Podium 22
Tracks
Breakout 2
| Sunday, September 8, 2024 |
| 11:50 AM - 12:20 PM |
| Dobson 2 |
Speaker
Mrs Jen Mepham
Physiotherapist
PNZCRSIG
Post-exertional malaise is the problem, not me.
Presentation Abstract
Background: There is limited research into safe exercise prescription in post viral conditions such as myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) and post-acute COVID-19 syndrome (PACS), reflecting the lack of financial investment. Post exertional malaise (PEM) describes exhaustion from physical, cognitive, and sensory activities. The onset of fatigue experienced can be delayed and the impact can last for days or longer and exceeds the level of activity that preceded it. PEM is a key feature of post viral conditions. Results from 2-day cardio-pulmonary exercise testing (2dCPET) demonstrate a dysfunction of the aerobic energy system however there are strong ethical considerations and challenges accessing 2dCPET. PEM is poorly understood by health care practitioners leading to unsafe exercise prescription.
Purpose: An assessment flowchart was created to show considerations to guide exercise prescription for individuals with PEM, to ensure a symptom led approach to return to activities and exercise.
Method: Existing recommendations for exercise after COVID-19 were reviewed and juxtaposed with current recommendations for the management of PEM. Insights were gathered from physiotherapists experienced in treating such conditions, leading to the development of screening questions. The flowchart delineates three primary pathways: further assessment by a GP, PEM evaluation, and a symptom-led return to exercise, detailed in the accompanying table. The flowchart was disseminated to physiotherapists and stakeholders knowledgeable in PEM and the flowchart was refined based on their feedback.
Results: The flow chart has been disseminated to physiotherapists and medical staff working in with people with post-viral conditions.
Conclusion:The lack of understanding regarding PEM and the issues surrounding 2dCPET hinder the safe rehabilitation of individuals with PEM. The practical tool provides a systematic approach to safely assess and prescribe symptom guided exercise.
Implication: Individuals experiencing PEM can be assessed and guided through a symptom led approach to exercise prescription to avoid exacerbating symptoms.
Purpose: An assessment flowchart was created to show considerations to guide exercise prescription for individuals with PEM, to ensure a symptom led approach to return to activities and exercise.
Method: Existing recommendations for exercise after COVID-19 were reviewed and juxtaposed with current recommendations for the management of PEM. Insights were gathered from physiotherapists experienced in treating such conditions, leading to the development of screening questions. The flowchart delineates three primary pathways: further assessment by a GP, PEM evaluation, and a symptom-led return to exercise, detailed in the accompanying table. The flowchart was disseminated to physiotherapists and stakeholders knowledgeable in PEM and the flowchart was refined based on their feedback.
Results: The flow chart has been disseminated to physiotherapists and medical staff working in with people with post-viral conditions.
Conclusion:The lack of understanding regarding PEM and the issues surrounding 2dCPET hinder the safe rehabilitation of individuals with PEM. The practical tool provides a systematic approach to safely assess and prescribe symptom guided exercise.
Implication: Individuals experiencing PEM can be assessed and guided through a symptom led approach to exercise prescription to avoid exacerbating symptoms.
Biography
Jen Mepham is a cardio-respiratory physiotherapist with over 15 years experience working with people from the acute setting to management of long term conditions in the community. Jen has a clinical interest in the safe rehabilitation of people living with Long COVID.
Dr Sarah Rhodes
Lecturer
School of Physiotherapy University of Otago
“Doors keep closing everywhere.” Experiences of accessing primary care by people living with long COVID.
Presentation Abstract
Background
Long COVID, or post-covid condition, is the persistence of symptoms beyond 12 weeks following acute Covid-19 infection. It is estimated to affect one in ten people, can present with wide ranging symptoms and, in some cases, is extremely debilitating. With few publicly funded long COVID clinics, most people rely on primary care providers as a first point of contact. There is currently limited understanding of the experience of accessing primary health care by adults living with long COVID in Aotearoa New Zealand.
Purpose
To explore the experiences of accessing primary health care by adults living with long COVID.
Methods
A narrative inquiry approach was used to capture participants’ lived experiences of accessing primary health care. Zoom interviews were conducted with study participants either in groups or individually. The automatically generated transcripts were reviewed and corrected where necessary. The collated data were analysed using Braun and Clarke’s thematic analysis.
Results
Eighteen people participated in the interviews. Codes were identified and, through an iterative process, themes were generated, reviewed, defined, and named. Themes included lack of validation; limited knowledge and support; unmet needs; and self-advocacy.
Conclusion
The picture painted by participants was bleak with a sense that the world had moved on from Covid-19 and left them behind. Despite the existence of long Covid for over three years, and the parallels with existing post-viral conditions, there appears to a lack of support in primary healthcare for those living with the condition.
Implications
There is a need to provide support to those delivering primary care to ensure a better healthcare experience for people living with long Covid. This might be achieved through a public awareness campaign, shared educational content for health professionals, and health navigators to advocate for, and support, patients on their healthcare journey.
Long COVID, or post-covid condition, is the persistence of symptoms beyond 12 weeks following acute Covid-19 infection. It is estimated to affect one in ten people, can present with wide ranging symptoms and, in some cases, is extremely debilitating. With few publicly funded long COVID clinics, most people rely on primary care providers as a first point of contact. There is currently limited understanding of the experience of accessing primary health care by adults living with long COVID in Aotearoa New Zealand.
Purpose
To explore the experiences of accessing primary health care by adults living with long COVID.
Methods
A narrative inquiry approach was used to capture participants’ lived experiences of accessing primary health care. Zoom interviews were conducted with study participants either in groups or individually. The automatically generated transcripts were reviewed and corrected where necessary. The collated data were analysed using Braun and Clarke’s thematic analysis.
Results
Eighteen people participated in the interviews. Codes were identified and, through an iterative process, themes were generated, reviewed, defined, and named. Themes included lack of validation; limited knowledge and support; unmet needs; and self-advocacy.
Conclusion
The picture painted by participants was bleak with a sense that the world had moved on from Covid-19 and left them behind. Despite the existence of long Covid for over three years, and the parallels with existing post-viral conditions, there appears to a lack of support in primary healthcare for those living with the condition.
Implications
There is a need to provide support to those delivering primary care to ensure a better healthcare experience for people living with long Covid. This might be achieved through a public awareness campaign, shared educational content for health professionals, and health navigators to advocate for, and support, patients on their healthcare journey.
Biography
Dr Sarah Rhodes is a cardio-respiratory physiotherapist and lecturer at the School of Physiotherapy, University of Otago. Her research interests include sleep health, telehealth to support physical activity behaviour change and long COVID. As part of the PNZ cardio-respiratory special interest group, Dr Rhodes has worked to raise awareness of long COVID, develop long COVID resources and advocate for those living with long COVID. She is passionate about using her role to provide a platform for those living with long term conditions to ensure their voices are heard, and to help drive change.
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