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A review of an innovative digital group therapy breathing & energy management programme designed to reduce symptoms of Long COVID.

Purpose

The purpose of this programme was to implement a service for patients suffering with symptoms of Long COVID (symptoms for longer than 12 weeks post COVID). 

The two most common symptoms of Long COVID are breathlessness and fatigue1. Two physiotherapists who are committee members of the special interest groups Breathing Pattern Disorders (BPD) and ‘Physio for ME’ ( fatigue management) collaborated with RespiriCare (independent company consisting of specialist respiratory physiotherapists) and 3 patients suffering with Long COVID to create a live, virtual 6-week breathing & energy management programme.

The home-based educational programme encourages good quality rest, energy management, sleep management, re-establishing efficient breathing and optimal nutrition and hydration which are essential for the recovery from COVID2.

71%
(n=74) patients had a clinically significant improvement in at least 1 of the SR-CRDQ domains (breathlessness, emotion, fatigue and mastery).
42%
(n=44) patients had a clinically significant improvement in anxiety or depression.


Patient feedback was extremely positive...
...“This course has been amazing for me - the information provided was spot on and level of knowledge and understanding from the team was unreal”

50%
(n=53) had a clinically significant improvement in FSS.

Approach

The Post-Covid Respiratory Rehabilitation Service was developed in response to the respiratory rehabilitation needs of patients post covid. The service model was developed by RespiriCare and agreed through the Greenwich & Bexley Respiratory Network, including Respiratory Consultants, Specialist Respiratory Nurses, Specialist Respiratory Nurses and Physiotherapists from the Community Respiratory Teams, GP Clinical Leads and RespiriCare. 

Referrals were received from both primary and secondary care. The inclusion criteria were patients that had suffered with SARS-CoV-2 infection (hospitalised and non-hospitalised) and were continuing to suffer with symptoms of fatigue and/or breathlessness 12 weeks post infection and had been medically screened and optimised

Digital qualitative questionnaires were completed pre and post programme and patient feedback was sought to establish the benefits of the programme. Questionnaires were emailed to the patient one week prior to assessment ensuring symptoms of cognitive fatigue were not exacerbated.

A live, virtual one to one assessment was then conducted by the specialist respiratory physiotherapist to assess suitability for the programme and to provide a platform for the patient to explain the complexity of their symptoms whilst being in the safe environment of their home.  The virtual delivery enabled the service to continue despite there being a COVID lockdown in place.

The programme consisted of six group educational sessions led by a specialist respiratory physiotherapist & a fatigue specialist physiotherapist. Sessions focused on breathing pattern retraining and establishing a good energy management balance. One session was led by a psychological well-being practitioner to facilitate access to the local psychological therapy teams (Bexley MIND & Greenwich Time to Talk) . 

A digital one to one follow up re-assessment was completed to establish changes from baseline measurements and to identify any ongoing management needs. Patients were referred onto services such as local IAPT (improving access to psychological therapy team), pulmonary rehabilitation or self-management.

Outcomes

105 patients were enrolled between Jan 2021 and June 2021, aged 21-81, 73 female, 32 male, 83 White British, 22 Black/Asian/Other ethnicity.

Baseline data showed 75% (n=79) had a breathing pattern disorder (Breathing Pattern Assessment Tool Score> 4.) 66% (n=69) had signs of hyperventilation (Nijmegen score > 23) and 70% (n=74) were suffering with severe fatigue (Fatigue Severity Scale (FSS) > 5).

 

Outcome measures included the Self-Reported Chronic Respiratory Disease Questionnaire (SR -CRDQ). General Anxiety Disorder 7 (GAD7), Patient Health Questionnaire (PHQ9) and Fatigue Severity Scale (FSS).

 

  • 71% (n=74) patients had a clinically significant improvement in at least 1 of the SR-CRDQ domains (breathlessness, emotion, fatigue and mastery).
  • 50% (n=53) had a clinically significant improvement in FSS.
  • 42% (n=44) patients had a clinically significant improvement in anxiety or depression.

 

Patient feedback was extremely positive. Some patient quotes:

 

“This course has been amazing for me - the information provided was spot on and level of knowledge and understanding from the team was unreal”

 

“Thank you so much for this course. It taught me loads. I had absolutely no idea how to breathe properly and what an effect that has on our bodies! Also being "heard" and to feel connected with other people that are going through similar difficulties was extremely helpful and reassuring. The team are friendly and lovely people with a wealth of knowledge and I am very grateful for what I have learned from them”

 

“The course was extremely relevant and met my needs in more ways than imagine”

Cost and savings

A small pilot project was run using existing funding allocated for Pulmonary Rehabilitation services. Following the success of the pilot, funding was made available for 30 patients per Borough in January 2021. With ongoing regular contact including the feedback of clinical activity and patient outcomes to the Bexley & Greenwich Respiratory Network, further money was made available via Covid Wave 2 Funding, enabling the service to continue.

 

Potential savings & other benefits:

  • Appropriate signposting of patients to onward services – IAPT, pulmonary rehabilitation, musculoskeletal physiotherapy, and community physiotherapy
  • Appropriate signposting to assessment services to exclude alternative causes for symptoms e.g., cardiology for further assessment of orthostatic intolerance
  • Reduction in long term morbidity through the education of a healthy lifestyle
  • Improving return to work status – getting people back out into the workplace and contributing to society
  • Improved working relationship between mental health and physical health NHS teams

Implications

The implication of this innovative service shows that a physiotherapy led live, virtual 6-week, educational breathing and energy management programme was beneficial for patients suffering with Long COVID from the safety of their own home.

Continued investigation and further research is required to evaluate the effectiveness of breathing retraining and energy management for patients suffering with Long COVID.       

Top three learning points

  1. Physiotherapists have the tools to help patients recover from Long COVID through a digital platform.
  2. Breathing well & good energy management are essential for the recovery from long COVID.
  3. It is beneficial to work closely with the mental health care team to provide holistic rehabilitation programmes to meet the needs of Long COVID sufferers.

Additional notes

Two abstracts have been accepted for the Primary Care Respiratory Society (PCRS) conference and British Thoracic Society (BTS) conference.

 

For further information about this work please contact Julie Moore.

 

References:

  1. P.M. George et al. Respiratory follow-up of patients with COVID-19 pneumonia. Thorax 2020. 
  2. Updated NICE guidance on chronic fatigue syndrome. BMJ 2020.