NHS Glos. CCG: Long COVID

Kirstie Tew, MSc., & Sophie Middleton

Executive Summary

Background

Since the COVID-19 pandemic began in early 2020, almost 600,000 people in the UK have been hospitalised after contracting COVID-19, with up to 4,000 patients receiving treatment in the intensive therapy unit (ITU) at any one time (GOV.UK, 2021). Many other individuals who have received a COVID-19 diagnosis, whether they have been hospitalised or not, are suffering from a novel condition referred to as long COVID, which is commonly associated with ongoing symptoms including chronic fatigue and shortness of breath. NHS Gloucestershire Commissioners felt that KiActiv® Health could be a valuable tool to support individuals suffering with the ongoing effects of long COVID to improve self-management.

Innovation

KiActiv® Health is a personalised and guided online service that empowers participants to optimise everyday physical activity in the context of their condition. KiActiv®’s patented technology evaluates minute-by-minute physical activity data from a validated wearable monitor, which is displayed instantly in the user’s personalised online dashboard, and is available 24/7 to provide meaningful and actionable feedback. Patients are also supported remotely by phone calls with a dedicated KiActiv® Mentor at 6 key time points during the 12-week programme, to help them build an understanding of the value of their daily activities and the confidence to plan, monitor and improve. At the end of the 12-weeks, the patients retain access to their personal dashboard and activity monitor, enabling them to continue their self-management using the technology if desired.

Purpose/objective

To provide an accessible service to enable patients suffering with long COVID to improve self-care through the optimisation of their everyday physical activity.

Methodology

Eligible patients were invited to participate in KiActiv® Health via a letter. Enrolled patients were sent a wearable activity monitor, before participating in the 12-week KiActiv® Health programme. They were supported at key time points throughout by a trained KiActiv® Mentor. Data was analysed from a range of sources: the KiActiv® Health platform, KiActiv® Mentor calls, and a self-administered online questionnaire. 

Key Findings:

  • Demographics: 25 patients started KiActiv® Health (13 females, 12 males), average age = 49 years, average body mass index (BMI) = 28.8kg/m2.

  • Completion: 12 patients (7 females, 5 males) have completed the 12-week programme to date. 13 patients are within the 12-week programme.

  • Engagement: The use of the technology was excellent and included 99% of days worn within programme, of which 90% of days were classed as having complete data sets.

  • PROMS: A self-administered online questionnaire was completed on completion of the 12-weeks of KiActiv® Health.
    • 80.0% of respondents felt that their understanding of physical activity had improved as a result of participation in KiActiv® Health.
    • 80.0% of respondents felt confident that they could manage their physical activity for their overall health now and in the future.
    • 80.0% of patients felt that KiActiv® Health had benefitted them in some way.
    • 80.0% of patients stated that they would recommend KiActiv® Health to a family member or friend.

  • Patient reported benefits included:
    • An increased awareness of all movement, not just exercise.
    • Understanding the accessibility of everyday physical activity, and finding more enjoyment in daily activities.
    • Improved pulmonary symptoms (i.e., reduced breathlessness, improved lung capacity).
    • Benefits to other aspects of lifestyle such as improved sleep, feeling fitter, stronger and more energised.
    • The ability to set realistic goals, self-manage, and improve daily physical activities.
    • A sense of control around how everyday physical activities affect their health and wellbeing, which has led to an improvement in physical and mental health, as well as overall QoL.

  • Physical Activity Data: Increasing physical activity is not always the primary goal for people recovering from hospitalisation due to COVID-19 or for those living with long COVID. However, 11 clients (91.7%) expressed that they wanted to increase their physical activity levels, yet many wanted to be cautious and not risk doing too much.
    • 100% of patients improved their physical activity in 1+ dimensions.
    • 100% of patients improved their physical activity in 3+ dimensions.
    • 73% of patients improved their physical activity in 4+ dimensions.
    • The average increases in physical activity from baseline (i.e., physical activity dose) across an average of 67 complete days were:
      • Non-Sedentary Time: +23hrs 52mins (+12%)
      • Moderate Activity: +10hrs 35mins (+100%)
      • Moderate Bouts: +1hr 7mins (+2,068%)
      • Calorie Burn: +5,167kcals (+2%)

Seven clients (58.3%) reported experiencing breathlessness similar to other pulmonary conditions such as COPD. Additional Moderate Activity carried out above baseline during the programme for these 7 individuals was 6-hours and 29-minutes across 68 complete days, equivalent to 5.7-minutes extra per day. A 2020 Cochrane Review found that following pulmonary rehabilitation, participants improved by an average of 4-minutes per day (Burge et al., 2020). As such, the cohort in this report likely received greater benefits than those experienced following a course of pulmonary rehabilitation.

Conclusion

KiActiv® Health proved effective amongst this cohort in part due to the accessibility of everyday physical activity, shifting the narrative away from structured exercise, instead adopting a more personalised approach to everyday physical activity, where the individual is able to self-manage their physical activity to determine what works best for them. This is important within this group, physical activity is often avoided by individuals with long COVID and those recovering from hospitalisation due to COVID-19 given the effect of physical exertion on cognitive and physical fatigue (Rudrofff et al., 2020). Despite such perceptions, maintaining and improving physical activity is extremely important as it has been shown to reduce breathlessness, as well as increase muscle strength and exercise capacity (Lan et al., 2013; Torres-Sánchez et al., 2017).

KiActiv® Health also provided patients with the tools to optimise physical activity to better manage fatigue levels. This is important given that COVID-19 rehabilitation and long COVID management must be tailored to the individual, accounting for their personal experiences of fatigue symptoms and post-exertional malaise (Nijs et al., 2004; Larun and Malterud, 2011; Humphreys et al., 2021). The one client who did not aim to increase their physical activity was able to identify and maintain an optimum level of physical activity to better self-manage their fatigue.

KiActiv® Health increased self-management skills and participants received person-centered care along with tailored individual advice on managing their daily activity to best support their rehabilitation from hospitalisation due to COVID-19 or ongoing management of long COVID symptoms. The remote nature of KiActiv® Health overcomes the travel barrier; ensuring participants are supported from the safety of their own homes. Not only is this particularly pertinent due to ongoing COVID-19 restrictions, reducing our reliance on transport to receive healthcare will also reduce carbon emissions, supporting the vision for a greener, healthier planet.

These results should also be reviewed in the context of our recently published pilot for patients with CFS/ME undertaken on behalf of the NHS, which included enrolments during the pandemic and highlight valuable comparisons.

23rd December 2021