The Covid-19 Yorkshire Rehabilitation Scale

Long Covid: The Challenge

Long COVID is a term used to describe a new and emerging condition faced by patients presenting with symptoms that develop during or after contracting COVID-19 and persist for more than 4 weeks according to NICE. The complex condition affects people in different ways, with symptoms of breathlessness, cough, and severe fatigue being amongst the most prevalent symptoms. It is a new problem overwhelming clinics following the peak of the pandemic due to the lack of validated tools to effectively assess and manage the sheer numbers of patients seeking support.

The Office for National Statistics (ONS) estimates there to be 1.7 million people suffering from Long Covid, and as of January 24th 2021 the World Health Organisation estimates there have 97.4 million confirmed cases of (acute) COVID-19, with the Office for National Statistics estimating that:

  • Around 20% of patients testing positive for COVID-19 exhibit symptoms for a period of 5 weeks or longer.
  • Around 10% of patients testing positive for COVID-19 exhibit symptoms for a period of 12 weeks or longer.

The C19-YRS outcome measure

The C19-YRS is a patient-reported outcome measure for capturing symptom severity, functional disability, and overall health state. It can also be used as an initial screening tool as part of a triage appointment.

Patients score the severity of symptoms at present moment to compare these with scores recalled from before their COVID infection to provide a baseline level or target to work towards as part of their rehabilitation.

Completing the C19-YRS over time provides a comprehensive overview of a patient’s progress, whether their condition is improving, deteriorating, or fluctuating.

The Original C19-YRS is a 22-item patient-reported outcome measure (PROM). Each item is rated on a 0-10 numerical rating scale, where 0 represents the symptom not being present, and 10 represents the symptom being extremely severe or life disturbing. The C19-YRS has four subscales concerned with the severity of patients’ key symptoms, functional limitations, overall health, and additional symptoms. The scale also captures pre-COVID scores for comparison. Questions 1-10 form the Symptom Severity sub-scale (with a total score from 0-100), Questions 11-15 the Functional Disability sub-scale (0-50), Question 16 is the overall health score (0-10), and Questions 17-22 the additional symptoms sub-scale (0-60).

The Modified C19-YRS (C19-YRSm) is a 17-item patient-reported outcome measure (PROM), with each item rated on a 0-3 numerical rating scale. Zero represents the symptom not being present; 1 represents a mild problem (not affecting daily life); 2 represents a moderate problem (affecting daily life to a certain extent); and 3 represents a severe problem (life disturbing or affecting all aspects of daily life). The C19-YRSm, similar to the original version, is broken down into four sub-scales concerned with the severity of patients’ key symptoms, functional limitations, other symptoms, and overall health. Pre-COVID scores are also captured for comparison. The worst scores for each item (Questions 1-10) sum to give the Symptom Severity sub-scale (score 0-30), Questions 11-15 sum to give the Functional Disability sub-scale (0-15), Question 16 is the other symptoms sub-scale (0-25), and Question 17 is the overall health score (0-10).

Digital C19-YRS

The digital platform has been developed by the digital health company, ELAROS, in a partnership with The University of Leeds, and both Leeds NHS Trusts. The digital system has been:

  • Recommended by NHS England
  • Funded by the National Institute for Health Research
  • Recognised by NICE
  • Developed with several NHS Trusts and is currently live across the UK
  • Endorsed by the British Society for Rehabilitation Medicine
  • Featured on BBC North West, ITV News, Daily Mail online and more, to demonstrate its success with patients and clinics

This is a not for profit initiative for all NHS organisations.

Examples using the C19-YRS

The first example below shows a patient who has gradually recovered over 4 months which can be demonstrated by their summative scores of burden decreasing over time, and their Overall Health scores improving.

Within ELAROS’ app, these scores are used to generate interactive charts overlaying these assessments to provide a an overview of the patient’s rehabilitation journey.

These graphs can be accessible by clinical teams to inform their clinical decision making with the necessary evidence to justify the allocation of resources to patients.

Patients themselves can also access their results to track their own progress, motivate them to engage in treatment regimes, and feel empowered and aware of the state of their condition.

Digital C19-YRS automatically calculates total symptom and functional burden for patients and staff

In the example below, this patient’s scores have remained moderately high without improvement over time.