During recent years, the integration of technology has substantially improved self-reported dietary assessment methods, such as food frequency questionnaires (FFQ), food records, and 24-h recalls. To further reduce measurement error, additional innovations are urgently needed. Memory-related measurement error is one of the aspects that warrants attention, which is where new smartphone technologies and ecological momentary assessment (EMA) approaches provide a unique opportunity. In this article, we describe the DIASS study, which was designed to evaluate an innovative 2-h recall (2hR) smartphone-based methodology, against traditional 24-h recalls, FFQ, and biomarkers, to assess both actual and habitual dietary intake. It is hypothesized that a 2-h reporting window decreases reliance on memory and reporting burden, and increases data accuracy. We included 215 men (28%) and women (72%), with a mean ± SD age of 39 ± 19 years and a mean ± SD BMI of 23.8 ± 4.0. Most participants were highly educated (58%). Response rates for the various dietary assessment methods were >90%. Besides the evaluation of the accuracy, usability, and perceived burden of the 2hR methodology, the study set-up also allows for (further) evaluation of the other administrated dietary assessment tools.

Background: Patients recovering from COVID-19 often experience persistent problems in their daily activities related to limitations in physical, nutritional, cognitive, and mental functioning. To date, it is unknown what treatment is needed to support patients in their recovery from COVID-19. Objective: This study aimed to evaluate the primary allied health care of patients recovering from COVID-19 at 6-month follow-up and to explore which baseline characteristics are associated with changes in the scores of outcomes between baseline and 6-month follow-up. Methods: This Dutch nationwide prospective cohort study evaluated the recovery of patients receiving primary allied health care (ie, dietitians, exercise therapists, occupational therapists, physical therapists, and speech and language therapists) after COVID-19. All treatments offered by primary allied health professionals in daily practice were part of usual care. Patient-reported outcome measures on participation, health-related quality of life, fatigue, physical functioning, and psychological well-being were assessed at baseline and at 3- and 6-month follow-up. Linear mixed model analyses were used to evaluate recovery over time, and uni- and multivariable linear regression analyses were used to examine the association between baseline characteristics and recovery. Results: A total of 1451 adult patients recovering from COVID-19 and receiving treatment from 1 or more primary allied health professionals were included. For participation (Utrecht Scale for Evaluation of Rehabilitation—Participation range 0-100), estimated mean differences of at least 2.3 points were observed at all time points. For the health-related quality of life (EuroQol Visual Analog Scale, range 0-100), the mean increase was 12.3 (95% CI 11.1-13.6) points at 6 months. Significant improvements were found for fatigue (Fatigue Severity Scale, range 1-7): the mean decrease was –0.7 (95% CI –0.8 to –0.6) points at 6 months. However, severe fatigue was reported by 742/929 (79.9%) patients after 6 months. For physical functioning (Patient-Reported Outcomes Measurement Information System—Physical Function Short Form 10b, range 13.8-61.3), the mean increase was 5.9 (95% CI 5.9-6.4) points at 6 months. Mean differences of –0.8 (95% CI –1.0 to –0.5) points for anxiety (Hospital Anxiety and Depression Scale range 0-21) and –1.6 (95% CI –1.8 to –1.3) points for depression were found after 6 months. A worse baseline score, hospital admission, and male sex were associated with greater improvement between baseline and 6-month follow-up, whereas age, the BMI, comorbidities, and smoking status were not associated with mean changes in any outcome measures. Conclusions: Patients recovering from COVID-19 who receive primary allied health care make progress in recovery but still experience many limitations in their daily activities after 6 months. Our findings provide reference values to health care providers and health care policy makers regarding what to expect from the recovery of patients who receive health care from 1 or more primary allied health professionals. Trial Registration: ClinicalTrials.gov NCT04735744; https://tinyurl.com/3vf337pn International Registered Report Identifier (IRRID): RR2-10.2340/jrm.v54.2506

Background: The nutritional problems of patients who are hospitalised for COVID‐19 are becoming increasingly clear. However, a large group of patients have never been hospitalised and also appear to experience persistent nutritional problems. The present study describes the nutritional status, risk of sarcopaenia and nutrition‐related complaints of patients recovering from COVID‐19 receiving dietetic treatment in primary care.Methods: In this retrospective observational study, data were collected during dietetic treatment by a primary care dietitian between April and December 2020. Both patients who had and had not been admitted to the hospital were included at their first visit to a primary care dietitian. Data on nutritional status, risk of sarcopaenia and nutrition‐related complaints were collected longitudinally.Results: Data from 246 patients with COVID‐19 were collected. Mean ± SD age was 57 ± 16 years and 61% of the patient population was female. At first consultation, two thirds of patients were classified as overweight or obese (body mass index >25 kg m^–2). The majority had experienced unintentional weight loss because of COVID‐19. Additionally, 55% of hospitalised and 34% of non‐hospitalised patients had a high risk of sarcopaenia. Most commonly reported nutrition‐related complaints were decreased appetite, shortness of breath, changed or loss of taste and feeling of being full. Nutrition‐related complaints decreased after the first consultation, but remained present over time.Conclusions: In conclusion, weight changes, risk of sarcopaenia and nutrition‐related complaints were prevalent in patients with COVID‐19, treated by a primary care dietitian. Nutrition‐related complaints improved over time, but remained prevalent until several months after infection.

A Dutch nationwide prospective cohort study was initiated to investigate recovery trajectories of people recovering from coronavirus disease 2019 (COVID-19) and costs of treatment by primary care allied health professionals. The study described recovery trajectories over a period of 12 months and associated baseline characteristics of participants recovering from COVID-19 who visited a primary care allied health professional. It also aimed to provide insight into the associated healthcare and societal costs. Participants completed participant-reported standardized outcomes on participation, health-related quality of life, fatigue, physical functioning, and costs at baseline (ie, start of the treatment), 3, 6, 9 and 12 months. A total of 1451 participants (64 % women, 76 % mild/moderate severity) with a mean (SD) age of 49 (12) years were included. Linear mixed models showed significant and clinically relevant improvements over time in all outcome measures between baseline and 12 months. Between 6 and 12 months, we found significant but not clinically relevant improvements in most outcome measures. Having a worse baseline score was the only baseline factor that was consistently associated with greater improvement over time on that outcome. Total allied healthcare costs (mean €1921; SEM €48) made up about 3% of total societal costs (mean €64,584; SEM €3149) for the average participant in the cohort. The health status of participants recovering from COVID-19 who visited an allied health professional improved significantly over a 12-month follow-up period, but nearly the improvement occurred between baseline and 6 months. Most participants still reported severe impairments in their daily lives, and generated substantial societal costs. These issues, combined with the fact that baseline characteristics explained little of the variance in recovery over time, underscore the importance of continued attention for the management of people recovering from COVID-19. clinicaltrials.gov (NCT04735744).

Importance: Current insight into recovery and real-world treatment of people with persistent complaints after SARS-CoV-2 infection is limited. Objective: The objective of this study was to describe the content, duration, and reasons for initiating and terminating physical therapist interventions and (factors contributing to) changes in outcomes before and after treatment. Design: This was a prospective cohort study in Dutch primary care allied health care. Participants: Participants were patients receiving allied health care treatment after SARS-CoV-2 infection. Intervention: The intervention was primary care physical therapy. Main outcomes and measures: Self-reported functioning (patient-specific functional scale [PSFS]), 6-min walk test (6MWT), sit-to-stand performance (5 times sit-to-stand [5TSTS]), grip strength, and treatment characteristics were measured pre- and post-treatment. Associations between baseline characteristics, pre-treatment scores, and clinically important improvement on PSFS were calculated. Results: Nine hundred ninety-two patients (mean age 50 years [SD = 13]) were included. Median treatment duration was 24 weeks (IQR = 17–26) and 31 sessions (19–43). Most selected treatment goals were to improve endurance (74%) and physical functioning (72%). In 59% of treatment episodes, therapists reported that patients had achieved the main treatment goal. Mean change scores (95% CIs) were −4.1 points (−4.4 to −3.8) on the PSFS, 70 m (61–78) on the 6MWT, −3.0 s (−3.4 to −2.5) on the 5TSTS, and 3.0 kg (2.1–3.9) on grip strength. Females and participants with worse baseline scores on PSFS had greater odds of reporting a clinically important improvement on the PSFS. Patients with longer 5TSTS times had lower odds. Conclusion: Most patients achieved their treatment goals and demonstrated clinically important improvements on PSFS and 6MWT. This study provides information on the most important therapeutic goals and provides estimates for realistic treatment episodes. Relevance: This article provides insight into real-world physical therapy in patients experiencing persistent complaints after SARS-CoV-2 infection. Additionally, insight into their recovery is provided, showing that patients improve significantly and clinically important on self-reported functioning, 6-min walk test, and sit-to-stand performance.

Objectives To report the recovery of patients receiving primary allied healthcare after a COVID-19 infection at a six-month follow-up, and to explore which patient characteristics are associated with the changes in outcomes between the baseline and six-month follow-up. Design Prospective cohort study. Setting Allied healthcare in Dutch primary care. Participants 1,452 adult patients recovering from COVID-19 and receiving treatment from one or more primary care allied health professional(s) (i.e., dietitian, exercise therapist, occupational therapist, physical therapist and/or speech and language therapist). Results For participation (USER-P range 0 to 100), estimated mean differences of at least 2.3 points were observed after six months. For HRQoL (EQ-VAS range 0 to 100), the mean increase was 12.31 at six months. Furthermore, significant improvements were found for fatigue (FSS range 1 to 7): the mean decrease was –0.7 at six months. For physical functioning (PROMIS-PF range 13.8 to 61.3), the mean increase was 5.9 at six months. Mean differences of –0.8 for anxiety (HADS range 0 to 21), and –1.5 for depression (HADS range 0 to 21), were found after six months. A better baseline score, hospital admission and male sex were associated with a positive change in score between the baseline and six-month follow-up, whereas age, BMI, comorbidities and smoking status were not associated with mean changes in any outcome measure. Conclusions Patients recovering from COVID-19 who receive primary allied healthcare make progress in recovery, but still experience many limitations in their daily activities after six months. Our findings provide reference values to healthcare providers and healthcare policy-makers regarding what to expect from the recovery of patients who received health care from one or more primary care allied health professionals. Trial registration Clinicaltrials.gov registry (NCT04735744).