British Thoracic Society survey of rehabilitation to support recovery of the post-COVID-19 population

  1. Sally J Singh
  2. Amy C Barradell
  3. Neil J Greening
  4. Charlotte Bolton
  5. Gisli Jenkins
  6. Louise Preston
  7. John R Hurst

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Abstract

A proportion of those recovering from COVID-19 are likely to have significant and ongoing symptoms, functional impairment and psychological disturbances. There is an immediate need to develop a safe and efficient discharge process and recovery programme. Established rehabilitation programmes are well placed to deliver a programme for this group but will most likely need to be adapted for the post-COVID-19 population. The purpose of this survey was to rapidly identify the components of a post-COVID-19 rehabilitation assessment and elements of a successful rehabilitation programme that would be required to deliver a comprehensive service for those post-COVID-19 to inform service delivery.

Design

A survey comprising a series of closed questions and a free-text comment box allowing for a qualitative analysis.

Setting

Online survey.

Participants

Multiprofessional clinicians across specialties were invited to take part.

Results

1031 participants responded from a broad range of specialties. There was overwhelming support for an early posthospital discharge recovery programme to advise patients about the management of fatigue (95% agreed/strongly agreed), breathlessness (94%) and mood disturbances (including symptoms of anxiety and depression, 92%). At the time point of 6–8 weeks, an assessment was considered important, focusing on a broad range of possible symptoms and supporting a return to work. Recommendations for the intervention described a holistic programme focusing on symptom management, return of function and return to employment. The free-text comments added depth to the survey and the need ‘not to reinvent the wheel’ but rather adapt well-established rehabilitation services to individually tailor needs-based care with continued learning for service development.

Conclusion

The responses indicate a huge interest and the urgent need to establish a programme to support and mitigate the long-term impact of COVID-19 by optimising and individualising existing rehabilitation programmes.

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  1. Version published to 10.1136/bmjopen-2020-040213
  2. ScreenIT

    SciScore for 10.1101/2020.05.07.20094151: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Completion of the survey was an indication of willingness to participate and implied consent.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A limitation is that it did not consider the views of patients and the public; this is currently being undertaken by the British Lung Foundation[23]. These two surveys taken together should support guidance on the provision of rehabilitation services for the post Covid-19 patient. It would seem that there is a real opportunity to develop a structured multidisciplinary rehabilitation programme that addresses the complex needs of the post Covid-19 population, alongside conventional pulmonary rehabilitation population. This would include those who had a period on ICU. The provision of post ICU rehabilitation although recommended[24] is poorly provided[25]. A legacy of this pandemic is the potential to raise the provision of post ICU care by integrating with established pulmonary rehabilitation services. However, it is important that capacity development is supported, as to not compromise the service for those who routinely access these programmes. However, the more immediate challenge is to deliver a recovery pathway for those individuals who are being discharged now and for all those who have been discharged over the last few weeks with a diagnosis of Covid-19. We should use this survey data to inform service delivery and work collaboratively across specialties and professions to deliver a comprehensive recovery package for the Covid-19 population. Whilst of course retaining the high quality of service delivered to the usual case load of individuals with chronic respiratory dis...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.05.07.20094151v1 on medRxiv