Technology supported rehabilitation for patients of critical illness caused by COVID-19: a protocol for a mixed-methods feasibility study

Gonçalves, Ana-Carolina; Leckie, Todd; Hunter, Alex; Fitzpatrick, Daniel; Richardson, Alan; Hardy, Benjamin; Venn, Richard; Hodgson, Luke

doi:10.12968/ijtr.2020.0102

Cited by 7 publications

(6 citation statements)

References 19 publications

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“…During the first wave of the COVID‐19 pandemic (March–May 2020), five acute general hospitals in the South‐East of England initiated a research study to observe the process of recovery of people who survived critical illness due to COVID‐19, up to 1 year following hospital discharge. As part of this larger study, 23 we conducted in‐depth qualitative interviews with three groups of stakeholders: survivors, informal carers and health care professionals, across the five hospital sites included in the study. Their narratives explored experiences of critical illness in the early days of the pandemic and the first three months of their rehabilitation.…”

Section: Design and Methodsmentioning

confidence: 99%

“…Participants from the three stakeholder groups were recruited between May and July of 2020. Detailed inclusion and exclusion criteria can be found in the study protocol 23 …”

Section: Design and Methodsmentioning

confidence: 99%

“…Detailed inclusion and exclusion criteria can be found in the study protocol. 23 Health professionals were recruited in all hospital sites through the participant information sheet being shared with team leads of…”

Section: Sampling and Recruitmentmentioning

confidence: 99%

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Surviving severe COVID‐19: Interviews with patients, informal carers and health professionals

Gonçalves

Williams

Leckie³

et al. 2022

Nursing in Critical Care

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Background The COVID‐19 pandemic has been associated with an unprecedented number of critical care survivors. Their experiences through illness and recovery are likely to be complex, but little is known about how best to support them. This study aimed to explore experiences of illness and recovery from the perspective of survivors, their relatives and professionals involved in their care. Study design In‐depth qualitative interviews were conducted with three stakeholder groups during the first wave of the pandemic. A total of 23 participants (12 professionals, 6 survivors and 5 relatives) were recruited from 5 acute hospitals in England and interviewed by telephone or video call. Data analysis followed the principles of Reflexive Thematic Analysis. Findings Three themes were generated from their interview data: (1) Deteriorating fast—a downhill journey from symptom onset to critical care; (2) Facing a new virus in a hospital—a remote place; and (3) Returning home as a survivor, maintaining normality and recovering slowly. Conclusions Our findings highlight challenges in accessing care and communication between patients, hospital staff and relatives. Following hospital discharge, patients adopted a reframed ‘survivor identity’ to cope with their experience of illness and slow recovery process. The concept of survivorship in this patient group may be beneficial to promote and explore further. Relevance to clinical practice All efforts should be made to continue to improve communication between patients, relatives and health professionals during critical care admissions, particularly while hospital visits are restricted. Adapting to life after critical illness may be more challenging while health services are restricted by the impacts of the pandemic. It may be beneficial to promote the concept of survivorship, following admission to critical care due to severe COVID‐19.

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Section: Design and Methodsmentioning

confidence: 99%

“…Participants from the three stakeholder groups were recruited between May and July of 2020. Detailed inclusion and exclusion criteria can be found in the study protocol 23 …”

Section: Design and Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Surviving severe COVID‐19: Interviews with patients, informal carers and health professionals

Gonçalves

Williams

Leckie³

et al. 2022

Nursing in Critical Care

Self Cite

View full text Add to dashboard Cite

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“…We conducted a prospective, multicenter observational trial in UK critical care units. The original protocol for this study was published previously [ 28 ].…”

Section: Methodsmentioning

confidence: 99%

Using Smartwatches to Observe Changes in Activity During Recovery From Critical Illness Following COVID-19 Critical Care Admission: 1-Year, Multicenter Observational Study

Hunter

Leckie

Coe

et al. 2022

JMIR Rehabil Assist Technol

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Background As a sequela of the COVID-19 pandemic, a large cohort of critical illness survivors have had to recover in the context of ongoing societal restrictions. Objective We aimed to use smartwatches (Fitbit Charge 3; Fitbit LLC) to assess changes in the step counts and heart rates of critical care survivors following hospital admission with COVID-19, use these devices within a remote multidisciplinary team (MDT) setting to support patient recovery, and report on our experiences with this. Methods We conducted a prospective, multicenter observational trial in 8 UK critical care units. A total of 50 participants with moderate or severe lung injury resulting from confirmed COVID-19 were recruited at discharge from critical care and given a smartwatch (Fitbit Charge 3) between April and June 2020. The data collected included step counts and daily resting heart rates. A subgroup of the overall cohort at one site—the MDT site (n=19)—had their smartwatch data used to inform a regular MDT meeting. A patient feedback questionnaire and direct feedback from the MDT were used to report our experience. Participants who did not upload smartwatch data were excluded from analysis. Results Of the 50 participants recruited, 35 (70%) used and uploaded data from their smartwatch during the 1-year period. At the MDT site, 74% (14/19) of smartwatch users uploaded smartwatch data, whereas 68% (21/31) of smartwatch users at the control sites uploaded smartwatch data. For the overall cohort, we recorded an increase in mean step count from 4359 (SD 3488) steps per day in the first month following discharge to 7914 (SD 4146) steps per day at 1 year (P=.003). The mean resting heart rate decreased from 79 (SD 7) beats per minute in the first month to 69 (SD 4) beats per minute at 1 year following discharge (P<.001). The MDT subgroup’s mean step count increased more than that of the control group (176% increase vs 42% increase, respectively; +5474 steps vs +2181 steps, respectively; P=.04) over 1 year. Further, 71% (10/14) of smartwatch users at the MDT site and 48% (10/21) of those at the control sites strongly agreed that their Fitbit motivated them to recover, and 86% (12/14) and 48% (10/21), respectively, strongly agreed that they aimed to increase their activity levels over time. Conclusions This is the first study to use smartwatch data to report on the 1-year recovery of patients who survived a COVID-19 critical illness. This is also the first study to report on smartwatch use within a post–critical care MDT. Future work could explore the role of smartwatches as part of a randomized controlled trial to assess clinical and economic effectiveness. International Registered Report Identifier (IRRID) RR2-10.12968/ijtr.2020.0102

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“…We do not yet know which modes of delivery are most appropriate for this patient population. Innovative tele-health services are beginning to be proposed for this patient group 17,18 , and the one Health Board in our survey that reported developing a new long Covid specific service, described providing a predominantly digital service. Data on rehabilitation services in Scotland is not routinely collected, so detailed information on the numbers of referrals of people experiencing long Covid, the problems with which they were presenting, duration of rehabilitation, and specific interventions delivered was unavailable.…”

Section: Discussionmentioning

confidence: 92%

A national survey of community rehabilitation service provision for people with long Covid in Scotland

et al. 2021

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Background: Over 50 million cases of COVID-19 have been confirmed globally as of November 2020. Evidence is rapidly emerging on the epidemiology of COVID-19, and its impact on individuals and potential burden on health services and society. Between 10–35% of people with COVID-19 may experience post-acute long Covid. This currently equates to between 8,129 and 28,453 people in Scotland. Some of these people will require rehabilitation to support their recovery. Currently, we do not know how to optimally configure community rehabilitation services for people with long Covid. Methods: This national survey aimed to provide a detailed description of current community rehabilitation provision for people with long Covid in Scotland. We developed, piloted, and conducted a national electronic survey of current community rehabilitation service provision for people presenting with long Covid symptomatology. Our sample were the Allied Health Professions Directors of all 14 territorial NHS Health Boards in Scotland. Fixed response and narrative data were analysed descriptively. Results: Responses were received from all respondents (14/14), enabling a national picture to be gained. Almost all Health Boards (13/14) currently deliver rehabilitation for people with long Covid within pre-existing services. Fatigue (11/14) and respiratory conditions (9/14) were the two most common presenting problems of patients. Most long Covid community rehabilitation services are delivered through a combination of face-to-face and digital contact (13/14). Conclusions: Community rehabilitation for people with long Covid is an emerging reality. This survey provides a national picture of current community rehabilitation for people with long Covid. We do not know how community rehabilitation can be optimally delivered for this population. This is vital as community rehabilitation services were already under pressure prior to the emergence of COVID-19. Further research is urgently required to investigate the implementation, outcomes and cost-effectiveness of differing models of community rehabilitation for this patient population.

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Technology supported rehabilitation for patients of critical illness caused by COVID-19: a protocol for a mixed-methods feasibility study

Cited by 7 publications

References 19 publications

Surviving severe COVID‐19: Interviews with patients, informal carers and health professionals

Surviving severe COVID‐19: Interviews with patients, informal carers and health professionals

Using Smartwatches to Observe Changes in Activity During Recovery From Critical Illness Following COVID-19 Critical Care Admission: 1-Year, Multicenter Observational Study

A national survey of community rehabilitation service provision for people with long Covid in Scotland

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