Enhancing COVID Rehabilitation with Technology (ECORT): protocol for an open-label, single-site randomized controlled trial evaluating the effectiveness of electronic case management for individuals with persistent COVID-19 symptoms

Abstract

Background As of May 2022, Ontario has seen more than 1.3 million cases of COVID-19. While the majority of individuals will recover from infection within 4 weeks, a significant subset experience persistent and often debilitating symptoms, known as “post-COVID syndrome” or “Long COVID.” Those with Long COVID experience a wide array of symptoms, with variable severity, including fatigue, cognitive impairment, and shortness of breath. Further, the prevalence and duration of Long COVID is not clear, nor is there evidence on the best course of rehabilitation for individuals to return to their desired level of function. Previous work with chronic conditions has suggested that the addition of electronic case management (ECM) may help to improve outcomes. These platforms provide enhanced connection with care providers, detailed symptom tracking and goal setting, and access to relevant resources. In this study, our primary aim is to determine if the addition of ECM with health coaching improves Long COVID outcomes at 3 months compared to health coaching alone. Methods The trial is an open-label, single-site, randomized controlled trial of ECM with health coaching (ECM+) compared to health coaching alone (HC). Both groups will continue to receive usual care. Participants will be randomized equally to receive health coaching (± ECM) for a period of 8 weeks and a 12-week follow-up. Our primary outcome is the WHO Disability Assessment Scale (WHODAS), 36-item self-report total score. Participants will also complete measures of cognition, fatigue, breathlessness, and mental health. Participants and care providers will be asked to complete a brief qualitative interview at the end of the study to evaluate acceptability and implementation of the intervention. Discussion There is currently little evidence about the optimal treatment of Long COVID patients or the use of digital health platforms in this population. The results of this trial could result in rapid, scalable, and personalized care for people with Long COVID which will decrease morbidity after an acute infection. Results from this study will also inform decision making in Long COVID and treatment guidelines at provincial and national levels. Trial registration ClinicalTrials.gov NCT05019963. Registered on 25 August 2021.

Coordination of Care for long COVID-19 Patients: A Scoping Review

“…In fact, according to clinical studies, rehabilitation is effective in reducing the fatigue associated with long COVID-19 [43]. It is suggested that different rehabilitation programs be developed depending on patients' needs and available resources [33]. A multidisciplinary approach to rehabilitation is suggested.…”

“…Numerous studies also highlight the importance of adopting a care organization for long COVID patients that promotes coordination between healthcare professionals working successively in primary, secondary, and tertiary care [18,33,35]. For example, the GP is the rst point of contact for long COVID patients.…”

“…Incorporating E-Health into the Coordination of Patient Care for long COVID-19 Some studies on of care for long COVID patients have focused on the impact of digital innovations and technologies in the care of these patients [31,33,34,43]. To facilitate care coordination, for example, it is suggested that digital health platforms, such as electronic case management, be incorporated into patient management to facilitate communication, symptom tracking, goal setting and monitoring, and access to specialist resources [33]. It is also advisable to include digital health interventions for remote monitoring [43].…”

Interventions for mental health, cognition, and psychological wellbeing in long COVID: a systematic review of registered trials

“…Eleven trials are examining psychological interventions: five selfmanagement programs (Blázquez, 2022;Busse & Potter, 2022;Chantal, Hiyam, & Karen, 2021;Collette, Willems, Cabello, & Lesoinne, 2022;Culos-Reed & Twomey, 2021;Martin & Lynall, 2022), three cognitive-behavioral therapy interventions (Acartürk & Öztürk, 2021;Håkansson, Hartman, & Cronhjort, 2021;Martin & Lynall, 2022) (one with components of acceptance and commitment therapy and one using peer support), two meditation interventions (Croghan, Hurt, Fokken, & Currie, 2022;Subramaniam, 2021), one psychoeducational intervention (Collette et al, 2022), and one case-management intervention (Hatcher, Ward, & Edgar, 2021). Components of multidisciplinary care are present in several; for example, a cognitive-behavioral therapy intervention includes stretching exercises (Acartürk & Öztürk, 2021), while other interventions include psychoeducation across cognition, diet, breathing, and other spheres of life (Blázquez, 2022;Busse & Potter, 2022;Culos-Reed & Twomey, 2021;Martin & Lynall, 2022).…”

“…clinical distress or a positive screen for clinical depression or anxiety (Acartürk & Öztürk, 2021;Håkansson et al, 2021), another includes cognitive impairment as an inclusion criterion (Collette et al, 2022), and one lists quality-of-life impairments as a requirement to participate (Hatcher et al, 2021). Six trials exclude individuals with severe or acute mental illness, or a history of mental illness (Acartürk & Öztürk, 2021;Blázquez, 2022;Collette et al, 2022;Croghan et al, 2022;Håkansson et al, 2021;Subramaniam, 2021), and two exclude individuals with substance use disorders (Acartürk & Öztürk, 2021;Collette et al, 2022); severe cognitive deficits are an exclusion criterion for three trials (Collette et al, 2022;Hatcher et al, 2021;Håkansson et al, 2021). (Melamed, Collins, & Palm, 2021), and atorvastatin (Anderson & Carcel, 2021).…”