Psychometric properties of the Spanish version of the EuroQol-5D-5L in previously hospitalized COVID-19 survivors with long COVID

[Spanish version of the Nordic Musculoskeletal Questionnaire: cross-cultural adaptation and validation in nursing aides]

BACKGROUND

The aim of this study is to translate, culturally adapt, and validate a Spanish version of the Nordic Musculoskeletal Questionnaire for a sample of nursing assistant aides.

METHODS

The questionnaire was translated and culturally adapted. Next, it was included in a battery of tests that was completed by 526 nursing assistants working in residential care homes in the Principality of Asturias (Spain). To assess its validity, the Exploratory Factor Analysis and the Confirmatory Factor Analysis were used. The internal consistency was estimated with McDonald's Omega coefficient (?), complemented by the test-retest reliability analysis through the intraclass correlation coefficient. The validity of the criteria was established by the correlation between total score on the test and quality of life measures, job insecurity and psychological demand, and social support at work.

RESULTS

The Exploratory Factor Analysis and Confirmatory Factor Analysis adjustment indices confirmed it is a unidimensional test. The internal consistency values indicated very high reliability (? = 0.81). Similarly, the intraclass correlation coefficient showed statistically significant values and an excellent correlation coefficient (r = 0.95). The validity of the criteria showed a statistically significant correlation with all the constructs studied, particularly with quality of life.

CONCLUSIONS

This Spanish version of the Nordic Musculoskeletal Questionnaire has good psychometric qualities for a population of nursing aides and therefore may be a valid and reliable tool for assessing musculoskeletal disorders.

Impact of Work-Life Balance on the Quality of Life of Spanish Nurses during the Sixth Wave of the COVID-19 Pandemic: A Cross-Sectional Study

This study addresses the health-related quality of life (HRQoL) of Spanish nurses during the sixth wave of the COVID-19 pandemic, assessed through the EQ-5D and EQ-VAS indices.

METHODS

This cross-sectional 334 study used online surveys, recruiting 305 Spanish nurses.

RESULTS

Nurses generally perceived a good HRQoL. "Negative work-family interaction" is adversely associated with the EQ-VAS (β = -0.337, 95% CI [-1.733, -0.723]) and EQ-5D (β = -0.399, 95% CI [-0.021, -0.01]) indices, while "positive work-family interaction" shows a positive relationship with the EQ-VAS (β = 0.218, 95% CI [0.381, 1.759]). The presence of a "paid supportive caregiver" is positively associated with the EQ-VAS (β = 0.18, 95% CI [1.47, 12.3]) and EQ-5D (β = 0.149, 95% CI [0.004, 0.117]) indices, but a higher "number of children" is negatively linked with the EQ-5D index (β = -0.146, 95% CI [-0.061, -0.002]). In addition, living with a partner (EQ-VAS β = 0.16, 95% CI [1.094, 14.67] and EQ-5D index β = 0.174, 95% CI [0.018, 0.163]) and working a "rotating shift" (EQ-5D index β = 0.158, 95% CI [0.005, 0.098]) are positively associated.

CONCLUSIONS

These findings highlight the need to comprehensively address nurses' well-being, considering both their working conditions and their home environment, especially in crisis contexts such as the current pandemic.

The knowns and unknowns of long COVID-19: from mechanisms to therapeutical approaches

The coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 has been defined as the greatest global health and socioeconomic crisis of modern times. While most people recover after being infected with the virus, a significant proportion of them continue to experience health issues weeks, months and even years after acute infection with SARS-CoV-2. This persistence of clinical symptoms in infected individuals for at least three months after the onset of the disease or the emergence of new symptoms lasting more than two months, without any other explanation and alternative diagnosis have been named long COVID, long-haul COVID, post-COVID-19 conditions, chronic COVID, or post-acute sequelae of SARS-CoV-2 (PASC). Long COVID has been characterized as a constellation of symptoms and disorders that vary widely in their manifestations. Further, the mechanisms underlying long COVID are not fully understood, which hamper efficient treatment options. This review describes predictors and the most common symptoms related to long COVID's effects on the central and peripheral nervous system and other organs and tissues. Furthermore, the transcriptional markers, molecular signaling pathways and risk factors for long COVID, such as sex, age, pre-existing condition, hospitalization during acute phase of COVID-19, vaccination, and lifestyle are presented. Finally, recommendations for patient rehabilitation and disease management, as well as alternative therapeutical approaches to long COVID sequelae are discussed. Understanding the complexity of this disease, its symptoms across multiple organ systems and overlapping pathologies and its possible mechanisms are paramount in developing diagnostic tools and treatments.

The impact of a neuromuscular rehabilitation programme on the quality of life of patients with acute coronary syndrome and its relationship with sexual dysfunction: a randomised controlled trial

PURPOSE

Many patients with acute coronary syndrome experience problematic or altered sexual function. This aspect of the disease is frequently ignored or overlooked by the healthcare community even though it can strongly influence health-related patient quality of life (HRQoL). Thus, the aim of this study was to compare the effects of a specific cardiac rehabilitation programme focused on aerobic and neuromuscular strength-resistance training to those of a classic rehabilitation programme, both in terms of HRQoL and erectile dysfunction in patients with acute coronary syndrome.

METHODS

This study reports both secondary and unregistered outcomes from a double-blinded, randomised, and controlled clinical trial. The proposed intervention was based on the completion of a 20-session (10-week) cardiac rehabilitation programme for patients with cardiovascular disease. The patient cohort had been diagnosed with acute coronary syndrome and was recruited at the Cardiology Service of a private tertiary hospital. The outcomes assessed in this study were HRQoL and erectile disfunction assessed at baseline, after the intervention, and at a 6-month follow-up.

RESULTS

A total of 30 participants were randomly allocated to each study arm. The results of the two-way mixed ANOVAs showed significant group × time interactions for all the outcome measures (EQ-5D_index, p = 0.004; EQ-5D_VAS, p = 0.017; QLMI-Q, p ≤ 0.001; and IIEF-5, p = 0.001).

CONCLUSION

The neuromuscular strength training programme was more effective than the classic strength training programme in terms of increasing the HRQoL and improving erectile dysfunction in patients following acute coronary syndrome, with differences still remaining between these groups at the 6-month follow-up.

High Plasma Osteopontin Levels Are Associated with Serious Post-Acute-COVID-19-Related Dyspnea

COVID-19 survivors commonly report persistent symptoms. In this observational study, we investigated the link between osteopontin (OPN) and post-acute COVID-19 symptoms and lung functional/imaging abnormalities. We recorded symptoms and lung imaging/functional data from previously hospitalized COVID-19 patients, who were followed for 4-84 weeks (122 patients/181 visits) post-symptom onset at our outpatient clinic. Circulating OPN was determined using ELISA. Plasma OPN levels were higher in symptomatic patients (compared with the asymptomatic ones); those with dyspnea (compared with those without dyspnea);those with a combination of serious symptoms, i.e., the presence of at least one of the following: dyspnea, fatigue and muscular weakness (compared with those with none of these symptoms); and those with dyspnea and m-MRC > 1 (compared with those with m-MRC = 0-1). Plasma OPN levels were inversely correlated with EQ-VAS (visual analog scale of the EQ-5D-5L health-related quality-of-life questionnaire) values. High-resolution CT or diffusion lung capacity (DLCO) findings were not related to circulating OPN. In the multiple logistic regression, the presence of symptoms, dyspnea, or the combination of serious symptoms were linked to female gender, increased BMI and pre-existing dyspnea (before the acute disease), while increased plasma OPN levels, female gender and pre-existing dyspnea with m-MRC > 1 were independently associated with severe post-COVID-19 dyspnea (m-MRC > 1). Using a correlation matrix to investigate multiple correlations between EQ-VAS, OPN and epidemiological data, we observed an inverse correlation between the OPN and EQ-VAS values. Increased circulating OPN was linked to the persistence of severe exertional dyspnea and impaired quality of life in previously hospitalized COVID-19 patients.

Digital physiotherapy is a satisfactory and effective method to improve the quality of life in Long COVID patients

Objective

This research aimed to explore Long COVID patient's quality of life, satisfaction and perception with an individualized and customizable digital physiotherapy intervention during a 4-week period.

Methods

A pre-post clinical trial was conducted with 32 Long COVID patients. Quality of life was assessed using the 12-Item Short Form Survey and the European Quality of Life-5 Dimensions questionnaire (EuroQol-5D), while satisfaction and perception were measured using the Telemedicine Satisfaction Questionnaire. Optional open-ended questions were added as qualitative approach. A mixed design method was conducted.

Results

After intervention, a statistically significant improvement (p < 0.05) was observed in quality of life. The SF-12 questionnaire showed an increase of 4.04 points in the physical component and 6.55 points in the mental component with a small/medium effect size. The EuroQoL-5D questionnaire demonstrated a medium effect size with an increase of 0.87 points. Patient perception indicated high rates of satisfaction and values above the minimal clinically important difference. The qualitative approach revealed several interesting findings.

Conclusion

Participants found the digital intervention satisfactory and effective in improving their quality of life. Suggestions for improvement, such as the inclusion of face-to-face sessions, a chat for immediate contact, sound in breath exercises in the digital program, longer duration and continuity of intervention, were mentioned. Larger sample studies and in-deep qualitative methodologies are needed to draw extrapolable conclusions.

Trial registration

NCT04742946.

Minimal Clinically Important Differences in EQ-5D-5L Index and VAS after a Respiratory Muscle Training Program in Individuals Experiencing Long-Term Post-COVID-19 Symptoms

The primary aim of this study was to determine the minimal clinically important difference (MCID) for the EuroQol-5D questionnaire (EQ-5D-5L) index and visual analogic scale (VAS) in individuals experiencing long-term post-COVID-19 symptoms. In addition, it was pretended to determine which variable discriminates better and to compare changes between individuals classified by the MCID.

DESIGN

Secondary analysis of a randomized controlled trial involving 42 individuals who underwent an 8-week intervention in a respiratory muscle training program.

RESULTS

A change of at least 0.262 and 7.5 for the EQ-5D-5L index and VAS represented the MCID, respectively. Only the EQ-5D-5L VAS showed acceptable discrimination between individuals who were classified as "improved" and those classified as "stable/not improved" (area under the curve = 0.78), although with a low Youden index (Youden index, 0.39; sensitivity, 46.2%; specificity, 93.1%). Those individuals who exceeded the established MCID for EQ-5D-5L VAS had significantly greater improvements in inspiratory muscle function, exercise tolerance, and peripheral muscle strength compared to participants classified as "stable/not improved".

CONCLUSIONS

Only the EQ-5D-5L VAS, especially when MCID was exceeded, showed an acceptable discriminative ability to evaluate the efficacy of an intervention in individuals with long-term post-COVID-19 symptoms.

Post COVID-19 condition and health-related quality of life: a longitudinal cohort study in the Belgian adult population

BACKGROUND

Since the onset of the COVID-19 pandemic, most research has focused on the acute phase of COVID-19, yet some people experience symptoms beyond, referred to as post COVID-19 conditions (PCC). However, evidence on PCC and its impacts on health-related quality of life (HRQoL) is still scarce. This study aimed to assess the impact of COVID-19 and PCC on HRQoL.

METHODS

This is a longitudinal cohort study of the Belgian adult population with recent SARS-CoV-2 infection. In total, 5,727 people were followed up between the time of their infection and three months later. HRQoL was measured with the EQ-5D-5L questionnaire before and during the infection and three months later. Linear mixed regression models were built to assess the longitudinal association between participants' characteristics and the evolution of their HRQoL.

RESULTS

This study found a significant decline in HRQoL during the SARS-CoV-2 infection in comparison to the situation before (β=-9.91, 95%CI=-10.13;-9.85), but no clinically important difference three months after the infection compared to the situation before, except among people reporting PCC (β=-11.15, 95%CI=-11.72;-10.51). The main symptoms of PCC with a significant negative impact on the different dimensions of HRQoL were fatigue/exhaustion (21%), headache (11%), memory problems (10%), shortness of breath (9%), and joint (7%) or muscle pain (6%). The dimension of HRQoL most negatively affected by several PCC symptoms was pain/discomfort.

CONCLUSIONS

With the growing number of people infected with SARS-CoV-2, PCC and its impact on HRQoL are becoming important public health issues. To allow people with PCC to recover and to limit its detrimental impact on HRQoL, it is essential to manage its various heterogeneous symptoms using a multidisciplinary approach.

Prolonged symptoms after COVID-19 in Japan: A nationwide survey of the symptoms and their impact on patients' quality of life

BACKGROUND

Clinical details of long COVID are still not well understood because of potential confounding with a wide range of pre-existing comorbidities.

METHODS

The present study used datasets from a nation-wide, cross-sectional, online survey. We determined which prolonged symptoms were more likely to be associated with post-COVID condition after adjusting for a wide range of comorbidities and baseline characteristics. This study also used EuroQol 5 dimensions 5-levels (EQ-5D-5L) and Somatic Symptom Scale-8 to assess health-related quality of life (QOL) and somatic symptoms in individuals with a previous history of COVID-19, defined as the diagnosis of COVID-19 made at least 2 months prior to the online survey.

RESULTS

In total, 19,784 respondents were included for analysis; of these, 2,397 (12.1%) had a previous history of COVID-19. The absolute difference of adjusted prevalence of symptoms attributed to prolonged symptoms after COVID-19 ranged from -0.4 % to +2.0 %. Headache (adjusted odds ratio [aOR]: 1.22; 95% confidence interval [95% CI]:1.07-1.39), chest discomfort (aOR:1.34, 95% CI:1.01-1.77), dysgeusia (aOR: 2.05, 95% CI: 1.39-3.04), and dysosmia (aOR: 1.96, 95% CI: 1.35-2.84) were independently associated with a previous history of COVID-19. Individuals with a history of COVID-19 had lower health-related QOL scores.

CONCLUSION

After adjusting for potential comorbidities and confounders, clinical symptoms, such as headache, chest discomfort, dysgeusia, and dysosmia, were found to be independently associated with a history of COVID-19, which was diagnosed two or more months previously. These protracted symptoms may have impacted QOL and the overall somatic symptom burden in subjects with a previous history of COVID-19.

Post-COVID Health-related Quality of Life and Somatic Symptoms: A National Survey in Japan

BACKGROUND

The characteristics and risk factors of post-COVID-19 condition affecting health-related quality of life and the symptom burden are unclear.

METHODS

The present, cross-sectional study used the JASTIS (Japan Society and New Tobacco Internet Survey) database. EQ-5D-5L and Somatic Symptom Scale-8 were used to assess health-related quality of life and somatic symptoms, respectively. The participants were classified into a no-COVID-19, COVID-19 not requiring oxygen therapy or COVID-19 requiring oxygen therapy group. First, the entire cohort was analyzed. Then, sensitivity analysis was performed after excluding patients in the no-COVID-19 group with a history of close contact with individuals known to have the disease.

FINDINGS

In total, 30130 individuals (mean age: 47.8; females: 51.2%), including 539 and 805 with COVID-19 requiring and not requiring oxygen therapy, respectively, participated. The analysis of the entire cohort as well as the sensitivity analysis demonstrated that individuals with a history of COVID-19 had significantly lower EQ-5D-5L and significantly higher SSS-8 scores than those with no COVID-19 history. The group requiring oxygen therapy was associated with significantly lower EQ-5D-5L and higher SSS-8 scores than the group not requiring oxygen therapy. Propensity-score matching confirmed these results. Furthermore, two or more COVID-19 vaccinations were independently associated with high EQ-5D-5L and low SSS-8 scores (P < 0.001).

INTERPRETATION

The participants with a COVID-19 history, especially those with severe disease, had a significantly higher somatic symptom burden. Analysis after adjusting for potential confounders found that their quality-of-life was also severely affected. Vaccination is crucial to addressing these symptoms, especially in high-risk patients.

Association of Kinesiophobia with Catastrophism and Sensitization-Associated Symptoms in COVID-19 Survivors with Post-COVID Pain

Pain symptoms after the acute phase of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are present in almost 50% of COVID-19 survivors. The presence of kinesiophobia is a risk factor which may promote and perpetuate pain. This study aimed to investigate variables associated with the presence of kinesiophobia in a sample of previously hospitalized COVID-19 survivors exhibiting post-COVID pain. An observational study was conducted in three urban hospitals in Spain, including one hundred and forty-six COVID-19 survivors with post-COVID pain. Demographic (age, weight, height), clinical (intensity and duration of pain), psychological (anxiety level, depressive level, sleep quality), cognitive (catastrophizing), sensitization-associated symptoms, and health-related quality of life variables were collected in 146 survivors with post-COVID pain, as well as whether they exhibited kinesiophobia. Stepwise multiple linear regression models were conducted to identify variables significantly associated with kinesiophobia. Patients were assessed a mean of 18.8 (SD 1.8) months after hospital discharge. Kinesiophobia levels were positively associated with anxiety levels (r: 0.356, p < 0.001), depression levels (r: 0.306, p < 0.001), sleep quality (r: 0.288, p < 0.001), catastrophism (r: 0.578, p < 0.001), and sensitization-associated symptoms (r: 0.450, p < 0.001). The stepwise regression analysis revealed that 38.1% of kinesiophobia variance was explained by catastrophism (r² adj: 0.329, B = 0.416, t = 8.377, p < 0.001) and sensitization-associated symptoms (r² adj: 0.381, B = 0.130, t = 3.585, p < 0.001). Kinesiophobia levels were associated with catastrophism and sensitization-associated symptoms in previously hospitalized COVID-19 survivors with post-COVID pain. Identification of patients at a higher risk of developing a higher level of kinesiophobia, associated with post-COVID pain symptoms, could lead to better therapeutic strategies.