Post-COVID functional limitations on daily living activities are associated with symptoms experienced at the acute phase of SARS-CoV-2 infection and internal care unit admission: A multicenter study

Relationship between long covid and functional disability in adults and the seniors in the south of Brazil

BACKGROUND

Individuals living with long COVID experience a range of symptoms that affect their ability to carry out daily activities or participate in social and community life. This study aimed to analyze association between functional disability and the occurrence of long COVID symptoms, as well as to analyze the effect of symptom persistence time on functional disability.

METHODS

This is a cross-sectional study using data from the SulCovid-19 study, which interviewed individuals who had COVID-19 between December 2020 and March 2021. The functional disability outcome was assessed using the Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL) scales, while the exposures were the symptoms of long COVID. Adjusted analyses between outcomes and exposures, stratified by time after the acute phase of infection, were performed using Poisson regression with robust variance adjustment.

RESULTS

The prevalence of BADL disability was 4.8% (95%CI 4.0;5.6), and for IADL disability, it was 8.4% (95%CI 7.4;9.4). The main symptoms associated with BADL disability were dyspnea, dry cough and sore throat, while for IADL, they were joint pain, muscle pain, loss of sensation, nasal congestion, sore throat and runny nose. When stratified by tertiles of time after the acute phase of infection, a relationship was found between BADL disability and dyspnea, ageusia and, nasal congestion in the 3rd tertile, while only ageusia was found to be related to IADL disability in the 3rd tertile.

CONCLUSIONS

Long COVID symptoms were associated wiht limitations in the functional capacity of adults and the seniors. The findings can be used to guide the care and rehabilitation of individuals with disabilities who have had COVID-19, particularly for referral to appropriate health professionals.

Predictors of Functional Impairment in Severe COVID-19 Patients Two Months After Discharge

Background

The Post-COVID-19 Functional Status (PCFS) scale is a validated tool used to measure the functional status of patients discharged from the hospital.

Objectives

To describe the functional limitations of hospitalized COVID-19 patients at the time of discharge and two months afterward, and to identify risk factors associated with functional impairment.

Design

Retrospective study.

Methods

A total of 540 patients were included in this monocentric study. The functional status assessment using the PCFS scale and ventilatory needs were recorded at discharge and two months later. Univariate and multivariate analyses were performed in order to identify the risk factors of a high PCFS score.

Results

Two months after discharge, the PCFS grade was 0 in 60,6% of the survivors, 1 in 24.5%, 2 in 6.9%, 3 in 2.8%, and 4 in 5.3%. The identified risk factors of a high PCFS scale were: age, arterial hypertension, diabetes mellitus, immunosuppression, cardiovascular disease, high need for oxygen and high News2 score at admission, a high percentage of ground glass at chest CT scan performed at admission or during follow-up, elevated leukocytes, neutrophils, LDH, D-dimers, procalcitonin, and serum creatinine levels. During the hospital stay, treatment with steroids, tocilizumab, longer duration of hospitalization, ICU admission and prolonged stay, and the occurrence of thromboembolic or hemorrhagic events were also significantly associated with a higher PCFS. Multivariate analysis identified that only age and a high News2 score at admission were independent risk factors of a low PCFS score.

Conclusion

Multiple risk factors for a higher PCFS score were identified, but only age and a high News2 score at admission were found to be independent risk factors.

Continuous Assessment of Function and Disability via Mobile Sensing: Real-World Data-Driven Feasibility Study

BACKGROUND

Functional limitations are associated with poor clinical outcomes, higher mortality, and disability rates, especially in older adults. Continuous assessment of patients' functionality is important for clinical practice; however, traditional questionnaire-based assessment methods are very time-consuming and infrequently used. Mobile sensing offers a great range of sources that can assess function and disability daily.

OBJECTIVE

This work aims to prove the feasibility of an interpretable machine learning pipeline for predicting function and disability based on the World Health Organization Disability Assessment Schedule (WHODAS) 2.0 outcomes of clinical outpatients, using passively collected digital biomarkers.

METHODS

One-month-long behavioral time-series data consisting of physical and digital activity descriptor variables were summarized using statistical measures (minimum, maximum, mean, median, SD, and IQR), creating 64 features that were used for prediction. We then applied a sequential feature selection to each WHODAS 2.0 domain (cognition, mobility, self-care, getting along, life activities, and participation) in order to find the most descriptive features for each domain. Finally, we predicted the WHODAS 2.0 functional domain scores using linear regression using the best feature subsets. We reported the mean absolute errors and the mean absolute percentage errors over 4 folds as goodness-of-fit statistics to evaluate the model and allow for between-domain performance comparison.

RESULTS

Our machine learning-based models for predicting patients' WHODAS functionality scores per domain achieved an average (across the 6 domains) mean absolute percentage error of 19.5%, varying between 14.86% (self-care domain) and 27.21% (life activities domain). We found that 5-19 features were sufficient for each domain, and the most relevant being the distance traveled, time spent at home, time spent walking, exercise time, and vehicle time.

CONCLUSIONS

Our findings show the feasibility of using machine learning-based methods to assess functional health solely from passively sensed mobile data. The feature selection step provides a set of interpretable features for each domain, ensuring better explainability to the models' decisions-an important aspect in clinical practice.

Long-term health consequences among individuals with SARS-CoV-2 infection compared to individuals without infection: results of the population-based cohort study CoMoLo Follow-up

BACKGROUND

Most of the previous studies on health sequelae of COVID-19 are uncontrolled cohorts and include a relatively short follow-up. This population-based multi-center cohort study examined health consequences among individuals about 1 to 1.5 years after SARS-CoV-2 infection compared with non-infected.

METHODS

The study population consisted of adults (≥ 18 years) from four municipalities particularly affected by the COVID-19 pandemic in the year 2020 who completed a detailed follow-up questionnaire on health-related topics. Exposure was the SARS-CoV-2 infection status (based on IgG antibodies, PCR test, or physician-diagnosis of COVID-19) at baseline (May to December 2020). Outcomes assessed at follow-up (October 2021 to January 2022; mean: 452 days) included recurrent or persistent health complaints, incident diseases, health-related quality of life (PROMIS-29), subjective health, and subjective memory impairment. Logistic and linear regression models were adjusted for baseline sociodemographic and lifestyle characteristics (age, sex, municipality, education, smoking, body mass index), pre-existing health conditions (chronic disease/health problem, health-related activity limitation, depressive/anxiety disorder), and follow-up time.

RESULTS

Among 4817 participants, 350 had a SARS-CoV-2 infection at baseline and 4467 had no infection at baseline or during follow-up. Those with an infection statistically significantly more often reported 7 out of 18 recurrent or persistent health complaints at follow-up: smell/taste disorders (12.8% vs. 3.4%, OR 4.11), shortness of breath (23.0% vs. 9.5%, 3.46), pain when breathing (4.7% vs. 1.9%, 2.36), fatigue (36.9% vs. 26.1%, 1.76), weakness in legs (12.8% vs. 7.8%, 1.93), myalgia/joint pain (21.9% vs. 15.1%, 1.53) and cough (30.8% vs. 24.8%, 1.34) and 3 out of 6 groups of incident diseases: liver/kidney (2.7% vs. 0.9%, 3.70), lung (3.2% vs. 1.1%, 3.50) and cardiovascular/metabolic (6.5% vs. 4.0%, 1.68) diseases. Those with an infection were significantly more likely to report poor subjective health (19.3% vs. 13.0%, 1.91), memory impairment (25.7% vs. 14.3%, 2.27), and worse mean scores on fatigue and physical function domains of PROMIS-29 than non-infected.

CONCLUSION

Even after more than one year, individuals with SARS-CoV-2 infection showed an increased risk of various health complaints, functional limitations, and worse subjective well-being, pointing toward profound health consequences of SARS-CoV-2 infection relevant for public health.

Comparison of Medical and Mental Health Sequelae Following Hospitalization for COVID-19, Influenza, and Sepsis

Importance

People who survive hospitalization for COVID-19 are at risk for developing new cardiovascular, neurological, mental health, and inflammatory autoimmune conditions. It is unclear how posthospitalization risks for COVID-19 compare with those for other serious infectious illnesses.

Objective

To compare risks of incident cardiovascular, neurological, and mental health conditions and rheumatoid arthritis in 1 year following COVID-19 hospitalization against 3 comparator groups: prepandemic hospitalization for influenza and hospitalization for sepsis before and during the COVID-19 pandemic.

Design, Setting, and Participants

This population-based cohort study included all adults hospitalized for COVID-19 between April 1, 2020, and October 31, 2021, historical comparator groups of people hospitalized for influenza or sepsis, and a contemporary comparator group of people hospitalized for sepsis in Ontario, Canada.

Exposure

Hospitalization for COVID-19, influenza, or sepsis.

Main Outcome and Measures

New occurrence of 13 prespecified conditions, including cardiovascular, neurological, and mental health conditions and rheumatoid arthritis, within 1 year of hospitalization.

Results

Of 379 366 included adults (median [IQR] age, 75 [63-85] years; 54% female), there were 26 499 people who survived hospitalization for COVID-19, 299 989 historical controls (17 516 for influenza and 282 473 for sepsis), and 52 878 contemporary controls hospitalized for sepsis. Hospitalization for COVID-19 was associated with an increased 1-year risk of venous thromboembolic disease compared with influenza (adjusted hazard ratio, 1.77; 95% CI, 1.36-2.31) but with no increased risks of developing selected ischemic and nonischemic cerebrovascular and cardiovascular disorders, neurological disorders, rheumatoid arthritis, or mental health conditions compared with influenza or sepsis cohorts.

Conclusions and Relevance

In this cohort study, apart from an elevated risk of venous thromboembolism within 1 year, the burden of postacute medical and mental health conditions among those who survived hospitalization for COVID-19 was comparable with other acute infectious illnesses. This suggests that many of the postacute consequences of COVID-19 may be related to the severity of infectious illness necessitating hospitalization rather than being direct consequences of infection with SARS-CoV-2.

Risk factors associated with limited functional status among out-of-hospital patients 30 days and one year after a diagnosis of COVID-19: a cohort study

Some people experience indefinitely persistent and disabling symptoms after acute COVID-19, even those who have not been hospitalized. The purpose of this study was to analyze the long-term health consequences at 30 days and one year among people who were not hospitalized after a diagnosis of COVID-19 and to analyze which variables predict limitations in functional status. This is a prospective cohort study with non-hospitalized adults infected with SARS-CoV-2 in the city of Londrina. After 30 days and one year of the acute symptoms of COVID-19, participants received the questionnaire through a social media that consisted of sociodemographic data and data on functionality through the Post-COVID Functional State Scale (PCFS)-the primary outcome of the study "presence of functional status limitation" was grouped into without functional status limitation (value: zero) and with functional limitation (value 1 to 4), fatigue through of the Fatigue Severity Scale (FSS) and dyspnea using the modified Borg scale. In the statistical analysis, multivariable analysis was performed. Statistical significance was set to 5%. Of 140 individuals analyzed, 103 (73.6%) were female with a median age of 35.5 (27-46) years. One year after the diagnosis of COVID-19, 44.3% had at least one self-reported symptom: memory loss (13.6%), gloominess (8.6%), anosmia (7.9%), body pain (7.1%), ageusia (7%), headache (6.4%), and cough (3.6%). According to the FSS and modified Borg scale 42.9% reported fatigue and 18.6% reported dyspnea, respectively. As for functionality, 40.7% reported some limitation, being 24.3% negligible functional limitation, 14.3% slight and 2.1% moderate according to the PCFS. There was a univariate association between the presence of limitation in the functional status with the female sex, diagnosis of anxiety and depression, presence of persistent symptoms after one year, fatigue and dyspnea. In the multivariable analysis, the predictor variables for functional status limitation were female sex, diagnosis of anxiety/depression, presence of at least one persistent symptom and fatigue one year after the diagnosis of COVID-19. One year after the disease, the patients presented functional limitation according to the PCFS, even without hospitalization. Risk factors associated with functional limitation include female sex, presence of fatigue, anxiety and depression, and at least one persistent symptom after one year of COVID-19 diagnosis.

The Symptom Experience and Functioning of Non-Hospitalized COVID-19 Patients Within the First 20 days

The adverse physical, psychological, and mental health consequences associated with COVID-19 illness are well-documented. However, how specific symptoms change over time and how COVID-19 affects one's day-to-day activities of daily living (ADL), Quality of Life (QoL), sleep quality, and fatigue severity are not well described. This longitudinal and descriptive study examined the changes in COVID-19 symptoms, ADL, QoL, sleep quality, and fatigue severity within the first 20 days. A convenience sample (n = 41) of non-hospitalized SARS-CoV-2 positive patients were recruited and followed for 20 days. Participants completed self-report measures: COVID-19 symptoms, ADL, QoL, sleep quality, and fatigue severity at days: 1, 10, and 20 following a diagnosis. Findings revealed that symptoms decreased over 20 days (p < .001). In parallel with the decrease in symptoms, QoL and ADL improved over 20 days (p < .05). However, sleep quality and fatigue severity did not improve within 20 days (p > .05). Our findings contribute to the growing evidence that COVID-19 symptoms can linger, especially fatigue and sleep quality, that affect overall day-to-day functioning for at least 20 days after diagnosis. To mitigate the effect of COVID-19 on QOL and ADL, findings underscore the need for clinicians to work collaboratively with patients to develop a symptom management plan for a variety of symptoms including fatigue and sleep quality. Beginning to repurpose existing self-management strategies for the longer term COVID-19 symptoms could be beneficial and help to optimize patient outcomes. Future work should examine these variables over a longer timeframe and among different samples of non-hospitalized patients.

A comparison of pain, fatigue, and function between post-COVID-19 condition, fibromyalgia, and chronic fatigue syndrome: a survey study

ABSTRACT

A growing number of individuals report prolonged symptoms following acute Coronavirus-19 (COVID-19) infection, known as post-COVID-19 condition (post-COVID-19). While studies have emerged investigating the symptom sequelae of post-COVID-19, there has been limited investigation into the characterization of pain, fatigue, and function in these individuals, despite initial reports of a clinical phenotype similar to fibromyalgia syndrome (FMS) and chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME). This study aimed to characterize multiple symptom domains in individuals reporting post-COVID-19 and compare its clinical phenotype with those with FMS and CFS. A total of 707 individuals with a single or comorbid diagnosis of post-COVID-19, FMS, and/or CFS completed multiple surveys assessing self-reported pain, fatigue, physical and cognitive function, catastrophizing, kinesiophobia, anxiety, depression, dyspnea, and sleep quality. In all 3 diagnoses, elevated pain, fatigue, anxiety, depression, catastrophizing, and kinesiophobia were reported. Physical and cognitive function were similarly impacted among individuals with post-COVID-19, FMS, and CFS; however, individuals with post-COVID-19 reported lower pain and fatigue than FMS and CFS. The comorbid diagnosis of post-COVID-19 with FMS and/or CFS further exacerbated pain, fatigue, and psychological domains when compared with post-COVID-19 alone. In summary, individuals with post-COVID-19 report a symptom phenotype similar to FMS and CFS, negatively impacting cognitive and physical function, but with less severe pain and fatigue overall. These findings may help direct future investigations of the benefit of a biopsychosocial approach to the clinical management of post-COVID-19.

Post-COVID-19 functional limitations in hospitalized patients and associated risk factors: A 3-month follow-up study

Background and Purpose

Many patients experience post‐COVID‐19 functional limitations. This study aimed to monitor the functional improvement of patients over 3 months of follow‐up and determine the risk factors.

Methods

This prospective cohort study evaluated 100 hospitalized patients who recovered from COVID‐19 infection. The mean age was 53.2 ± 13.1 years. Fifty‐nine had at least one comorbid condition. The mean lengths of the hospital and ICU stays were 7.8 ± 3.3 and 5.3 ± 2.5 days, respectively. The functional status of the patients was evaluated using functional independence measure (FIM) and post‐COVID‐19 functional status (PCFS) questionnaires at four time‐points of discharge, 1 week, 1 month, and 3 months after discharge.

Results

Mean FIM score was 107.2 ± 17.4 at the time of discharge, 113.3 ± 14.9 at 1 week, 120.3 ± 10.2 at 1 month, and 124.3 ± 6.4 at 3 months after discharge (p < 0.001). The PCFS score was 2.71 ± 1.25 at discharge, 2.09 ± 1.3 at 1 week, 1.14 ± 1.1 at 1 month, and 0.64 ± 0.59 at 3 months after discharge (p < 0.001). Female sex, older age, and the lengths of hospital and ICU stays were negatively correlated with the functional status score.

Discussion

Post‐COVID‐19 functional limitations are observed in hospitalized patients and improve over 3 months after discharge. Female sex, older age, longer hospital, and ICU stays are risk factors that negatively impact functional status.

Persistent, new-onset symptoms and mental health complaints in Long COVID in a Brazilian cohort of non-hospitalized patients

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections lead to acute- and chronic Long COVID (LC) symptoms. However, few studies have addressed LC sequelae on brain functions. This study was aimed to examine if acute symptoms of coronavirus disease 2019 (COVID-19) would persist during LC, and if memory problems would be correlated with sleep, depressive mood, or anxious complaints.

METHODS

Our work followed a cohort of 236 patients from two public hospitals of the Federal District in mid-western Brazil. Patients' interviews checked for clinical symptoms during acute and LC (5-8 months after real-time reverse transcription polymerase chain reaction, RT-qPCR).

RESULTS

Most cases were non-hospitalized individuals (86.3%) with a median age of 41.2 years. While myalgia (50%), hyposmia (48.3%), and dysgeusia (45.8%) were prevalent symptoms in acute phase, fatigue (21.6%) followed by headache (19.1%) and myalgia (16.1%) commonly occurred during LC. In LC, 39.8% of individuals reported memory complaints, 36.9% felt anxious, 44.9% felt depressed, and 45.8% had sleep problems. Furthermore, memory complaints were associated with sleep problems (adjusted OR 3.206; 95% CI 1.723-6.030) and depressive feelings (adjusted OR 3.981; 95% CI 2.068-7.815).

CONCLUSIONS

The SARS-CoV-2 infection leads to persistent symptoms during LC, in which memory problems may be associated with sleep and depressive complaints.