Development, deployment and evaluation of a digitally enabled rehabilitation programme for patients with long Covid

Problem

Large numbers of patients are suffering from distressing and disabling symptoms for many months after being infected with Covid. There is a large variety of long term symptoms but the majority of patients suffer from fatigue, breathlessness, cognitive impairment and anxiety. NHS is creating new long covid clinic to help treat this large cohort of patients but faces challenges over large patient numbers and lack of available staff.

Approach

We built on previous experience of providing efficient, effective, personalised support to large numbers of patients, using User-Centred Design (UCD) principles to adapt and iteratively refine an existing platform. The digital intervention includes an App for patients which collects Patient Reported Outcome Measures (PROMS), provides information, support and treatments and allows 2-way messaging between patients and their clinicians. There is a digital dashboard for clinicians which displays the PROMS data, allowing rapid, efficient review of large numbers of patients. nitial content focused on fatigue, deconditioning and breathing pattern disorders, however, as other long-term sequelae emerged, we added content around anxiety, depression, brain fog and nutrition. Our agile UCD approach allows for rapid iterative development cycles, with changes to content, navigation and usability in line with user feedback.

A clinical pathway directs patients who are safe and suitable for rehab to an MDT assessment where treatment goals are agreed and patients onboarded onto the App. They are reviewed weekly by a physio, using the dashboard.

Findings

DHI is implemented in the Camden, Barts hospital and Hampshire and Isle of Wight / Solent (6 clinics). In the first six months, 99 patients, with demographics as above, have been registered on the App. Of these >60% use the App regularly, with engagement probably outperforming that of face-to-face clinics. Looking at those patients who have been on the App for at least one week, patients undertake a mean average 7.0 actions per week covering recording weight, completing a patient reported outcome measure (PROM) such as questionnaires, tracking exercise and/or fatigue diary. On average each patient has read eleven articles with approximately half of patients creating and tracking goals.

Consequences

Over 150 Patients now onboarded across all the clinics and In the process of being implemented in Barnet, Enfield, Islington, Homerton, and North East London Foundation Trust, Oxford, Kent and Medway