Post-COVID-19 functional status scale: Cross-cultural adaptation and measurement properties of the Brazilian Portuguese version

Insomnia, cardiorespiratory function and quality of life in individuals with post-COVID-19 fatigue

Objective

This study aimed to compare the prevalence of insomnia, lung function, inspiratory muscle function, functional capacity, and quality of life in individuals with and without post-COVID-19 fatigue.

Methods

Thirty-four post-COVID-19 individuals participated in the study, 20 with fatigue (32 ± 12 years old, 15% male) and 14 without fatigue (31 ± 12 years old, 42.9% male). The Chalder Fatigue Scale (CFS) was employed to categorize the volunteers into two groups: those with fatigue (score ≥4) and those without fatigue (score <4). The Insomnia Severity Index (ISI) and the Epworth Sleepiness Scale (ESS) were used to assess insomnia and excessive daytime sleepiness, respectively. Pulmonary function was evaluated by spirometry, inspiratory muscle strength was assessed by the maximum inspiratory pressure (MIP), and inspiratory endurance was evaluated by maintaining an inspiratory load of 60% of MIP until fatigue. The 6-min walk test (6MWT) was used to evaluated functional capacity, while the WHOQOL-BREF questionnaire assessed quality of life.

Results

Individuals with post-COVID-19 fatigue demonstrated a higher prevalence of insomnia (80% vs. 49%) and excessive daytime sleepiness (45% vs. 7%), as well as lower MIP, shorter distance covered in the 6MWT, and lower FEV1/FVC (forced expired volume in the first second divided by forced vital capacity), and FEV1/FVC% of predicted. Additionally, they exhibited poorer quality of life in the physical and environmental domains. CFS demonstrated a direct correlation with ISI (r=0.436, p=0.01) and ESS (r=0.593, p=0.001), as well as an inverse correlation with the distance covered in the 6MWT (r=-0.398, p=0.022) and FEV1 (r=-0.412, p=0.01). ISI was an independent predictor of CFS, with 62% of CFS variance explained by ISI variance.

Conclusion

Individuals with symptoms of post-COVID-19 fatigue may have a higher prevalence of insomnia, reduced inspiratory muscle strength, functional capacity, and Tiffeneau index, along with impaired quality of life. ISI is an independent predictor of post-COVID-19 fatigue.

Post-COVID-19 functional status in socioeconomically vulnerable neighborhoods attended in primary health care in two Brazilian cities: a cross-sectional study

BACKGROUND

The prolonged effects of COVID-19 present social costs and pose challenges to public health infrastructure, necessitating the implementation of public policies for comprehensive post-COVID-19 care.

OBJECTIVE

This study aimed to assess post-COVID functional status and associated sociodemographic factors and health inequalities among residents of socioeconomically vulnerable neighborhoods who attended primary health care in two Brazilian cities.

METHODS

A cross-sectional study was conducted from July 2022 to July 2023 in Salvador and Rio de Janeiro. We included participants who sought COVID-19 tests in primary health care services, had previously contracted COVID-19, and completed the post-COVID-19 functional status scale. Post-COVID syndrome was classified as none, negligible/slight, or moderate/severe. Sociodemographic characteristics, health conditions, and access to health services were analyzed as explanatory variables. Descriptive and bivariate analyses were performed. Using multinomial logistic regression, we estimated the adjusted odds ratios (aORs) and their 95% confidence intervals (95%CIs).

RESULTS

Among the 3,067 participants, the overall prevalence of post-COVID functional limitations status was 34.6% (26.7% and 7.9% reporting negligible/slight and moderate/severe, respectively). The following variables were associated with moderate/severe functional status: living in households with fewer rooms (aOR = 1.66, 95%CI: 1.23-2.24), female gender (aOR = 1.57, 95%CI: 1.14-2.16), older age (aOR = 1.02, 95%CI: 1.01-1.03), self-reported diabetes mellitus (aOR = 1.78, 95%CI: 1.17-2.69), respiratory diseases (aOR = 2.59, 95%CI: 1.56-4.29), having contracted COVID-19 two or more times (aOR = 1.57, 95%CI: 1.15-2.14), not having had a medical appointment in the last 12 months (aOR = 1.70, 95%CI: 1.24-2.33), difficulty accessing COVID-19 testing (aOR = 1.63, 95%CI: 1.05-2.52), and experience discrimination in health services (aOR = 2.85, 95%CI: 1.87-4.35).

CONCLUSIONS

Our findings indicate varying degrees of post-COVID functional limitation status among residents of socioeconomically vulnerable neighborhoods who have recovered from COVID-19. People who live in homes with fewer rooms, are female, older, have pre-existing diabetes or respiratory diseases, have been reinfected with COVID-19, have difficulty accessing COVID-19 testing and those who experienced discrimination in health services are at higher chance of developing post-COVID syndrome.

Mobile application development to improve the active search for functional impairment and persistent symptoms in individuals post-COVID-19

OBJECTIVES

This study aimed to develop a mobile application (App) to be used by primary care teams in the active search for functional impairment, long-term symptoms, and disabilities in individuals who have recovered from COVID-19, contributing to early treatment and referrals for multidisciplinary care and rehabilitation. This experimental study used the minimum viable product (MVP) methodology to develop an App named ReabilitaCOVID.

METHODS

This methodology involves ideation, content creation, prototype creation, usability tests, and adjustments based on feedback. The study was conducted in Brazil, and the population of the study included community health workers, who were the App's target users, and individuals from the community who had previously had COVID-19 and were at risk of developing PCS.

RESULTS

The App included a sociodemographic questionnaire, a clinical questionnaire, the post-COVID-19 Functional Status Scale (PCFS), the Modified Medical Research Council (MRC) Dyspnea Scale, and a flowchart. Usability tests were conducted, with feedback collected and adjustments made for improvements. Barriers to community health workers' use of the application were identified.

CONCLUSION

A tailored app was developed for primary care teams to use in the active search for PCS. Functional and usability tests were performed in simulated and real environments. The App has the potential to facilitate referrals for multidisciplinary care and rehabilitation efficiently, and it will be available freely to public health care services. MVP is a suitable approach for developing a tailored App for healthcare teams.

Health Resort Treatment Improves Functioning and Physical Performance in Long COVID Patients: A Retrospective Study

BACKGROUND/OBJECTIVES

The physical performance and functional status of individuals with long COVID may be altered. Health resort treatment comprises balneology, exercises, physical medicine modalities, and climate therapy. Complex treatment in a sanatorium may have a positive effect on long COVID patients. This study assessed functional status, physical performance, and fatigue in people with long COVID that qualified for the health resort treatment and its efficacy in this group of patients.

METHODS

A retrospective review of the medical records of 116 patients (66 women and 50 men) undergoing health resort treatment for long COVID in 2021 at the Rehabilitation Hospital and Sanatorium "Gwarek" in Goczałkowice-Zdrój (Poland) was conducted. Data were collected between March and May 2024. Their functional status, physical performance, and level of fatigue were assessed twice: before and after the treatment.

RESULTS

After the health resort treatment, their physical performance (10.41 points ± 1.84 points vs. 11.57 points ± 0.94 points; p < 0.00001) and functional status (2.13 points ± 0.88 points vs. 1.23 points ± 0.62 points; p < 0.00001) improved. Their fatigue (4.83 points ± 2.38 points vs. 2.15 points ± 1.31 points; p < 0.00001) level was diminished after the treatment.

CONCLUSIONS

Fatigue was of moderate intensity in the long COVID patients that qualified for the health resort treatment. Most of the long COVID patients reported mild functional limitations, whereas their physical performance was undisturbed. Health resort treatment improved functioning in patients with persistent COVID-19 symptoms by reducing fatigue, improving their functional capacity and physical performance. It should be recommended as a supplement to the standard treatment because of its complexity.

The Tinetti Balance Test Is an Effective Predictor of Functional Decline in Non-Hospitalized Post-COVID-19 Individuals: A Cross-Sectional Study

Background/Objectives: Individuals with post-COVID-19 conditions risk developing short- and/or long-term neuromuscular impairments, including postural imbalance. However, there is limited evidence showing whether balance deficits are associated with declines in the functional status in post-COVID-19 individuals. This study examined postural balance in non-hospitalized post-COVID-19 individuals using different assessment tools and tested the most relevant balance tools in predicting functional status. Methods: This cross-sectional study enrolled 60 adults split into control (n = 30) and post-COVID-19 (n = 30) groups. Postural balance was assessed in both groups using the Functional Reach Test (FRT), Berg Balance Scale (BBS), Timed Up and Go (TUG), Tinetti Balance Test (Tinetti), and Mini-BESTest (MBT). Functional status in the post-COVID-19 group was assessed using post-COVID-19 functional status (PCFS). Results: Significant differences in postural stability between groups were found only for the FRT. All balance tests showed a statistically significant correlation with PCFS in the post-COVID-19 group, with better performance in all tests being associated with better functional status: Tinetti (r = -0.584), FRT (r = -0.542), MBT (r = -0.530), BBS (r = -0.415) and TUG (r = 0.368). Tinetti was the independent variable that significantly played an important role in determining PCFS (adjusted R2 = 0.318, p < 0.001). Conclusions: Post-COVID-19 functional status is best determined by the Tinetti Balance Test, making it an effective tool for assessing postural balance deficits in this population, with potential implications for postural control assessment and rehabilitation.

Reliability and validity of the online application of London Chest Activity of Daily Living scale in assessing dyspnea-related functional impairment in individuals after hospitalization for COVID-19

PURPOSE

To investigate the test-retest reliability and construct validity of the LCADL scale applied via online form in individuals after hospitalization for COVID-19.

METHODS

Methodological study. After hospitalization for COVID-19 individuals completed the LCADL via online form at two separate times. They also answered the post-COVID-19 Functional Status Scale (PCFS), dyspnea, fatigue, and health perception scales, modified Medical Research Council (MRCm), Short Form Health Survey 36 (SF-36). Hospitalization data were collected from the individual's medical record.

RESULTS

104 individuals participated in the study (57 men, 45.2 ± 11.9 years). The LCADL showed moderately to high test-retest reliability (ICC: 0.73-0.86; p < 0.001), there was no difference in scores between test and retest (p > 0.05), the mean difference between the applications was smaller than the standard error of measurement and the internal consistency was adequate (Cronbach's α = 0.70-0.94). In addition, it demonstrated adequate construct validity, showing correlations with PCFS, dyspnea perception, fatigue and health scales, mMRC, SF-36, and length of stay in the Intensive Care Unit (p < 0.05). The LCADL as percentage of the total score presented a significant floor effect (25%).

CONCLUSION

The LCADL applied online was reliable and valid for assessing limitations due to dyspnea in ADL in individuals after hospitalization for COVID-19.

Prediction models for physical function in COVID-19 survivors

BACKGROUND

The burden of caring for patients who have survived COVID-19 will be enormous in the coming years, especially with respect to physical function. Physical function has been routinely assessed using the Post-COVID-19 Functional Status (PCFS) scale.

AIM

This study built prediction models for the PCFS scale using sociodemographic data, clinical findings, lung function, and muscle strength.

METHOD

Two hundred and one patients with post-COVID-19 syndrome (PCS) completed the PCFS scale to assess physical function. Their levels of general fatigue were also assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale, handgrip strength (HGS), and spirometry.

RESULTS

The number of participants who scored 0 (none), 1 (negligible), 2 (slight), 3 (moderate), and 4 (severe) on the PCFS scale was 25 (12%), 40 (20%), 39 (19%), 49 (24%), and 48 (24%), respectively. The PCFS scale was significantly correlated with the following variables: FACIT-F score (r = -0.424, P < 0.001), HGS (r = -0.339, P < 0.001), previous hospitalization (r = 0.226, P = 0.001), body mass index (r = 0.163, P = 0.021), and sex (r = -0.153, P = 0.030). The regression model with the highest coefficient of regression (R = 0.559) included the following variables: age, sex, body mass index, FACIT-F, HGS, and previous hospitalization.

CONCLUSIONS

Worse general fatigue and HGS are associated with more severe physical function impairments in PCS patients. Furthermore, a history of prior hospitalization results in worse physical function. Thus, prediction models for the PCFS scale that incorporate objective measures enable a better assessment of the physical function of these patients, thus helping in the selection of candidates for a program of physical reconditioning.

Interrater Reliability of the Spanish (Colombia) Version of the Post-COVID-19 Functional Status Scale

Background

COVID-19 has been one of the most critical public health challenges of recent decades. This disease develops severely in one in five patients, and approximately 5% require admission to a critical care unit. Due to the impact of the sequelae, the Post-COVID-19 Functional Status Scale (PCFS) was developed. This study is aimed at determining the interrater reliability of the Spanish (Colombia) version of the PCFS in adult patients with post-COVID-19 infection.

Methods

This is an observational study performed with patients diagnosed with COVID-19. Two evaluators repeated the test-retest of the PCFS scale with knowledge and clinical experience in the care of patients with COVID-19 and had previously applied the test. The PCFS assesses functional limitations at discharge and can be used at 4 and 8 weeks to evaluate practical consequences and determine the degree of disability these patients may have. For interrater reliability, Cronbach's alpha was applied with its respective confidence interval and the Bland-Altman method. A 95% confidence interval (CI) was taken as the basis for the interpretation of the Intraclass Correlation Coefficient (ICC).

Results

A total of 112 adult patients participated in the study, aged 51.46 ± 15.94 years. It was evidenced that the survival, constant care, and activities of daily living questions have an ICC of one (1.000) with an ICC (1.000-1.000), demonstrating excellent reliability, while those close to one were instrumental activities, role participation, symptoms, and final score with an ICC 0.918 to 0.984 and an ICC (0.881-0.989). Thus, a homogeneous distribution of the interrater data was evident.

Conclusions

Excellent interobserver reliability of the Spanish (Colombia) version of the PCFS in patients with different degrees of functional status was reported.