Long COVID rehabilitation: A collaborative approach to managing a new phenomenon

Abstract

Purpose: Post COVID Syndrome (Long COVID) is the continuation of symptoms related to a COVID-like-illness after 12 weeks post onset (NICE Guidelines December 2020). Most recent ONS prevalence data (April 2021) predicts that as many as 1 in 7 people, 13.7% of 20,000, have symptoms lasting more than 12 weeks, with a significant impact on daily function, employment and quality of life. The aim of this project was to evaluate a new collaborative service, designed to meet the needs of this complex patient group. Methods: In Oxfordshire, there were no specific services available to support and rehabilitate patients with Long COVID, despite the growing number of patients experiencing a multitude of complex symptoms including breathlessness, fatigue, and anxiety. Given the range of primary symptoms, a holistic and multidisciplinary approach to managing the cohort was paramount. Medical and Allied Health Professionals from already established and existing services joined forces to develop a rehabilitation strategy that would put patients at its centre. With the additional funding released by NHSE for Post COVID Assessment Clinics, a full collaboration began to evolve with the local CCG, acute and community trusts, named the Oxfordshire Post COVID Service. It was anticipated that this collaborative approach would enable us to provide a seamless approach to care. Results: At time of writing, 434 patients had been referred to the Rehabilitation pathway of the Oxfordshire Post COVID Service, of whom 250 assessed and established on rehabilitation strategies. Patients referred are triaged by both leading Acute Trust Consultant and Community Trust AHP to identify the best place of care based on symptoms and functionality, utilising the Post COVID Functional Scale. At assessment, patients share their ‘story’, establish goals and identify most appropriate rehabilitative strategy. Clinicians involved in these processes include Respiratory and Rehabilitation Medicine Consultants, Psychiatrists, Psychologists, CBT Therapists, Physiotherapists and Occupational Therapists. Processes are in place to offer patients an individualised approach to rehabilitation through the use of web based platform, symptom tracking application, development of virtual groups and encouraging use of external resources including ENO Breathe, Your COVID Recovery, NHS Yoga Platforms and we have linked locally with Age UK and Generation Games initiatives. Patient feedback has been actively sought from the outset, ensuring that the patient voice is always heard and listened to. So far, it has been overwhelmingly positive. Conclusion(s): Close collaboration between multiple professions, Trusts and Organisations resulted in seamless care, patient satisfaction and an excellent model of service delivery. Further work is required to support the recognition of health inequalities, with specific focus on BAME communities. We are in the process of collaborating with local GP's, inequality leads and local centres to develop focus groups ensuring that these voices are heard, and plans established to ensure equitable services are accessible to all. Impact: COVID has enabled us to break down barriers, both real and perceived, to establish a successful and recognised service that can be used as a model of service delivery to demonstrate how other conditions could be, and potentially should be, managed in the future.