Long COVID is defined by the World Health Organization as ‘the continuation or development of new symptoms three months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least two months with no other explanation’ (World Health Organization 2022).

It is estimated that between five and 10 per cent of people in Australia who contracted the COVID-19 virus infection in 2020–22 subsequently experienced long COVID symptoms (Australian Institute of Health and Welfare 2022), although the reliability of this figure has been questioned (Attwooll 2023).

Karen Borschmann, a physiotherapist and research fellow, saw a need among her physiotherapist colleagues to understand more about long COVID.

‘Our impetus was to try to make sense of the information out there and to use research and education to help our colleagues support their patients as best they could, within a really uncertain space,’ says Karen.

Given the high number of COVID-19 infections in Melbourne in 2021, it was seen as the ideal place to conduct research on the clinical impact of the virus.

‘When we were setting up the project team, Melbourne had some of the biggest lockdowns’ says Karen.

‘Western Health, Alfred Health and St Vincent’s were among the key tertiary hospitals seeing high numbers of COVID-19 patients in Melbourne, so we thought it would be a good idea to collaborate and get the biggest patient numbers for research, as well as the clinical expertise.’

The original research team also included Professor Anne Holland and Janet Bondarenko, from Alfred Health, Associate Professor Kimberley Haines and Dr Danielle Hitch from Western Health, and Dr Karen Borschmann and Mark Tran from St Vincent’s Hospital Melbourne.

A successful grant from the Pat Cosh Trust in 2021 soon followed, at which point Rita Kinsella APAM, an advanced musculoskeletal physiotherapist and clinical researcher at St Vincent’s Hospital Melbourne, joined the project team as co-lead.

‘The first part of the project was a clinician survey to find out what physiotherapists and physiotherapy students would want in a package designed to support their practice, rather than what we felt they wanted’ says Rita.

‘It was important to get a sense of whether they felt they knew it all or needed to know more, to see if a package would be useful to them.

'We realised that patients were turning up to public and private clinics and physiotherapists didn’t necessarily know how best to manage them.’

From the start of the project, there was a belief that physiotherapy could play a primary role in the treatment of long COVID, alongside the work of other healthcare clinicians.

‘There’s a strong feeling that physiotherapists can be very much involved in the management of long COVID but it’s really important to couch that within the multidisciplinary team’ says Rita.

‘Our work continues to evolve just as knowledge of long COVID evolves.

'Even though infection numbers have peaked, long COVID numbers are still coming through, and COVID-19 is still happening across the world.’

It seems quite apt that a research project focusing on the complexities of COVID-19 would face several roadblocks due to the restrictions imposed to contain the virus.

‘Although the project team initially planned to undertake an extensive evaluation of physical, respiratory and cognitive outcomes in patients presenting with long COVID, we shifted the focus of the project’ says Rita.

‘This was due partly to the COVID-related restrictions on hospital-based research, but also because there was a huge breadth of data emerging, both nationally and internationally, about long COVID outcomes, and duplication of this effort wasn’t ideal.

‘So we turned the milestones on their head and focused mainly on the clinician survey to determine the gaps in knowledge and barriers to optimal treatment, and from there developed the e-learning package.’

Another addition to the team was Kate Woodhead APAM, a physiotherapist and acting clinical education lead at St Vincent’s Hospital Melbourne, who saw the obvious benefits of the project.

‘The idea of creating the e-learning package and making it interactive and online is that it’s readily accessible to all physiotherapists, whatever their clinical area’ says Kate.

‘It’s a living document and a resource for consumers as well, so people experiencing long COVID can have this information to take to their physiotherapist and vice versa.’

Kate worked closely with the other members of the team to produce the content, with expert cardiorespiratory input, particularly from Anne and Janet at Alfred Health.

Diagnosis of long COVID is still difficult because there is no single test available for it (Woodhead et al 2023) and there are ‘no uniform guidelines… to aid in standardized and earlier detection’ (Srikanth et al 2023).

‘It’s a diagnosis of exclusion, which makes it hard to pinpoint when someone has it’ says Kate.

‘So the actual percentage of people within the population who might be experiencing it is difficult to quantify.

'More than 250 symptoms have been associated with long COVID.’

Trying to understand these symptoms and help patients means working in a constantly evolving space, where usual healthcare processes may not be sufficient.

‘What we were trying to do with patients presenting with symptoms after their acute admission to hospital was to try to slot them into programs that already existed for other conditions, like cardiopulmonary rehab’ says Kate.

‘But the clinicians in that space were realising that people experiencing long COVID had all these additional symptoms on top of just shortness of breath, and there were other aspects that we didn’t quite understand yet.’

The e-learning package for physiotherapists sits within a broader resource, Enabling and optimising recovery from COVID-19 (Hitch et al 2023), designed to be used by a wide range of clinicians as well as patients and consumers.

‘There may be patients presenting to private practice with a knee injury, for example, who also report fatigue or other long COVID symptoms that are potentially a barrier to their overall knee rehabilitation and recovery’ says Rita.

‘The package will help more broadly, not just for those patients presenting with more obvious respiratory and neurological conditions but also for those presenting with musculoskeletal conditions as well.’

The word ‘pivot’ became synonymous with adapting to the unforeseen and unexpected world of COVID and this research was no different.

‘We were able to work with the Pat Cosh Trust to pivot on our milestones and on what the funding was originally going to be directed to’ says Karen.

‘Not all funding bodies are quite so flexible, which makes research challenging at the best of times, and COVID was a particularly difficult time.

'Working together, we achieved a great outcome, despite the project plan changing over time.

‘Now that it’s live, we have a united plan to disseminate it through the APA, to find out who are the key people who are actually using it, and gain feedback on how useful it is.’

Head to Enabling and Optimising Recovery from COVID-19 to access the e-learning package.

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• References

Course of interest: 

Management of post exertional malaise in long COVID