Tele-rehabilitation for patients who have been hospitalised with Covid-19: a mixed-methods feasibility trial protocol

Abstract

Background: Tele-rehabilitation has been proposed as a post-hospitalisation rehabilitation pathway for Covid-19 survivors, however patients’ willingness and ability to engage with this online intervention remains unknown.

Objectives: The aim of this study is to determine the feasibility of tele-rehabilitation in this population, specifically with regards to recruitment, intervention acceptability and adherence, data quality and primary outcome measure selection.

Methods: A protocol for a single centre, fast-track (wait-list), randomised mixed-methods, feasibility trial of tele-rehabilitation for patients that have been hospitalised with Covid-19 is presented. The tele-rehabilitation programme is based on pulmonary rehabilitation principles and will encompass an initial assessment followed by twice-weekly exercise classes and education sessions for 6 weeks. Six educational sessions on the topics of rehabilitation from Covid-19; coping with breathlessness; exercise; nutrition; return to work; and fatigue management will be delivered by a multi-disciplinary team of healthcare professionals. A series of feasibility, clinical and safety outcomes will be quantitively described and patient experiences and opinions explored using thematic analysis of semi-structured interviews.

Discussion: We anticipate that results from the study will inform a multi-centre randomised controlled trial for post-Covid-19 tele-rehabilitation and the results from the qualitative analysis may provide guidance to improve participant experience.

Keywords:

• Covid-19
• tele-rehabilitation
• pulmonary rehabilitation
• long-Covid
• post-Covid-19 syndrome

Disclosure statement

No potential conflict of interest was reported by the author(s).

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Additional information

Notes on contributors

Lucy Hyde

Lucy Hyde completed a BSc in Applied Exercise Science for Health in 2020 and is currently completing a Masters by Research, on the topic of telerehabilitation following hospitalisation from Covid-19, at University of Hull. This is her first publication.

Andrew J. Simpson

Dr Andrew Simpson is a Lecturer in Exercise and Respiratory Physiology the University of Hull. In 2015, Andrew was awarded a doctorate qualification, from Brunel University, for a thesis investigating the pathophysiology of exercise-induced bronchoconstriction in athletes. This topic complemented his undergraduate qualification in sport and exercise science, and his clinical experience as health advisor for BUPA and respiratory physiologist at Imperial College London. Before taking up his role at Hull, Dr Simpson completed post-doc training at the University of Manchester, investigating the role of mHealth technology in asthma self-management.

Marion Nettleton

Marion Nettleton graduated as a physiotherapist in 2006 and has worked within the Hull Teaching Hospitals NHS Trust ever since. She has over 10 years’ experience working in acute clinical settings including respiratory, medicine and oncology as well as developing the adult cystic fibrosis physiotherapy service for the trust. For the past few years, she has worked in the field of research and facilitates the Trans Humber Consumer Research Panel. Her research experience includes HERO (home-based extended rehabilitation for older people), INSPIRE (Effectiveness and cost-effectiveness of INSPIRatorymusclE training (IMT) for reducing postoperative pulmonary complications (PPC)).

Joanne Shepherdson

Joanne Shepherdson graduated as a physiotherapist in 2003 and has 18 years clinical experience within the NHS Acute Care sector. She is the Clinical Lead Physiotherapist for Acute Medicine and Rapid Response, and for the past 10 years has specialised in admission avoidance and frailty within a large Major Trauma Centre. In 2017, Joanne was a Health Service Journal Award finalist in the “Most effective adoption and diffusion of existing practice” for the work that she did to establish an Urgent and Emergency Care programme. Joanne is interested in rehabilitation research and has been involved in a national research study of home based extended rehabilitation for older people post acute hospitalisation. During the COVID pandemic, Joanne helped to implement the British Thoracic Society guidelines for the 6 week, post discharge, follow up rehabilitation reviews for patients who required respiratory support due to COVID 19, and helped to deliver the intervention for participants in the tele-rehabilitation study.

Clare Killingback

Clare Killingback since graduating as a physiotherapist from the University of Nottingham (1999), Clare has worked in various NHS trusts and most recently in the area of community rehabilitation. Clare spent 10-years working internationally as a physiotherapist with 4-years in Northern Iraq seeking to develop physiotherapy services. Her PhD (awarded in 2016) focused on the role of community-based group exercise programmes in supporting physical activity in older people. In 2019 Clare set up the BSc (Hons) Physiotherapy programme at the University of Hull which she now leads as a senior lecturer. Her current research interests lie in person-centred practice, self-management, and pedagogy.

Phil Marshall

Phil Marshall is a lecturer in strength and conditioning at the University of Hull. He is an NSCA- and UKSCA-accredited strength and conditioning coach with more than 20 years of coaching experience. After studying undergraduate sport science at the University of Hull, he completed an MSc in Sport and Exercise Science at Leeds Metropolitan University. His research interests focus on strength and conditioning, and include the application of strength and conditioning methods in clinical populations, the use of technology for the remote delivery of training interventions, quantification of training load in elite sporting environments and optimal conditioning methods in rugby league.

Michael G. Crooks

Michael Crooks was appointed as a Senior Clinical Lecturer and Honorary Consultant in Respiratory Medicine in 2016 and works in the Respiratory Research Group within the Institute of Clinical and Applied Health Research, Hull York Medical School. Michael is also the Clinical Lead for the Humber Coast and Vale Respiratory Network. He undertook his undergraduate training in Dundee before moving to Edinburgh where he completed his Foundation Training. He moved to Hull in 2009 as an NIHR Academic Clinical Fellow before completing his MD. He was subsequently awarded an NIHR Clinical Lecturer position at Hull York Medical School where he developed his interest in airways diseases including asthma and COPD. Michael is a member of the Hull University Teaching Hospitals Airways Team and leads the local integrated COPD service. He leads a range of clinical trials and other research projects relating to the diagnosis and management of airways disease and both acute and long-term effects of COVID-19.

Angela Green

Angela Green graduated as a physiotherapist in 1987 and specialised in neurological rehabilitation (children and adults) in both acute and community NHS Trusts. She now supports people with cancer related fatigue. Angela’s PhD (awarded in 2008), focussed on patient involvement in physiotherapeutic consultations. She has been a fellow of the National Institute for Health and Care Excellence. She has also worked in the Yorkshire and Humber region to increase Allied Health Professional engagement in research, in conjunction with the NIHR Yorkshire clinical research network, and as a hub lead for the Council for Allied Health Professional Research (CAHPR) network. Her current research interests lie in person-centred practice and rehabilitation, particularly in relation to long COVID. Angela is passionate about increasing the visibility of Allied Health Professionals (AHPs) at system level and increasing AHP engagement in research.