The largest clinical trial of long Covid care to date has found that specialist NHS long Covid services may help reduce fatigue, one of the condition’s most common and disabling symptoms.
The findings, published in Nature Medicine and led by researchers and clinicians from UCL and UCLH funded by the National Institute for Health and Care Research (NIHR), come from the STIMULATE-ICP trial.
The study, supported by the NIHR Biomedical Research Centre: UCLH, involved more than 1,100 people receiving care through six NHS long Covid clinics in England, making it the largest trial to evaluate different approaches to delivering long Covid care.
Researchers found that patients' fatigue improved during the first 12 weeks of specialist multidisciplinary care, regardless of whether they also received a specialist multi-organ MRI scan or a digital rehabilitation programme.
Long Covid continues to affect millions of people and can have a profound impact on every aspect of daily life. For some patients, the condition can persist for years after the initial infection, affecting multiple organs and making it difficult to work, care for family or carry out everyday activities.
One of those patients is Dr Anjali Chakraborty, a GP and mother of two, who developed long Covid after contracting Covid-19 in 2020. Five years later, she is still living with the condition, but credits the support of the UCLH long Covid service with helping her regain parts of her life and return to work.
Reflecting on the impact of the condition, Anjali said: "Since 2020, I've had problems with my heart, my lungs, my skin, with my GI tract, my brain, my joints, my eyes. I've had a blood clot in my lungs. I've had POTS, and I've developed MCAS. I just have lots and lots of very strange things, medically."
When she first attended the UCLH long Covid clinic, her children were toddlers. "There's been the health aspect of it, and then there's been the life aspect of it," she said. "There has been a real coming to terms with the loss of my identity as a healthy functioning working person in society."
The STIMULATE-ICP trial evaluated different elements of long Covid care, including specialist multidisciplinary assessment, multi-organ MRI scans and a digital rehabilitation programme.
Researchers found that while comprehensive MRI scans did not improve fatigue or quality of life compared with standard specialist care, patients receiving specialist clinic support experienced meaningful improvements in fatigue. The digital rehabilitation programme, Living With Covid Recovery™, produced small but statistically significant improvements in fatigue and quality of life after 24 weeks.
UCLH consultant cardiologist and UCL professor of clinical data science Amitava Banerjee said: "Long Covid continues to affect millions of people and places a considerable burden on patients and health services. Our findings show that specialist, multidisciplinary long Covid care can make a real difference to patients' fatigue, which is one of the most common and disabling symptoms."
"Importantly, we found no evidence that routinely adding comprehensive multi-organ MRI scans improves patients' outcomes. This could be because we do not know how best to treat the multi-organ dysfunction which was picked up by the scans. At the same time, digital rehabilitation shows promise as part of longer-term support, but further research is needed to understand how it can best be used."
Dr Melissa Heightman, clinical lead for the post-Covid service at UCLH, said: "This study provides valuable evidence to help shape long Covid services. Patients attending specialist clinics experienced meaningful improvements in fatigue, reinforcing the value of multidisciplinary assessment, rehabilitation and ongoing support."
"Long Covid is a complex condition and there is no single solution that works for everyone. Studies like STIMULATE-ICP help us understand which parts of care provide the greatest benefit, allowing us to focus NHS resources where they can make the biggest difference."
Participants in the study had been living with long Covid symptoms for more than a year on average and typically experienced around nine ongoing symptoms when they entered the trial, with severe levels of fatigue.
Around six in ten participants experienced a clinically meaningful improvement in fatigue over the first 12 weeks of specialist care.
For Anjali, one of the most important aspects of her care has been having access to a team that understands the complexities of long Covid.
"What has made the difference for me is being able to contact my care team, having a reliable, supportive team," she said. "This team understand that my D-dimer runs just under 1000, and every time I can feel when something's wrong, they trust me and get my bloods done, rather than sending me to A&E for people to dismiss me."
She also highlighted the importance of vocational rehabilitation, a key component of support offered to many patients living with persistent symptoms.
"I'm linked into vocational rehab, which has revolutionised my life," she said. "I've been learning how to pace myself, how to understand my battery, about cognitive loading. They've helped me really figure it out, and find my own way."
The trial participants had been living with long Covid symptoms for more than a year on average and typically reported around nine ongoing symptoms when they entered the study, with severe levels of fatigue. Around six in 10 participants experienced a clinically meaningful improvement in fatigue during the first 12 weeks of specialist care.
Although Anjali continues to face significant challenges, she has recently returned to practising as a GP through an NHS England-funded return-to-practice programme.
"This January I started back working as a GP, really slowly, in a supportive practice," she said. "I've remembered that I was this competent person who had a brain, who functioned, who ran a practice. I've remembered what a privilege it is to see people, to see patients, to hear their story."
The research team says the findings provide important evidence to help guide the future development of NHS long Covid services and demonstrate that large-scale NHS trials of long Covid care are feasible, creating opportunities to evaluate new models of care and future treatments.
The team will continue to analyse additional data from the trial, including mental health outcomes, healthcare use and cost-effectiveness, to help identify the most effective and sustainable approaches to caring for people living with Long Covid.
For patients such as Anjali, the findings also validate the importance of ongoing specialist support for a condition that many continue to live with every day.
"People are so over Covid, right? Except for the people who have it," she said. "Even the most caring of people don't understand, and it's a hard thing for them to get their head around."
But, she added, specialist support has helped her navigate the uncertainty of recovery and find a way forward. "They've helped me really figure it out, and find my own way."
