• Julie Darbyshire, Trisha Greenhalgh, Nawar D Bakerly, Kumaran Balasundaram, Sareeta Baley, Megan Ball, Emily Bullock, Rowena Cooper, Helen Davies, Johannes H De Kock, Carlos Echevarria, Sarah Elkin, Rachael Evans, Zacc Falope, Cliodhna Flynn, Emily Fraser, Stephen Halpin, Samantha Jones, Rachel Lardner, Cassie Lee, Ashliegh Lovett, Victoria Masey, Harsha Master, Ghazala Mir, Adam Mosley, Jordan Mullard, Rory J O'Connor, Amy Parkin, Anton Pick, Janet Scott, Nikki Smith, Emma Tucker, Paul Williams, Darren Winch, Conor Wood, Manoj Sivan, and LOCOMOTION consortium.
• Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. Electronic address: julie.darbyshire@phc.ox.ac.uk.
• Clin Med (Lond). 2024 Sep 1; 24 (5): 100237100237.

AbstractThe protracted form of COVID-19 known as 'long covid' was first described in 2020. Its symptoms, course and prognosis vary widely; some patients have a multi-system, disabling and prolonged illness. In 2021, ring-fenced funding was provided to establish 90 long covid clinics in England; some clinics were also established in Scotland and Wales. The NIHR-funded LOCOMOTION project implemented a UK-wide quality improvement collaborative involving ten of these clinics, which ran from 2021 to 2023. At regular online meetings held approximately 8-weekly, participants prioritised topics, discussed research evidence and guidelines, and presented exemplar case histories and clinic audits. A patient advisory group also held a priority-setting exercise, participated in quality meetings and undertook a service evaluation audit. The goal of successive quality improvement cycles aimed at changing practice to align with evidence was sometimes hard to achieve because definitive evidence did not yet exist in this new condition; many patients had comorbidities; and clinics were practically constrained in various ways. Nevertheless, much progress was made and a series of 'best practice' guides was produced, covering general assessment and management; breathing difficulties; orthostatic tachycardia and other autonomic symptoms; fatigue and cognitive impairment; and vocational rehabilitation. This paper summarises key findings with the frontline clinician in mind.Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.

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