Abstract
BackgroundFirst studies indicate that up to 6 months after hospital discharge, coronavirus disease 2019 (COVID-19) causes severe physical, cognitive, and psychological impairments, which may affect participation and health-related quality of life (HRQoL). After hospitalization for COVID-19, a number of patients are referred to medical rehabilitation centers or skilled nursing facilities for further treatment, while others go home with or without aftercare. The aftercare paths include 1] community-based rehabilitation; 2] in- and outpatient medical rehabilitation; 3] inpatient rehabilitation in skilled nursing facilities; and 4] sheltered care (inpatient). These aftercare paths and the trajectories of recovery after COVID-19 urgently need long-term in-depth evaluation to optimize and personalize treatment. CO-FLOW aims, by following the outcomes and aftercare paths of all COVID-19 patients after hospital discharge, to systematically study over a 2-year period: 1] trajectories of physical, cognitive, and psychological recovery; 2] patient flows, healthcare utilization, patient satisfaction with aftercare, and barriers/facilitators regarding aftercare as experienced by healthcare professionals; 3] effects of physical, cognitive, and psychological outcomes on participation and HRQoL; and 4] predictors for long-term recovery, health care utilization, and patient satisfaction with aftercare.MethodsCO-FLOW is a multicenter prospective cohort study in the mid-west of the Netherlands with a 2-year follow-up period. Measurements comprise non-invasive clinical tests and patient reported outcome measures from a combined rehabilitation, pulmonary, and intensive care perspective. Measurements are performed at 3, 6, 12, and 24 months after hospital discharge and, if applicable, at rehabilitation discharge. CO-FLOW aims to include at least 500 patients who survived hospitalization for COVID-19, aged ≥18 years.DiscussionCO-FLOW will provide in-depth knowledge on the long-term sequelae of COVID-19 and the quality of current aftercare paths for patients who survived hospitalization. This knowledge is a prerequisite to facilitate the right care in the right place for COVID-19 and comparable future infectious diseases.Trial registrationThe Netherlands Trial Register (NTR), https://www.trialregister.nl. Registered: 12-06-2020, CO-FLOW trialregister no. NL8710.
Highlights
First studies indicate that up to 6 months after hospital discharge, coronavirus disease 2019 (COVID19) causes severe physical, cognitive, and psychological impairments, which may affect participation and healthrelated quality of life (HRQoL)
CO-FLOW will provide in-depth knowledge on the long-term sequelae of COVID-19 and the quality of current aftercare paths for patients who survived hospitalization. This knowledge is a prerequisite to facilitate the right care in the right place for COVID-19 and comparable future infectious diseases
Organization of COVID-19 aftercare: questionnaire to assess the level of organization of COVID-19 aftercare as perceived by healthcare professionals and to explore barriers and facilitators for aftercare experienced by the professionals
Summary
Eligibility criteria All COVID-19 patients who survived hospitalization in one of the hospitals in the Rotterdam-Rijnmond-Delft region, which is in the mid-west of the Netherlands, are eligible if they fulfill the following in- and exclusion criteria. Additional non-invasive measurements are performed by a trained researcher or research assistant. These measurements are performed when patients visit their own hospital for their regular follow-up after hospital discharge. After patients are discharged from regular care, they are invited to visit Erasmus MC, University Medical Center Rotterdam, for the remaining study visits. A] Trajectories of recovery Physical function Pulmonary function: spirometry measuring forced vital capacity (FVC), forced expiratory capacity at the first second of exhalation (FEV1), and diffusing capacity of the lung for carbon monoxide adjusted for hemoglobin (DLCOc) results are collected, if tests are performed during aftercare. Cognitive function Subjective: Cognitive Failure Questionnaire (CFQ) to assess the frequency of experienced cognitive failures in everyday life, such as absent-mindedness, slips and errors of perception, memory, and motor functioning [38, 39]
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