The modified COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) patient-reported outcome measure for Long Covid or Post-COVID syndrome

Abstract

Background: The C19-YRS was the first validated scale reported in the literature for patient assessment and monitoring in Long Covid or Post-COVID syndrome. The 22-item scale contains four subscales measuring symptom severity, functional disability, overall health and additional symptoms. Objectives: This study aimed to modify and refine the scale based on psychometric properties, emerging evidence on additional Long Covid symptoms, and feedback from a working group of patients and healthcare professionals. Methods: Data were collected from 370 patients who completed the C19-YRS scale in a community Long COVID service. The psychometric properties of the Symptom Severity and Functional Disability subscales were assessed using a Rasch Measurement Theory framework, where all individual scale items were assessed for model fit, local dependency, response category functioning and differential item functioning (DIF) by age group and sex. Additionally, the subscales were assessed for targeting, reliability and unidimensionality. The overall health subscale is a single item, and the additional symptoms subscale is not intended to be summed, therefore neither is appropriate for Rasch analyses. Psychometric results and implications were relayed back to the working group for discussion, alongside clinical evidence of emerging and relevant symptoms not covered by the original C19-YRS. Results: Rasch analysis revealed promising psychometric properties of the symptom severity and functional disability subscales, with both displaying good targeting and reliability, although some individual measurement anomalies were noted. The original 0-10 item response category structure did not operate as intended for both the subscales. Post-hoc rescoring suggested that a 4-point response category structure would be more appropriate for both the subscales, and this aligned with patient feedback. This scoring change was implemented, alongside changes in the item composition of the symptom severity and additional symptoms subscales. The functional disability item set, and the overall health single-item subscale remained unchanged. Conclusion: A modified version of the C19-YRS was developed based on a combination of psychometric evidence, clinical relevance of the content and feedback from the working group (comprising patients and healthcare professionals). Future studies including NIHR funded LOCOMOTION study will undertake large-scale, multi-centre validation of the modified C19-YRS.

HEART rate variability biofeedback for LOng Covid symptoms (HEARTLOC): protocol for a feasibility study

“…27 28 The modified scale provides a symptom severity score (out of 30), functional disability score (out of 15), other symptoms score (out of 25) and overall health score (out of 10). 29 The participant will complete C19YRS at weekly intervals to monitor the impact of the intervention on LC symptoms. They will also have weekly telephone reviews with study researchers for troubleshooting and to ensure maximal compliance with the study.…”

LOng COvid Multidisciplinary consortium Optimising Treatments and servIces acrOss the NHS (LOCOMOTION): protocol for a mixed-methods study in the UK

“…The COVID-19 Yorkshire Rehabilitation Scale has been modified based on increasing knowledge of the condition and preliminary psychometric analysis. 51 Further psychometric evaluation of the modified COVID-19 Yorkshire Rehabilitation Scale in this new sample will use a Rasch measurement model to explore the scale item’s model fit, local dependency, response category functioning and differential item functioning. If necessary, we will refine the scale through an iterative process of psychometric testing and modifications.…”

Psychometric analysis of the modified COVID-19 Yorkshire Rehabilitation Scale (C19-YRSm) in a prospective multicentre study

“…16 17 The original 22-item C19-YRS underwent psychometric evaluation including both classical and modern psychometric evaluation methods, resulting in a 17-item modified tool, the C19-YRSm. 18 Both the original 22-item and the modified version have undergone a limited degree of subsequent validation. 10 19 The C19-YRS has been shown to have good construct validity but moderate responsiveness.…”

“…Instruments COVID-19 Yorkshire Rehabilitation Scale-Modified (C19-YRSm) The C19-YRSm is a 17-item instrument 18 designed to capture the key symptoms of LC and its impact on activities of daily living and overall health (online supplemental material). The items comprise four subscales: Symptom Severity (SS, 10 items), Functional Disability (FD, 5 items), Overall Health (OH, a single item) and Other Symptoms (OS).…”