The effect of COVID rehabilitation for ongoing symptoms Post HOSPitalisation with COVID-19 (PHOSP-R): protocol for a randomised parallel group controlled trial on behalf of the PHOSP consortium
Authors: Daynes Enya , Baldwin Molly , Greening Neil J. , Yates Thomas , Bishop Nicolette C. , Mills George , Roberts Matthew , Hamrouni Malik , Plekhanova Tatiana , Vogiatzis Ioannis , Echevarria Carlos , Nathu Rashmita , McAuley Hamish J. C. , Latimer Lorna , Glennie Jennifer , Chambers Francesca , Penfold Ruth , Hume Emily , Megaritis Dimitrios , Alexiou Charikleia , Potthoff Sebastian , Hogg Mitchell James , Haighton Catherine , Nichol Bethany , Leavy Olivia C. , Richardson Matthew , Elneima Omer , Singapuri Amisha , Sereno Marco , Saunders Ruth M. , Harris Victoria C. , Nolan Claire M. , Bolton Charlotte , Houchen-Wolloff Linzy , Harrison Ewen M. , Lone Nazir , Quint Jennifer , Chalmers James D. , Ho Ling-Pei , Horsley Alex , Marks Michael , Poinasamy Krisnah , Ramen Betty , Wain Louise V. , Brightling Christopher , Man William D.-C. , Evans Rachael , Singh Sally J. 
Published: January 2023

Abstract
Introduction
Many adults hospitalised with COVID-19 have persistent symptoms such as fatigue, breathlessness and brain fog that limit day-to-day activities. These symptoms can last over 2 years. Whilst there is limited controlled studies on interventions that can support those with ongoing symptoms, there has been some promise in rehabilitation interventions in improving function and symptoms either using face-to-face or digital methods, but evidence remains limited and these studies often lack a control group.

Methods and analysis
This is a nested single-blind, parallel group, randomised control trial with embedded qualitative evaluation comparing rehabilitation (face-to-face or digital) to usual care and conducted within the PHOSP-COVID study. The aim of this study is to determine the effectiveness of rehabilitation interventions on exercise capacity, quality of life and symptoms such as breathlessness and fatigue. The primary outcome is the Incremental Shuttle Walking Test following the eight week intervention phase. Secondary outcomes include measures of function, strength and subjective assessment of symptoms. Blood inflammatory markers and muscle biopsies are an exploratory outcome. The interventions last eight weeks and combine symptom-titrated exercise therapy, symptom management and education delivered either in a face-to-face setting or through a digital platform (www.yourcovidrecovery.nhs.uk). The proposed sample size is 159 participants, and data will be intention-to-treat analyses comparing rehabilitation (face-to-face or digital) to usual care.

Ethics and dissemination
Ethical approval was gained as part of the PHOSP-COVID study by Yorkshire and the Humber Leeds West Research NHS Ethics Committee, and the study was prospectively registered on the ISRCTN trial registry (ISRCTN13293865). Results will be disseminated to stakeholders, including patients and members of the public, and published in appropriate journals.

Article summary
Strengths and limitations of this study
• This protocol utilises two interventions to support those with ongoing symptoms of COVID-19
• This is a two-centre parallel-group randomised controlled trial
• The protocol has been supported by patient and public involvement groups who identified treatments of symptoms and activity limitation as a top priority