institute, University Health Network, Toronto, ON, Canada
| | - Todd E Davenport
- Department of Physical Therapy, School of Health Sciences, University of the Pacific, Stockton, CA, USA
| | - Douglas P Gross
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Susan Jaglal
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Michelle Kho
- School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Jaylyn Leighton
- St. John's Rehab Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Meera Premnazeer
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Alexandra Rendely
- Toronto Rehab Institute, University Health Network, Toronto, ON, Canada
| | - Orianna Scali
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Stacey Skoretz
- School of Audiology & Speech Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Marina Wasilewski
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Jill I Cameron
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Kabir MF, Nyein Yin K, Htwe O, Saffree Jeffree M, Binti Ahmedy F, Faizal Zainudin M, Jahan S, Hossain MZ, Hossain KMA, Islam MW, Hossain T. Symptom response and episodic disability of long COVID in people with spinal cord injury: A case-control study. PLoS One 2024; 19:e0304824. [PMID: 38941308 PMCID: PMC11213303 DOI: 10.1371/journal.pone.0304824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/18/2024] [Indexed: 06/30/2024] Open
Abstract
BACKGROUND Spinal cord injury (SCI) is a consequence of significant disability and health issues globally, and long COVID represents the symptoms of neuro-musculoskeletal, cardiovascular and respiratory complications. PURPOSE This study aimed to identify the symptom responses and disease burden of long COVID in individuals with spinal cord injury. METHODS This case-control study was conducted on patients with SCI residing at a specialised rehabilitation centre in Bangladesh. Forty patients with SCI with and without long COVID symptoms (LCS) were enrolled in this study at a 1:1 ratio according to WHO criteria. RESULT Twelve LCS were observed in patients with SCI, including fatigue, musculoskeletal pain, memory loss, headache, respiratory problems, anxiety, depression, insomnia, problem in ADL problem in work, palpitation, and weakness. The predictors of developing long COVID include increasing age (p<0.002), increasing BMI (p<0.03), and longer duration of spinal cord injury (p<0.004). A significant difference (p<0.01) in overall years of healthy life lost due to disability (YLD) for non-long COVID cases was 2.04±0.596 compared to long COVID (LC) cases 1.22±2.09 was observed. CONCLUSION Bangladeshi patients of SCI presented 12 long COVID symptoms and have a significant disease burden compared to non long COVID cases.
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Affiliation(s)
- Md. Feroz Kabir
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology (JUST), Jashore, Bangladesh
| | - Khin Nyein Yin
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Ohnmar Htwe
- Faculty of Medicine, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohammad Saffree Jeffree
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | - Fatimah Binti Ahmedy
- Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia
| | | | - Sharmila Jahan
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology (JUST), Jashore, Bangladesh
| | - Md. Zahid Hossain
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology (JUST), Jashore, Bangladesh
| | - K. M. Amran Hossain
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology (JUST), Jashore, Bangladesh
| | - Md. Waliul Islam
- Department of Physiotherapy, Centre for the Rehabilitation of the Paralysed (CRP), Savar, Dhaka, Bangladesh
| | - Tofajjal Hossain
- Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology (JUST), Jashore, Bangladesh
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Caldas B, Portela M, Stelson E, Singer S, Amaral T, Amaral C, Escosteguy C, Martins M, de Andrade CLT, Soares L, Cornish F, Rosenthal M, Aveling EL. Promoting equity, diversity, and inclusion in surveys: insights from a patient-engaged study to assess long COVID health-care needs in Brazil. J Clin Epidemiol 2024; 173:111423. [PMID: 38880435 DOI: 10.1016/j.jclinepi.2024.111423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/01/2024] [Accepted: 06/09/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND AND OBJECTIVE Long COVID (LC) refers to persistent symptoms after acute COVID-19 infection, which may persist for months or years. LC affects millions of people globally, with substantial impacts on quality of life, employment, and social participation. Ensuring access to effective, patient-centered care for LC demands evidence, grounded in inclusive representation of those affected by the condition. Yet survey studies frequently under-represent people with the most disabling disease presentations and racially and socioeconomically marginalized groups. We aimed to describe a patient-engaged approach to developing a survey to inform public LC health care and to assess its implementation in terms of enabling participation by diverse LC patients in Brazil. METHODS Survey development was iterative, achieved through an interdisciplinary collaboration among researchers including people living with LC, and grounded in 3 guiding principles: (1) evidence-based; (2) inclusive, intersectional, and patient-centered understanding of chronic illness and research participation; and (3) sensitivity to the context of health-care access. RESULTS The product of our collaboration was a longitudinal survey using a questionnaire assessing: LC symptoms; their clinical and functional evolution; and impacts on quality of life, household income, health service access, utilization, and out-of-pocket expenses. We illustrate how we operationalized our 3 principles through survey content, instrument design, and administration. Six hundred fifty-one participants with diverse LC symptoms, demography, and socioeconomic status completed the survey. We successfully included participants experiencing disabling symptoms, Black and mixed race participants, and those with lower education and income. CONCLUSION By centering patient experience, our novel, principles-based approach succeeded in promoting equity, diversity, and inclusion in LC survey research. These principles guiding patient-engaged collaboration have broad transferability. We encourage survey researchers working on chronic illness and in other contexts of marginalization and inequality to adopt them.
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Affiliation(s)
- Bárbara Caldas
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
| | - Margareth Portela
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Elisabeth Stelson
- Patient-Led Research Collaborative, Calabasas, CA, USA; Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sara Singer
- Department of Health Policy, School of Medicine, Stanford University, Stanford, CA, USA
| | - Thatiana Amaral
- Center for Health Sciences and Sports, Universidade Federal do Acre (UFAC), Rio Branco, Brazil
| | - Cledir Amaral
- Instituto Federal do Acre (IFAC), Rio Branco, Brazil
| | - Claudia Escosteguy
- Epidemiology Service, Hospital Federal dos Servidores do Estado, Rio de Janeiro, Brazil
| | - Mônica Martins
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Carla Lourenço Tavares de Andrade
- Department of Health Administration and Planning, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Flora Cornish
- Department of Methodology, London School of Economics and Political Science, London, UK
| | - Meredith Rosenthal
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Emma-Louise Aveling
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, MA, USA
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Jones F, Domeny A, Fish J, Leggat F, Patel I, McRae J, Rowe C, Busse ME. Using co-design methods to develop new personalised support for people living with Long Covid: The 'LISTEN' intervention. Health Expect 2024; 27:e14093. [PMID: 38783782 PMCID: PMC11116943 DOI: 10.1111/hex.14093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/12/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Many Covid-19 survivors are living with unresolved, relapsing and remitting symptoms and no 'one size' of treatment is likely to be effective for everyone. Supported self-management for the varied symptoms of Long Covid (LC) is recommended by the National Institute for Health and Care Excellence in the United Kingdom. We aimed to develop a new personalised support intervention for people living with LC using a structured co-design framework to guide replication and evaluation. METHODS We used the improvement methodology, Experience-Based Co-Design, in an accelerated form to harness the collective experiences of people with LC. Incorporating evidence from 'Bridges Self-Management' (Bridges) an approach in which healthcare professionals (HCPs)are trained to support knowledge, confidence and skills of individuals living with long term conditions. Co-designed resources are also central to Bridges. Adults who self-identified as living with or recovered from LC, from England or Wales, aged 18 years and over were recruited, and HCPs, with experience of supporting people with LC. Participants took part in a series of small co-design group meetings and larger mixed meetings to agree priorities, core principles and generate resources and intervention content. RESULTS People with LC (n = 28), and HCPs (n = 9) supported co-design of a book (hard-copy and digital form) to be used in 1:1 support sessions with a trained HCP. Co-design stages prioritised stories about physical symptoms first, and psychological and social challenges which followed, nonlinear journeys and reconceptualising stability as progress, rich descriptions of strategies and links to reputable advice and support for navigating healthcare services. Co-design enabled formulation of eight core intervention principles which underpinned the training and language used by HCPs and fidelity assessments. CONCLUSION We have developed a new personalised support intervention, with core principles to be used in one-to-one sessions delivered by trained HCPs, with a new co-designed book as a prompt to build personalised strategies and plans using narratives, ideas, and solutions from other people with LC. Effectiveness and cost effectiveness of the 'LISTEN' intervention will be evaluated in a randomised controlled trial set within the context of the updated Framework for Developing and Evaluating Complex Interventions. PATIENT AND PUBLIC CONTRIBUTION The LISTEN Public and Patient Involvement (PPI) group comprised seven people living with LC. They all contributed to the design of this study and five members were part of a larger co-design community described in this paper. They have contributed to this paper by interpreting stages of intervention design and analysis of results. Three members of our PPI group are co-authors of this paper.
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Affiliation(s)
- Fiona Jones
- Population Health Research InstituteSt George's University of LondonLondonUK
- Bridges Self‐ManagementLondonUK
| | - Anne Domeny
- Bridges Self‐ManagementLondonUK
- LISTEN Lived Experience Advisory GroupLondonUK
| | - Jessica Fish
- Department of Clinical Neuropsychology and Clinical Health PsychologySt George's University Hospitals NHS Foundation TrustLondonUK
- Mental Health and Wellbeing, School of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Fiona Leggat
- Population Health Research InstituteSt George's University of LondonLondonUK
| | - Ian Patel
- LISTEN Lived Experience Advisory GroupLondonUK
| | - Jackie McRae
- Centre for Allied Health, Institute for Medical, Biomedical and Allied EducationSt George's University of LondonLondonUK
| | - Carol Rowe
- LISTEN Lived Experience Advisory GroupLondonUK
| | - Monica E. Busse
- Centre For Trials Research, School of MedicineCardiff UniversityCardiffWalesUK
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Henderson AD, Butler-Cole BFC, Tazare J, Tomlinson LA, Marks M, Jit M, Briggs A, Lin LY, Carlile O, Bates C, Parry J, Bacon SCJ, Dillingham I, Dennison WA, Costello RE, Wei Y, Walker AJ, Hulme W, Goldacre B, Mehrkar A, MacKenna B, Herrett E, Eggo RM. Clinical coding of long COVID in primary care 2020-2023 in a cohort of 19 million adults: an OpenSAFELY analysis. EClinicalMedicine 2024; 72:102638. [PMID: 38800803 PMCID: PMC11127160 DOI: 10.1016/j.eclinm.2024.102638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/10/2024] [Accepted: 04/29/2024] [Indexed: 05/29/2024] Open
Abstract
Background Long COVID is the patient-coined term for the persistent symptoms of COVID-19 illness for weeks, months or years following the acute infection. There is a large burden of long COVID globally from self-reported data, but the epidemiology, causes and treatments remain poorly understood. Primary care is used to help identify and treat patients with long COVID and therefore Electronic Health Records (EHRs) of past COVID-19 patients could be used to help fill these knowledge gaps. We aimed to describe the incidence and differences in demographic and clinical characteristics in recorded long COVID in primary care records in England. Methods With the approval of NHS England we used routine clinical data from over 19 million adults in England linked to SARS-COV-2 test result, hospitalisation and vaccination data to describe trends in the recording of 16 clinical codes related to long COVID between November 2020 and January 2023. Using OpenSAFELY, we calculated rates per 100,000 person-years and plotted how these changed over time. We compared crude and adjusted (for age, sex, 9 NHS regions of England, and the dominant variant circulating) rates of recorded long COVID in patient records between different key demographic and vaccination characteristics using negative binomial models. Findings We identified a total of 55,465 people recorded to have long COVID over the study period, which included 20,025 diagnoses codes and 35,440 codes for further assessment. The incidence of new long COVID records increased steadily over 2021, and declined over 2022. The overall rate per 100,000 person-years was 177.5 cases in women (95% CI: 175.5-179) and 100.5 in men (99.5-102). The majority of those with a long COVID record did not have a recorded positive SARS-COV-2 test 12 or more weeks before the long COVID record. Interpretation In this descriptive study, EHR recorded long COVID was very low between 2020 and 2023, and incident records of long COVID declined over 2022. Using EHR diagnostic or referral codes unfortunately has major limitations in identifying and ascertaining true cases and timing of long COVID. Funding This research was supported by the National Institute for Health and Care Research (NIHR) (OpenPROMPT: COV-LT2-0073).
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Affiliation(s)
| | - Ben FC. Butler-Cole
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - John Tazare
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Laurie A. Tomlinson
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Michael Marks
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Mark Jit
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Andrew Briggs
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Liang-Yu Lin
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Oliver Carlile
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Chris Bates
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds LS18 5PX, UK
| | - John Parry
- TPP, TPP House, 129 Low Lane, Horsforth, Leeds LS18 5PX, UK
| | - Sebastian CJ. Bacon
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Iain Dillingham
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | | | - Ruth E. Costello
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Yinghui Wei
- Centre for Mathematical Sciences, School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth, UK
| | - Alex J. Walker
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - William Hulme
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Ben Goldacre
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Amir Mehrkar
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Brian MacKenna
- Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, OX2 6GG, UK
| | - Emily Herrett
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Rosalind M. Eggo
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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9
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Palacios-Ceña D, Bautista-Villaécija O, Güeita-Rodríguez J, García-Bravo C, Pérez-Corrales J, Del Corral T, López-de-Uralde-Villanueva I, Fabero-Garrido R, Plaza-Manzano G. Supervised Telerehabilitation and Home-Based Respiratory Muscle Training for Post-COVID-19 Condition Symptoms: A Nested Qualitative Study Exploring the Perspectives of Participants in a Randomized Controlled Trial. Phys Ther 2024; 104:pzae043. [PMID: 38507659 DOI: 10.1093/ptj/pzae043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/18/2023] [Accepted: 02/14/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The purpose of this study was to describe the experiences of individuals with post-coronavirus 19 (COVID-19) condition symptoms who underwent a supervised telerehabilitation and home-based respiratory muscle training (TSHB-RMT) program. METHODS A qualitative descriptive study was conducted. Participants were recruited using purposeful sampling. The inclusion criteria consisted of: patients aged over 18 years who presented persistent COVID-19 symptoms of fatigue and dyspnea for at least 3 months after the COVID-19 diagnosis. In total, 28 patients were included. In-depth interviews and researcher field notes were used to collect the data. A thematic analysis was performed. RESULTS Three themes reflect the patients' perspective on the TSHB-RMT before the program (reasons for participating), during the treatment program, and upon completion of the study. Among the reasons for participation, participants highlighted the absence of improvement and treatment, and feeling abandoned and forgotten by the health system. The treatment required discipline on behalf of the patients. Mondays and Tuesdays were the most difficult days for performing the therapy, and the physical therapist was perceived as a tool for adherence, change, and a source of validated information. The patients perceived positive effects quite soon; however, it was necessary to extend the follow-up after completing the program because they abandoned the program due to the lack of guidance for exercise supervision. CONCLUSION This study described relevant aspects that physical therapist professionals should consider when providing TSHB-RMT treatment. IMPACT TSHB-RMT requires discipline, perseverance, effort, and a commitment to the group. The physical therapist is perceived as the tool that facilitates adherence and participation. The effects are rapidly perceived, leading to improved self-confidence and autonomy; however, it is necessary to increase the follow-up time.
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Affiliation(s)
- Domingo Palacios-Ceña
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Comunidad Autónoma de Madrid (Alcorcón), Spain
| | - Oscar Bautista-Villaécija
- Nursing Department, Sant Joan de Deus, Universitat de Barcelona, Generalitat de Cataluña (Barcelona), Spain
| | - Javier Güeita-Rodríguez
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Comunidad Autónoma de Madrid (Alcorcón), Spain
| | - Cristina García-Bravo
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Comunidad Autónoma de Madrid (Alcorcón), Spain
| | - Jorge Pérez-Corrales
- Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos, Comunidad Autónoma de Madrid (Alcorcón), Spain
| | - Tamara Del Corral
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid (UCM), Comunidad Autónoma de Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ibai López-de-Uralde-Villanueva
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid (UCM), Comunidad Autónoma de Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Raúl Fabero-Garrido
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid (UCM), Comunidad Autónoma de Madrid, Spain
| | - Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid (UCM), Comunidad Autónoma de Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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10
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Harrison M, Rhodes T, Lancaster K. Constitution of Long COVID illness, patienthood and recovery: a critical synthesis of qualitative studies. BMJ Open 2024; 14:e083340. [PMID: 38548364 PMCID: PMC10982801 DOI: 10.1136/bmjopen-2023-083340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/18/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVES To investigate the lived experiences of Long COVID. DESIGN Critical interpretive synthesis of qualitative research. DATA SOURCES PubMed and Web of Science databases were searched on 14 September 2023. ELIGIBILITY CRITERIA Original peer-reviewed qualitative studies describing the experiences of Long COVID were eligible for inclusion. DATA EXTRACTION AND SYNTHESIS We used established qualitative synthesis methods to search, screen and manually code the included studies. Critical interpretation methods were used to analyse the data and develop synthetic constructs. RESULTS 68 articles were identified in the first phase of sampling, with 16 studies and 879 participants included in the final synthesis. The analysis of these studies was organised into three thematic constructions of Long COVID: (1) the illness, (2) the patient and (3) recovery. Long COVID was diversely characterised across study approaches, designs and findings but was underpinned by shared diagnostic logics, which shaped the identification and measurement of symptoms. The boundaries between different constitutions of Long COVID in qualitative accounts of illness experience were often imprecise. Slippages between different definitions of Long COVID had implications for patient experiences in relation to diagnosis, help-seeking and care, and expectations of recovery. CONCLUSIONS Long COVID is a site of multiple and diverse qualitative interpretation. Accounts of lived experience emphasise the constitutions of illness, patienthood and recovery as situated and emergent. The ongoing context-based negotiation of Long COVID is a defining qualitative feature of the condition. Approaches to researching, diagnosing and developing health interventions must be as adaptive as the varieties of Long COVID lived experience.
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Affiliation(s)
- Mia Harrison
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Tim Rhodes
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
- London School of Hygiene & Tropical Medicine, London, UK
| | - Kari Lancaster
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
- Goldsmiths, University of London, London, UK
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11
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Sivan M, Smith AB, Osborne T, Goodwin M, Lawrence RR, Baley S, Williams P, Lee C, Davies H, Balasundaram K, Greenwood DC. Long COVID Clinical Severity Types Based on Symptoms and Functional Disability: A Longitudinal Evaluation. J Clin Med 2024; 13:1908. [PMID: 38610673 PMCID: PMC11012375 DOI: 10.3390/jcm13071908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 03/19/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Long COVID (LC) is a multisystem clinical syndrome with functional disability and compromised overall health. Information on LC clinical severity types is emerging in cross-sectional studies. This study explored the pattern and consistency of long COVID (LC) clinical severity types over time in a prospective sample. Methods: Participants with LC completed the condition-specific outcome measure C19-YRSm (Yorkshire Rehabilitation Scale modified version) at two assessment time points. A cluster analysis for clinical severity types was undertaken at both time points using the k-means partition method. Results: The study included cross-sectional data for 759 patients with a mean age of 46.8 years (SD = 12.7), 69.4% females, and a duration of symptoms of 360 days (IQR 217 to 703 days). The cluster analysis at first assessment revealed three distinct clinical severity type clusters: mild (n = 96), moderate (n = 422), and severe (n = 241). Longitudinal data on 356 patients revealed that the pattern of three clinical severity types remained consistent over time between the two assessments, with 51% of patients switching clinical severity types between the assessments. Conclusions: This study is the first of its kind to demonstrate that the pattern of three clinical severity types is consistent over time, with patients also switching between severity types, indicating the fluctuating nature of LC.
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Affiliation(s)
- Manoj Sivan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (T.O.); (M.G.); (R.R.L.)
- COVID Rehabilitation Service, Leeds Community Healthcare NHS Trust, Leeds LS11 0DL, UK
- National Demonstration Centre of Rehabilitation Medicine, Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
| | - Adam B. Smith
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (A.B.S.); (D.C.G.)
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9JT, UK
| | - Thomas Osborne
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (T.O.); (M.G.); (R.R.L.)
| | - Madeline Goodwin
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (T.O.); (M.G.); (R.R.L.)
| | - Román Rocha Lawrence
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK; (T.O.); (M.G.); (R.R.L.)
- ELAROS 24/7 Digital Company, Sheffield S1 2BJ, UK
| | - Sareeta Baley
- Birmingham Community Healthcare NHS Trust, Birmingham B7 4BN, UK;
| | - Paul Williams
- Hertfordshire Community NHS Trust, Welwyn AL6 9PW, UK;
| | - Cassie Lee
- Imperial College Healthcare NHS Trust, London W2 1NY, UK;
| | - Helen Davies
- Cardiff and Vale University Hospitals NHS Trust, Cardiff CF14 4XW, UK;
| | - Kumaran Balasundaram
- NIHR Leicester Biomedical Research Centre—Respiratory & Infection Theme, Glenfield Hospital, Leicester LE3 9QP, UK;
| | - Darren C. Greenwood
- School of Medicine, University of Leeds, Leeds LS2 9JT, UK; (A.B.S.); (D.C.G.)
- Leeds Institute for Data Analytics, University of Leeds, Leeds LS2 9JT, UK
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12
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Leggat FJ, Heaton-Shrestha C, Fish J, Siriwardena AN, Domeney A, Rowe C, Patel I, Parsons J, Blair J, Jones F. An exploration of the experiences and self-generated strategies used when navigating everyday life with Long Covid. BMC Public Health 2024; 24:789. [PMID: 38481230 PMCID: PMC10938753 DOI: 10.1186/s12889-024-18267-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Around one in ten people who contract Covid-19 report ongoing symptoms or 'Long Covid'. Without any known interventions to cure the condition, forms of self-management are routinely prescribed by healthcare professionals and described by people with the condition. However, there is limited research exploring what strategies are used to navigate everyday life with Long Covid, and experiences that initiate development of these strategies. Our study aimed to explore the range and influence of self-generated strategies used by people with Long Covid to navigate everyday life within the context of their own condition. METHODS Forming part of the Long Covid Personalised Self-managemenT support co-design and EvaluatioN (LISTEN) project, we conducted a qualitative study using narrative interviews with adults who were not hospitalised with Covid-19. Participants aged over 18 years, who self-identified with Long Covid, were recruited from England and Wales. Data were analysed with patient contributors using a reflexive thematic analysis. RESULTS Eighteen participants (mean age = 44 years, SD = 13 years) took part in interviews held between December 2021 and February 2022. Themes were constructed which depicted 1) the landscape behind the Long Covid experience and 2) the everyday experience of participants' Long Covid. The everyday experience comprised a combination of physical, emotional, and social factors, forming three sub-themes: centrality of physical symptoms, navigating 'experts' and the 'true colour' of personal communities, and a rollercoaster of psychological ambiguity). The third theme, personal strategies to manage everyday life was constructed from participants' unique presentations and self-generated solutions to manage everyday life. This comprised five sub-themes: seeking reassurance and knowledge, developing greater self-awareness through monitoring, trial and error of 'safe' ideas, building in pleasure and comfort, and prioritising 'me'. CONCLUSIONS Among this sample of adults with Long Covid, their experiences highlighted the unpredictable nature of the condition but also the use of creative and wide ranging self-generated strategies. The results offer people with Long Covid, and healthcare professionals supporting them, an overview of the collective evidence relating to individuals' self-management which can enable ways to live 'better' and regain some sense of identity whilst facing the impact of a debilitating, episodic condition. TRIAL REGISTRATION LISTEN ISRCTN36407216.
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Affiliation(s)
- Fiona J Leggat
- Population Health Research Institute, St George's, University of London, London, England, UK
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University, London, England, UK
| | - Celayne Heaton-Shrestha
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University, London, England, UK
| | - Jessica Fish
- Department of Clinical Neuropsychology & Clinical Health Psychology, St George's University Hospitals NHS Foundation Trust, London, England, UK
- Mental Health & Wellbeing, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | | | - Anne Domeney
- LISTEN Lived Experience Advisory Group, London, UK
- Bridges Self-Management, London, England, UK
| | - Carol Rowe
- LISTEN Lived Experience Advisory Group, London, UK
| | - Ian Patel
- LISTEN Lived Experience Advisory Group, London, UK
| | | | - John Blair
- LISTEN Lived Experience Advisory Group, London, UK
| | - Fiona Jones
- Population Health Research Institute, St George's, University of London, London, England, UK.
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University, London, England, UK.
- Bridges Self-Management, London, England, UK.
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13
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Von Nordheim D, Johnson M, Caburnay C, Alleman S, Kreuter M, McQueen A. Describing the Lived Experience and Resource Needs of Individuals With Long COVID. Health Promot Pract 2024:15248399241228823. [PMID: 38361434 DOI: 10.1177/15248399241228823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Individuals with long COVID report diverse symptoms lasting weeks or months after initial infection, causing significant psychosocial distress. Navigating health care interactions are often difficult for these individuals due to the diffuse nature of their symptoms, a lack of effective treatment options, and skepticism from some providers. To better understand these challenges, this study sought to further describe the lived experience of individuals with long COVID. A survey was conducted with individuals evaluated for long COVID at a specialty clinic (n = 200), which included questions about prior conditions, symptoms, use of medical and support services, and information and resource needs. Participants reported a mean of 10.75 persistent symptoms, the most common being fatigue and difficulty concentrating, with broad effects on daily functioning. Participants saw a mean of 5.92 providers for treatment of their symptoms, and 88.5% identified health care providers as a trusted source of information. Interest in research findings (60.5%) and opportunities for participation (47.5%) were moderate and varied by COVID vaccination status. Unvaccinated individuals (n = 27) also reported less trust in government sources of information, less college education, lower household income, and greater likelihood of having public insurance. Our findings suggest that individuals with long COVID experience many ongoing and complex symptoms with diverse effects on daily living; that health care providers are an important source for public health messaging about long COVID; and that unvaccinated individuals are likely to have differing needs and receptiveness to information than vaccinated individuals with long COVID.
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Affiliation(s)
| | | | | | - Sarah Alleman
- Washington University in St. Louis, St. Louis, MO, USA
| | | | - Amy McQueen
- Washington University in St. Louis, St. Louis, MO, USA
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14
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Barnhill J, Chilcoat A, Kavalakatt B, Mata R, Tiedt M, Roth I. Different but the Same: Common Themes in Illness Experience Among People With Diverse Long COVID Symptoms and the Potential Benefits of Virtual Group Medical Visits. J Patient Exp 2024; 11:23743735241230144. [PMID: 38357361 PMCID: PMC10865942 DOI: 10.1177/23743735241230144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Long coronavirus disease 2019 (COVID-19) is poorly understood, widespread and debilitating. Integrative medical group visits (IMGVs) provide group medical care virtually or in person and are reimbursed by insurance payors. IMGV introduces integrative modalities such as mindfulness, nutrition, and acupressure in a person-centered, supportive, and educational environment. To evaluate a telehealth IMGV program called Nourish to Flourish (N2F) for patients with long COVID, three researchers conducted a qualitative analysis of pre- and post-group individual interviews. Twenty-five patients provided interviews, of which fifteen included pre- and post-group individual interviews. Main themes were unpredictable symptom patterns, a common range of emotions associated with long COVID experience, reconceptualizing self-identity, multiple barriers to care in conventional settings, and connections formed in N2F. Although symptoms varied, N2F participants found commonalities in their experiences of living with long COVID. They empathized with one another regarding changing symptoms, inconsistent social support, shifting identities, and barriers to effective medical care.
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Affiliation(s)
- Jessica Barnhill
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aisha Chilcoat
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Raveena Mata
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Malik Tiedt
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Isabel Roth
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Hung P, Brehon K, Miciak M, Brown DA, Bostick G, Brown C, Churchill K, Hall M, Hoddinott L, Hudon A, Hunter S, Perreault K, Wieler M, Skolnik K, Lam GY, Weatherald J, Gross DP. "I Had to Know About It, I Had to Find It, I Had to Know How to Access it": Experiences of Access to Rehabilitation Services Among People Living with Long COVID. Physiother Can 2024; 76:8-24. [PMID: 38465303 PMCID: PMC10919370 DOI: 10.3138/ptc-2023-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/11/2023] [Accepted: 10/02/2023] [Indexed: 03/12/2024]
Abstract
Purpose The aim of this qualitative study is to understand the need for, access to, and quality of rehabilitation services for people living with Long COVID. Little is known about the experiences of people living with Long COVID accessing rehabilitation services. Therefore, we explored health concerns leading people living with Long COVID to seek help to address functional concerns and their experiences with accessing and participating in rehabilitation. Method Interpretive description guided exploration of participants' experiences with Long COVID rehabilitation in Alberta, Canada. Semi-structured interviews were completed with 56 participants recruited from: three publicly funded Long COVID clinics, a specialized private physiotherapy clinic, a telephone-based rehabilitation advice line, and a Workers' Compensation Board-funded Long COVID rehabilitation program. Recruitment through mass media coverage allowed us to include people who did not access rehabilitation services. Data analysis was informed by Braun and Clarke's reflexive thematic analysis. Results Four themes were identified: (1) the burden of searching for guidance to address challenges with functioning and disability; (2) supportive relationships promote engagement in rehabilitation; (3) conditions for participation in safe rehabilitation; and (4) looking forward - provision of appropriate interventions at the right time. Conclusions Our findings highlight the experiences of accessing rehabilitation services for people living with Long COVID. Results suggest approaches to Long COVID rehabilitation should be accessible, multi-disciplinary, flexible, and person-centred.
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Affiliation(s)
- Pam Hung
- From the:
Rehabilitation Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Katelyn Brehon
- From the:
Rehabilitation Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Maxi Miciak
- From the:
Rehabilitation Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Darren A. Brown
- Chelsea and Westminster Hospital NHS Foundation Trust, London, England, United Kingdom of Great Britain and Northern Ireland
| | - Geoffrey Bostick
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Cary Brown
- Department of Occupational Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Katie Churchill
- University Health Network – Rehabilitative Care Alliance, Toronto, Ontario, Canada
| | - Mark Hall
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | | | - Anne Hudon
- School of Rehabilitation, Faculty of Medicine, Université de Montreal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), and CIUSSS du Centre-Sud-de-Montréal Quebec, Canada
| | | | - Kadija Perreault
- École des Sciences de la Réadaptation, Faculté de Médecine, Université Laval and Centre for interdisciplinary research in rehabilitation and social integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec, Canada
| | - Marguerite Wieler
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Kate Skolnik
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Grace Y. Lam
- Faculty of Medicine & Dentistry – Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jason Weatherald
- Faculty of Medicine & Dentistry – Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas P. Gross
- From the:
Rehabilitation Research Centre, University of Alberta, Edmonton, Alberta, Canada
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
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16
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Gómez-Moyano E, Rodríguez-Capitán J, Gaitán Román D, Reyes Bueno JA, Villalobos Sánchez A, Espíldora Hernández F, González Angulo GE, Molina Mora MJ, Thurnhofer-Hemsi K, Molina-Ramos AI, Romero-Cuevas M, Jiménez-Navarro M, Pavón-Morón FJ. Postural orthostatic tachycardia syndrome and other related dysautonomic disorders after SARS-CoV-2 infection and after COVID-19 messenger RNA vaccination. Front Neurol 2023; 14:1221518. [PMID: 37654428 PMCID: PMC10467287 DOI: 10.3389/fneur.2023.1221518] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/21/2023] [Indexed: 09/02/2023] Open
Abstract
The COVID-19 pandemic has caused a challenge for our society due to the post-acute sequelae of the disease. Persistent symptoms and long-term multiorgan complications, known as post-acute COVID-19 syndrome, can occur beyond 4 weeks from the onset of the COVID-19 infection. Postural orthostatic tachycardia syndrome (POTS) is considered a variety of dysautonomia, which is characterized by chronic symptoms that occur with standing and a sustained increase in heart rate, without orthostatic hypotension. POTS can lead to debilitating symptoms, significant disability, and impaired quality of life. In this narrative review, the etiopathogenic basis, epidemiology, clinical manifestations, diagnosis, treatment, prognosis, and socioeconomic impact of POTS, as well as other related dysautonomic disorders, after COVID-19 infection and SARS-CoV-2 postvaccination, were discussed. After a search conducted in March 2023, a total of 89 relevant articles were selected from the PubMed, Google Scholar, and Web of Science databases. The review highlights the importance of recognizing and managing POTS after COVID-19 infection and vaccination, and the approach to autonomic disorders should be known by all specialists in different medical areas. The diagnosis of POTS requires a comprehensive clinical assessment, including a detailed medical history, physical examination, orthostatic vital signs, and autonomic function tests. The treatment of POTS after COVID-19 infection or vaccination is mainly focused on lifestyle modifications, such as increased fluid and salt intake, exercise, and graduated compression stockings. Pharmacotherapy, such as beta-blockers, fludrocortisone, midodrine, and ivabradine, may also be used in selected cases. Further research is needed to understand the underlying mechanisms, risk factors, and optimal treatment strategies for this complication.
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Affiliation(s)
| | - Jorge Rodríguez-Capitán
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), IBIMA-Plataforma BIONAND, Universidad de Málaga, Málaga, Spain
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Daniel Gaitán Román
- Department of Cardiology, Hospital Regional Universitario de Málaga, Málaga, Spain
| | | | | | | | | | | | - Karl Thurnhofer-Hemsi
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), IBIMA-Plataforma BIONAND, Universidad de Málaga, Málaga, Spain
- Department of Computer Languages and Computer Sciences, University of Malaga, Málaga, Spain
| | - Ana Isabel Molina-Ramos
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), IBIMA-Plataforma BIONAND, Universidad de Málaga, Málaga, Spain
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Miguel Romero-Cuevas
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), IBIMA-Plataforma BIONAND, Universidad de Málaga, Málaga, Spain
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Manuel Jiménez-Navarro
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), IBIMA-Plataforma BIONAND, Universidad de Málaga, Málaga, Spain
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
- Department of Medicine and Dermatology, University of Malaga, Málaga, Spain
| | - Francisco Javier Pavón-Morón
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), IBIMA-Plataforma BIONAND, Universidad de Málaga, Málaga, Spain
- Department of Cardiology, Hospital Universitario Virgen de la Victoria, Málaga, Spain
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17
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Gottlieb M, Spatz ES, Yu H, Wisk LE, Elmore JG, Gentile NL, Hill M, Huebinger RM, Idris AH, Kean ER, Koo K, Li SX, McDonald S, Montoy JCC, Nichol G, O’Laughlin KN, Plumb ID, Rising KL, Santangelo M, Saydah S, Wang RC, Venkatesh A, Stephens KA, Weinstein RA. Long COVID Clinical Phenotypes up to 6 Months After Infection Identified by Latent Class Analysis of Self-Reported Symptoms. Open Forum Infect Dis 2023; 10:ofad277. [PMID: 37426952 PMCID: PMC10327879 DOI: 10.1093/ofid/ofad277] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 05/15/2023] [Indexed: 07/11/2023] Open
Abstract
Background The prevalence, incidence, and interrelationships of persistent symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection vary. There are limited data on specific phenotypes of persistent symptoms. Using latent class analysis (LCA) modeling, we sought to identify whether specific phenotypes of COVID-19 were present 3 months and 6 months post-infection. Methods This was a multicenter study of symptomatic adults tested for SARS-CoV-2 with prospectively collected data on general symptoms and fatigue-related symptoms up to 6 months postdiagnosis. Using LCA, we identified symptomatically homogenous groups among COVID-positive and COVID-negative participants at each time period for both general and fatigue-related symptoms. Results Among 5963 baseline participants (4504 COVID-positive and 1459 COVID-negative), 4056 had 3-month and 2856 had 6-month data at the time of analysis. We identified 4 distinct phenotypes of post-COVID conditions (PCCs) at 3 and 6 months for both general and fatigue-related symptoms; minimal-symptom groups represented 70% of participants at 3 and 6 months. When compared with the COVID-negative cohort, COVID-positive participants had higher occurrence of loss of taste/smell and cognition problems. There was substantial class-switching over time; those in 1 symptom class at 3 months were equally likely to remain or enter a new phenotype at 6 months. Conclusions We identified distinct classes of PCC phenotypes for general and fatigue-related symptoms. Most participants had minimal or no symptoms at 3 and 6 months of follow-up. Significant proportions of participants changed symptom groups over time, suggesting that symptoms present during the acute illness may differ from prolonged symptoms and that PCCs may have a more dynamic nature than previously recognized. Clinical Trials Registration. NCT04610515.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Erica S Spatz
- Section of Cardiovascular Medicine, Yale School of Medicine,New Haven, Connecticut, USA
- Department of Epidemiology, Yale School of Public Health,New Haven, Connecticut, USA
- Yale Center for Outcomes Research and Evaluation, Yale School of Medicine,New Haven, Connecticut, USA
| | - Huihui Yu
- Section of Cardiovascular Medicine, Yale School of Medicine,New Haven, Connecticut, USA
- Yale Center for Outcomes Research and Evaluation, Yale School of Medicine,New Haven, Connecticut, USA
| | - Lauren E Wisk
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Joann G Elmore
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Nicole L Gentile
- Post-COVID Rehabilitation and Recovery Clinic, Department of Family Medicine, Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| | - Mandy Hill
- Department of Emergency Medicine, UTHealth, Houston, Texas, USA
| | | | - Ahamed H Idris
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Efrat R Kean
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Katherine Koo
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Shu-Xia Li
- Yale Center for Outcomes Research and Evaluation, Yale School of Medicine,New Haven, Connecticut, USA
| | - Samuel McDonald
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Juan Carlos C Montoy
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Graham Nichol
- Departments of Medicine and Emergency Medicine, University of Washington, Seattle, Washington, USA
| | - Kelli N O’Laughlin
- Departments of Emergency Medicine and Global Health, University of Washington, Seattle, Washington, USA
| | - Ian D Plumb
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kristin L Rising
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Center for Connected Care, Sidney Kimmel Medical School, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michelle Santangelo
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Sharon Saydah
- National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ralph C Wang
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Arjun Venkatesh
- Yale Center for Outcomes Research and Evaluation, Yale School of Medicine,New Haven, Connecticut, USA
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Kari A Stephens
- Departments of Family Medicine, Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Robert A Weinstein
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
- Department of Internal Medicine, Cook County Hospital, Chicago, Illinois, USA
- The CORE Center, Chicago, Illinois, USA
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18
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Navas-Otero A, Calvache-Mateo A, Martín-Núñez J, Calles-Plata I, Ortiz-Rubio A, Valenza MC, López LL. Characteristics of Frailty in Perimenopausal Women with Long COVID-19. Healthcare (Basel) 2023; 11:healthcare11101468. [PMID: 37239754 DOI: 10.3390/healthcare11101468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 05/28/2023] Open
Abstract
The aim of this study was to compare the prevalence of risk factors for frailty between perimenopausal women with long COVID-19 syndrome, women having successfully recovered from COVID-19, and controls from the community. Women with a diagnosis of long COVID-19 and at least one symptom related to the perimenopausal period, women who had successfully recovered from COVID-19, and healthy women of comparable age were included in this study. Symptom severity and functional disability were assessed with the COVID-19 Yorkshire Rehabilitation Scale, and the presence of frailty was evaluated considering the Fried criteria. A total of 195 women were included in the study, distributed over the three groups. The long COVID-19 group showed a higher prevalence of perimenopausal symptoms and impact of COVID-19. Statistically significant differences were found between the long COVID-19 group and the other two groups for the frailty variables. When studying the associations between frailty variables and COVID-19 symptom impact, significant positive correlations were found. Perimenopausal women with long COVID-19 syndrome present more frailty-related factors and experience a higher range of debilitating ongoing symptoms. A significant relationship is shown to exist between long COVID-19 syndrome-related disability and symptoms and frailty variables, resulting in an increased chance of presenting disability.
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Affiliation(s)
- Alba Navas-Otero
- Physical Therapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Andrés Calvache-Mateo
- Physical Therapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Javier Martín-Núñez
- Physical Therapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Irene Calles-Plata
- Physical Therapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Araceli Ortiz-Rubio
- Physical Therapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Marie Carmen Valenza
- Physical Therapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
| | - Laura López López
- Physical Therapy Department, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain
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