Table 4.
Symptom | Example interventions considered: |
---|---|
Chest and pleuritic pain | • Education of self-management strategies (avoiding over exertion) |
• Medical management occasionally required such as electrocardiogram (ECG) screening to rule out potentially life threatening diagnoses | |
Repeated chest infections | • Secretion clearance strategies |
• Swallowing screen for aspiration then medical management if required | |
• Medical management to optimize underlying respiratory conditions may be required | |
Muscular and joint pain | • Hot/cold therapy |
• Exercise prescription for pain related deconditioning | |
• Multi-disciplinary team discussion if potentially neuropathic pain | |
Shortness of breath at rest | • Assessment of breathing pattern to rule out Breathing Pattern Disorder |
• Use of Borg Rating of Perceived Exertion Scale (RPE) and oximetry | |
• Breathing retraining (Diaphragmatic and nasal) | |
• Assessment of N-terminal pro-brain natriuretic peptide (NT-proBNP) if indicated | |
• Diffusing capacity for carbon monoxide (DCLO) and overnight pulse oximetry warranted in a minority of complicated cases | |
Shortness of breath on exertion | • Breathing techniques whilst moving |
• Purse lip breathing strategies if nasal breathing effortful | |
• Positioning | |
• Use of fan | |
• Using Borg-RPE scale and oximetry with activity to guide and educate patient to safe level exercise | |
• Assessment of NT-proBNP if indicated | |
Desaturation on exertion | • Use of pulse oximetry to relate to breathlessness score on Borg-RPE scale, and recovery time |
• Review how patient manages desaturation | |
• Grade up activity gradually starting with non-de-saturation tasks | |
• Education of self-management and breathing control for recovery/managing desaturation | |
• Positioning | |
• Assessment of NT-proBNP if indicated | |
• Assessment of need for further respiratory investigation | |
Palpitations and tachycardia | • Medical assessments such as ECG, ambulatory ECG, and thyroid function, biomarkers and exercise testing |
• Advice around exercise | |
• Medical management including salt loading and hydration volume, medications | |
Dizziness | • Vestibular retraining if indicated |
• Investigate whether related to postural drop or Postural Tachycardia Syndrome (PoTS) | |
• Education/advice around postural drop and positional changes | |
• Medication review | |
Post viral fatigue or post-exertional malaise | • Diaries (fatigue/sleep/thinking) |
• Education around pacing and prioritization | |
• Identification of own unique occupational balance | |
• Education on relaxation strategies and “quality” rest | |
• Lifestyle management (diet, sleep and stress management) | |
• Enrolment onto virtual fatigue course | |
• Vocational support | |
Anxiety and depression | • Enrolment onto virtual fatigue course |
• Education on relaxation and mindfulness | |
• Use of restorative activity | |
• Referral to psychological services/Leeds Wellbeing service | |
Poor memory and concentration | • Cognitive assessment if indicated |
• Education around cognitive processes and post viral syndrome | |
• Brain Training exercises (eg, Luminosity) | |
• Diaries- fatigue/sleep/thinking | |
• Vocational support | |
• Memory aids | |
• Education on relaxation and mindfulness | |
• Use of restorative activity | |
Voice Disorders Upper airways Disorders Reflux related laryngeal symptoms |
• Voice care advice and therapy |
• Inducible laryngeal obstruction (ILO) management | |
• Cough suppression techniques | |
• Education and support of post viral laryngeal recovery | |
• Specific relaxation techniquesand CBT strategies | |
Word finding difficulties (anomia) | • Linguistic approach to improve semantics |
• Cognitive approach to improve verbal short-term memory and speed of naming | |
• Compensatory approach, for example, circumlocution | |
• Interventions may be provided in person and/or via computer therapy to support dosage/independent practice |