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IntroductionOur aim is to develop a Framework of Measurement for people living with Long COVID and their caregivers for use in Long COVID research and clinical practice. Specifically, we will characterise evidence pertaining to outcome measurement and identify implementation considerations for use of outcome measures among adults and children living with Long COVID and their caregivers.Methods and analysisWe will conduct a scoping study involving: (1) an evidence review and (2) a two-phased consultation, using methodological steps outlined by the Arksey and O’Malley Framework and Joanna Briggs Institute. We will answer the following question: What is known about outcome measures used to describe, evaluate or predict health outcomes among adults and children living with Long COVID and their caregivers? Evidence review: we will review peer review published and grey literature to identify existing outcome measures and their reported measurement properties with people living with Long COVID and their caregivers. We will search databases including MEDLINE, Embase, CINAHL, PsycINFO and Scopus for articles published since 2020. Two authors will independently review titles and abstracts, followed by full text to select articles that discuss or use outcome measures for Long COVID health outcomes, pertain to adults or children living with Long COVID and/or their caregivers and are based in research or clinical settings. We will extract data including article characteristics, terminology and definition of Long COVID, health outcomes assessed, characteristics of outcome measures, measurement properties and implementation considerations. We will collate and summarise data to establish a preliminary Framework of Measurement. Consultation phase 1: we will conduct an environmental scan involving a cross-sectional web-based questionnaire among individuals with experience using or completing outcome measures for Long COVID, to identify outcome measures not found in the evidence review and explore implementation considerations for outcome measurement in the context of Long COVID. Consultation phase 2: we will conduct focus groups to review the preliminary Framework of Measurement and to highlight implementation considerations for outcome measurement in Long COVID. We will analyse questionnaire and focus group data using descriptive and content analytical approaches. We will refine the Framework of Measurement based on the focus group consultation using community-engaged approaches with the research team.Ethics and disseminationProtocol approved by the University of Toronto Health Sciences Research Ethics Board (protocol #46503) for the consultation phases of the study. Outcomes will include a Framework of Measurement, to enhance measurement of health outcomes in Long COVID research and clinical practice. Knowledge translation will also occur in the form of publications and presentations.

The reality of Long COVID emerged soon after the beginning of the COVID-19 pandemic. More than five years later, thousands of articles have been published with multiple case definitions, heterogenous populations, and numerous measurement instruments, yielding a massive amount of evidence. Health outcome measurement is vital for identifying health challenges, changes in health status and predicting future health states for people with Long COVID. Nevertheless, distinct issues of measurement require attention in the context of Long COVID. In this commentary, we discuss complexities, challenges and considerations associated with health outcome measurement in research and clinical practice with people with Long COVID. Specifically, we address: (i) identifying the population in the context of variable terminology, definitions and symptoms affecting people with Long COVID; (ii) identifying the complexity of health constructs, often multidimensional, to measure with numerous health-related consequences associated with Long COVID; (iii) identifying the purpose of measurement while taking into account the dynamic nature of Long COVID and (iv) identifying appropriate outcome measures used with people with Long COVID and their limitations. We highlight important considerations for measurement in research and clinical practice, including the impacts of the various symptoms and the dynamic nature of Long COVID. We provide examples of outcome measures used to date in the context of Long COVID to illustrate the complexities throughout, with a glimpse at wider consequences. We conclude with a brief discussion of considerations to help pave the way forward for the improvement in health outcomes measurement in Long COVID research and clinical practice. Advancing knowledge on Long COVID requires a return to the fundamentals of measurement science. It is critical to appropriately assess the measurement properties of existing instruments for their ability to accurately and reliably measure health-related constructs associated with this condition. Identifying limitations of currently used tools is also essential to prevent perpetuation of issues in the development of condition-specific measurement instruments for Long COVID. This, in turn, will help pave the way for more robust measurement and improved data interpretation in the context of Long COVID.

Composite finger flexion (CFF) is proposed to be a convenient alternative to total active motion (TAM) and total passive motion (TPM). Passive CFF (PCFF) may be useful for early monitoring in post-operative rehabilitation of traumatic hand injuries. To determine whether active and passive CFF are reliable, valid, and responsive measures of hand motion and of higher utility to the tester. Cross-sectional observational clinical measurement study. Fifty hand injury patients were recruited from a hospital-based out-patient clinic. TAM, TPM, repeated measures of active CFF (ACFF) and PCFF, self-reported stiffness, patient reported wrist/hand evaluation (PRWHE) scores, and grip strength were recorded. Intraclass correlation coefficients (ICCs) and standard error of measurement were calculated for inter-rater and test-retest reliability. Criterion and construct validity were assessed using correlation coefficients. Responsiveness was explored by calculating correlation coefficients of change scores, effect sizes, and standardized response means. Time taken to measure CFF and TAM/TPM was recorded to consider utility. The average age of participants was 47 years and 36% were female. Inter-rater and test-retest reliability estimates for ACFF and PCFF were excellent (ICCs = 0.95-98). Standard error of measurement values ranged from 0.21 to 0.33. The correlation coefficient for criterion validity between ACFF and TAM was −0.69; PCFF and TPM was −0.65; and ACFF and PCFF was 0.83. For construct validity, ACFF and TAM were similarly correlated with PRWHE. Correlations between changes in stiffness with ACFF and PCFF were 0.43 and 0.26, respectively. Effect sizes of ACFF and PCFF were small at 0.1 and 0.2. Time taken to measure CFF was much shorter than TAM/TPM. The results of this study support the use of active and passive CFF as a reliable, valid, and efficient tool in the clinical setting. Further study is required to verify the responsiveness of CFF. •Our study examined the measurement properties of composite finger flexion (CFF).•CFF is a reliable, valid, and time-efficient tool in the clinical setting.•Further research is required to verify its responsiveness.•CFF can inform clinical decision-making in post-operative follow-up.•Passive CFF is particularly useful for early acute monitoring.