The Post-COVID-19 Functional Status scale: a tool to measure functional status over time after COVID-19

Traditional Chinese medicine for post-COVID: A retrospective cohort study

Post-COVID syndrome affects at least 10% of individuals recovering from COVID-19. Currently, there is no causal treatment. This retrospective cohort study aimed to evaluate the potential of traditional Chinese medicine (TCM) in treating post-COVID symptoms. TCM physicians in Germany and Austria completed online questionnaires to retrospectively record symptoms, treatment approaches, and outcomes for patients diagnosed with post-COVID. Nine physicians collected data from 79 patients (65% female, 47 ± 16 SD). The most common TCM treatments for post-COVID were acupuncture (n = 66; 85%), Chinese pharmacological therapy (n = 61; 77%), and Chinese dietary counseling (n = 32; 41%). After an average of 7 ± 4 TCM consultations, physicians rated global symptom improvement as 62% ± 29%. Significant alleviation from the start of TCM treatment was observed in major symptoms, such as fatigue (P < .001), impaired physical performance (P < .001), and exertional dyspnea (P < .001). TCM treatment was associated with significant improvements in post-COVID symptoms, warranting further evaluation through randomized controlled studies.

Course of neuropsychological health in post-COVID patients differs 6 and 12 months after inpatient rehabilitation

Background

Rehabilitation is an effective and feasible approach for post-COVID patients to improve mental health and cognitive complaints. However, knowledge regarding the long-term impact of rehabilitation on neuropsychological health of these patients is lacking.

Objective

This study aims to investigate psychological health, fatigue, and cognitive function 6 and 12 months after inpatient post-COVID rehabilitation of patients, who acquired COVID-19 in the workplace. In addition, group differences in these outcome parameters according to sex, age, acute COVID status, socioeconomic status, profession, and pre-existing diseases will be detected.

Methods

This longitudinal observational study examined the changes in mental and cognitive health of 127 patients with COVID-19 as an occupational disease or work accident. Symptoms of depression and anxiety, fatigue severity, somatic symptom severity, trauma-related symptoms, and cognitive functioning were assessed at the beginning as well as six and 12 months after rehabilitation. Group differences concerning sex, age, acute COVID status, socioeconomic status, occupational status, and existing diseases prior to COVID-19 were also analyzed.

Results

The results showed that the improvements direct after rehabilitation in mental health and fatigue severity could not be maintained six and 12 months after rehabilitation discharge. Contrary, patients' cognitive function maintained stable during follow-up. Significant group differences were observed regarding age, sex, acute COVID status, socioeconomic status, occupational status, and pre-existing diseases.

Conclusion

This study highlights the importance of the aftercare process and the implementation of adequate and individualized therapeutic interventions such as psychological support and strengthen self-management skills.The study is registered in the German Clinical Trials Register with the identifier DRKS00022928.

Ashwagandha (Withania somnifera (L.) Dunal) for promoting recovery in long covid: protocol for a randomised placebo-controlled clinical trial (APRIL Trial)

BACKGROUND

Long covid describes a syndrome of persistent symptoms following COVID-19 and is responsible for substantial healthcare and economic burden. Currently, no effective treatments have been established. Ashwagandha (Withania somnifera (L.) Dunal) is a medicinal herb traditionally used in India for its immune-strengthening and anti-inflammatory properties. Withanolides, a family of steroid-derived molecules unique to Ashwagandha, have been shown to modulate inflammatory pathways in animal models, and several small randomised trials in humans support its effectiveness for reducing symptoms that are also associated with long covid. Therefore, this study aims to assess whether Ashwagandha is effective and safe for improving functional status and reducing symptom burden in adults living with long covid.

METHODS

A randomised double-blind placebo-controlled trial will be performed at participating general practice (GP) surgeries and long covid clinics across the UK. Individuals diagnosed with long covid will be screened for eligibility and then randomised 1:1 to take 1000 mg daily of Ashwagandha root extract tablets (standardised to <0.9% withanolides) or matching placebo tablets for 3 months (target, n = 2500). Monthly online surveys will be performed to collect patient-reported outcomes, and monthly safety monitoring, including liver function tests, will be conducted by clinical site teams. The primary outcome of the Post-COVID Functional Status Scale score at 3 months will be assessed by baseline-adjusted ordinal logistic regression, according to a pre-published statistical analysis plan. The secondary outcomes included validated quality of life and long covid symptom scales, work status and productivity and adverse events. The trial has been approved as a Clinical Trial of an Investigational Medicinal Produce by the Medicines and Healthcare Regulatory Authority and by the NHS Research Ethics Committee and Health Research Authority.

DISCUSSION

Treatments for long covid are urgently needed. This trial will robustly evaluate the safety and efficacy of a candidate treatment with a promising efficacy and safety profile. If found to be effective, the findings will likely influence treatment guidelines and improve health outcomes in those living with long covid.

TRIAL REGISTRATION NUMBER

This trial was pre-registered on 15/08/2022: ISRCTN12368131.

Hyper-reactivity of CD8+ T cells and high expression of IL-3 correlates with occurrence and severity of Long-COVID

Following SARS-CoV-2 infection, some individuals develop Long-COVID-syndrome lasting for more than 3 months. We analyzed blood samples from patients with Long-COVID, controls without persistent symptoms following SARS-CoV-2-infection and non-infected donors without a history of infection. Long-COVID patients showed clear signs of T cell hyper-activation predominantly in the CD8+ T cell subset with a 4-fold higher expression of CD25 and 2-fold more effector-memory T cells. Following polyclonal T cell stimulation, we found a 2-fold stronger upregulation of CD25 and a 7-fold higher release of IL-3 in Long-COVID. Intracellular staining revealed 5-fold more IL-3-expressing CD8+ T cells in Long-COVID, while GM-CSF, IFN-γ and IL-2 were much less upregulated. These changes correlated with the severity of Long-COVID and persisted for up to 18 months after infection. Our data reveal a pronounced and long-lasting CD8+ T cell hyper-activation and hyper-reactivity in Long-COVID and speak for a trial of T cell-immunosuppression in patients with Long-COVID.

Post-acute sequelae of COVID-19 in people of Black ethnicities living with HIV in the United Kingdom

BackgroundThe COVID-19 pandemic disproportionately affected people of Black ethnicities, however, there are limited data on the post-acute sequelae of COVID-19 infection in these populations, and none in those with HIV.MethodsWe conducted a cross-sectional study in people of Black ethnicities with HIV in the UK. Participants were assessed for functional impairment, frailty, respiratory symptoms, anxiety and depression; they were also asked to rate aspects of their physical and mental health on a scale from 1 (poor) to 10 (excellent), both at enrolment and prior to the pandemic. We report associations with COVID-19 history and recovery status.ResultsWe enrolled 183 participants between June 2021 and October 2022, 131 (72%) of whom reported COVID-19. A history of COVID-19 was associated with a reduced ability to carry out usual activities (OR 2.54 [1.03-6.21], p = 0.04), an increase in pain, tiredness and breathlessness, and overall decline in physical health. Of those with a history of COVID-19, 111 (85%) reported to have fully recovered. Those who had not fully recovered reported poorer functional status (p < 0.001) and had higher generalised anxiety scores (p = 0.02). Objective measures of physical function were similar in those who reported no COVID-19, COVID-19 with full recovery, and COVID-19 with incomplete recovery.ConclusionsIn this cohort of Black people with HIV, participants with a history of COVID-19 reported a reduced ability to carry out activities of daily living and various other health issues. Although most people reported full recovery from COVID-19, self-reported limitations in functional status and anxiety were common sequelae.

Exploring the Potential of Dietary Supplements to Alleviate Pain Due to Long COVID

Long COVID, characterized by persistent symptoms following COVID-19 infection, significantly impacts individuals' health and daily functioning due to fatigue and pain. Focusing on pain, this review addresses nociplastic and chronic pain conditions. Interventions designed to reduce inflammation, oxidative stress, and enhance vagal activity may offer a promising approach to managing post-pandemic pain. This review presents individual components of food supplements with demonstrated efficacy in one or more pain conditions, focusing on their proposed mechanisms and clinical activity in pain, including their use in post-COVID-19 pain when available. Many of these substances have a long history of safe use and may offer an alternative to long-term analgesic drug treatment, which is often associated with potential side effects. This review also explores the potential for synergistic effects when combining these substances with each other or with conventional analgesics, considering the advantages for both patients and the healthcare system in using these substances as adjunctive or primary therapies for pain symptoms related to long COVID. While preclinical scientific literature provides a mechanistic basis for the action of several food supplements on pain control mechanisms and signaling pathways, clinical experience, particularly in the field of long COVID-associated pain, is still limited. However, the reviewed literature strongly suggests that the use of food supplements in long COVID-associated pain is an attainable goal, provided that rigorous clinical trials are conducted.

Patient Perspectives on the Care in a Long COVID Outpatient Clinic-A Regional Qualitative Analysis from Germany

Background/Objectives: Long COVID specialized outpatient clinics (sOCs), which are part of the recommended long COVID care, usually face high demand. Few studies focused on the experience of care in such facilities in Germany. This study investigated how patients experience care in a sOC at a German university hospital. Methods: Semi-structured interviews were conducted with patients attending this clinic between October 2022 and January 2023. Data analysis was based on thematic analysis. Results: The themes from interviews with 14 patients (F = 11, M = 3) could be broadly categorized into statements on the pathway to the sOC, and statements on care provided in the sOC. Findings show that patients' high expectations at the sOC appointment were shaped by previous experiences with care, which were mainly perceived as inadequate. Care in the sOC was predominantly perceived as competent, empathetic and relevant for further care and coping with the disease. A deterioration in health directly related to the consultation (classifiable as post-exertional malaise) was frequently described, as was a high need for ongoing consultation. Conclusions: Overall, the findings point to a need for adaptations in the sOC, such as identifying optimized models of care and tailoring them to the patients' limited resources. This includes measures to improve care outside the sOC.

Analysis of the A-B Neuropsychological Assessment Schedule as a Cognitive Screener for Long COVID

Aim To determine the sensitivity and specificity of the psychometric measures of the A-B Neuropsychological Assessment Schedule (ABNAS) to aid screening of long COVID (LC). Methods The participants (N=235) were recruited from an online study of cognitive and psychological consequences of LC, involving individuals attending an LC service in an acute tertiary university hospital and a comparison sample of community controls.The ABNAS for LC, a patient-perceived assessment scale in relation to the challenges they had encountered from LC, was used to identify the specific psychometric measures implicated in LC. Results The optimal cut-off value for total ABNAS scores and its psychometric subsets were obtained from receiver operating characteristic (ROC) curves. The sensitivity of the total ABNAS score of ≥21.5 was 81.6% for LC, taken as a post-COVID functional status (PCFS)grade of ≥ 2 as true positives, with a specificity = 72.3%. The specificity of the ABNAS fatigue subscale score of ≥ 8.5 for LC was 87.2%, while its sensitivity was 66.7%. The sensitivity of the ABNAS mental slowing subscale score of ≥ 4.5 was 82.8%, and the specificity was 70.3%. Conclusion Total ABNAS scores and their psychometric subsets (fatigue and mental slowing) are sensitive and specific for LC.

Developing a Multisensor-Based Machine Learning Technology (Aidar Decompensation Index) for Real-Time Automated Detection of Post-COVID-19 Condition: Protocol for an Observational Study

BACKGROUND

Post-COVID-19 condition is emerging as a new epidemic, characterized by the persistence of COVID-19 symptoms beyond 3 months, and is anticipated to substantially alter the lives of millions of people globally. Patients with severe episodes of COVID-19 are significantly more likely to be hospitalized in the following months. The pathophysiological mechanisms for delayed complications are still poorly understood, with a dissociation seen between ongoing symptoms and objective measures of cardiopulmonary health. COVID-19 is anticipated to alter the long-term trajectory of many chronic cardiovascular and pulmonary diseases, which are common among those at risk of severe disease.

OBJECTIVE

This study aims to use a single, integrated device-MouthLab, which measures 10 vital health parameters in 60 seconds-and a cloud-based proprietary analytics engine to develop and validate the Aidar Decompensation Index (AIDI), to predict decompensation in health among patients who previously had severe COVID-19.

METHODS

Overall, 200 participants will be enrolled. Inclusion criteria are patients in the US Department of Veterans Affairs health care system; "severe" COVID-19 infection during the acute phase, defined as requiring hospitalization, within 3-6 months before enrollment; aged ≥18 years; and having 1 of 6 prespecified chronic conditions. All participants will be instructed to use the MouthLab device to capture daily physiological data and complete monthly symptom surveys. Structured data collection tables will be developed to extract the clinical characteristics of those who experience decompensation events (DEs). The performance of the AIDI will depend on the magnitude of difference in physiological signals between those experiencing DEs and those who do not, as well as the time until a DE (ie, the closer to the event, the easier the prediction). Information about demographics, symptoms (Medical Research Council Dyspnea Scale and Post-COVID-19 Functional Status Scale), comorbidities, and other clinical characteristics will be tagged and added to the biomarker data. The resultant predicted probability of decompensation will be translated into the AIDI, where there will be a linear relationship between the risk score and the AIDI. To improve prediction accuracy, data may be stratified based on biological sex, race, ethnicity, or underlying clinical characteristics into subgroups to determine if there are differences in performance and detection lead times. Using appropriate algorithmic techniques, the study expects the model to have a sensitivity of >80% and a positive predicted value of >70%.

RESULTS

Recruitment began in January 2023, and at the time of manuscript submission, 204 patients have been enrolled. Publication of the complete results and data from the study is expected in 2025.

CONCLUSIONS

The focus on identifying predictor variables using a combination of biosensor-derived physiological features should enable the capture of heterogeneous characteristics of complications related to post-COVID-19 condition across diverse populations.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05220306; https://clinicaltrials.gov/study/NCT05220306.

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.

Health-Related Quality of Life and Functional Status of Post-COVID-19 Patients

BACKGROUND

COVID-19 mainly affects the respiratory system, although its manifestations are multisystemic. We are increasingly recognizing complications that present after the acute phase, which are associated with impaired functional status and health-related quality of life (HRQoL). The objective was to assess the functional status and HRQoL of patients with post-COVID-19.

METHODS

This was a cross-sectional study involving individuals affected by COVID-19 who had persistent symptoms for one month after the acute phase of the disease. Functional status was measured with the six-minute walk test (6MWT), the Fatigue Severity Scale (FSS), the Medical Research Council (MRC) Dyspnea Scale, and the Post-COVID-19 Functional Status Scale (PCFS). HRQoL was confirmed with the Short-Form Health Survey 36 (SF-36).

RESULTS

We included 123 patients; 73 (59.35%) were male, with a mean age of 49.17 ± 13.48 years and a body mass index of 31.02 ± 6.56 stratified into three groups: the not-recovered group (NRG = 23), the ward-recovered group (WHG = 60), and the intensive-care-unit group (ICUG = 40). The main symptoms were muscle weakness (74.17%) and dyspnea (68.33%). The predicted distances for the 6MWT were missed by 12.83% by the GNR group, 20.21% by the GNR group, and 28.82% by the UGCI group. The MRC dyspnea scale had a mean value of less than 3, and the FSS scale had a mean value of over 4, indicating considerable fatigue. In the PCFS scale, a significant difference was observed (p < 0.0005), while in the SF-36, all HRQoL domains were compromised.

CONCLUSION

Post-COVID-19 patients involved in this study showed a significant decline in functional status and an impairment of HRQoL.

Plasma exchange therapy for the post COVID-19 condition: a phase II, double-blind, placebo-controlled, randomized trial

The post-COVID-19 condition (PCC) is a highly debilitating and persistent postinfectious syndrome that affects millions of people worldwide and has no effective treatment. Therapeutic plasma exchange (TPE) has the potential to improve the PCC by clearing the peripheral soluble pro-inflammatory immune milieu derived from acute or persistent SARS-CoV-2 infection. In a phase II, double-blind, placebo-controlled, randomized trial, fifty subjects with PCC were randomly assigned (1:1) to receive six sessions of either TPE or a sham plasma exchange and were followed for 90 days (ClinicalTrials.gov registration: NCT05445674). The primary endpoint was safety; secondary endpoints included functional status, symptomology, quality of life, neurocognitive symptoms, and peripheral biochemistry, hematology, coagulation and inflammation parameters. Both study arms had a similarly favorable safety profile. There were no diferences between groups in any of the efficacy parameters evaluated. Whereas TPE is safe, it did not lead to any discernible improvement of the PCC in this clinical trial.

Use of wearables to measure the effects of long COVID on activities of daily living and their relationship to perceived exertion, occupational performance, and quality of life

Introduction

This study introduces a novel approach to understanding the impact of long COVID symptoms on daily life by integrating wearable devices to assess their influence on physical and mental quality of life, as well as perceived performance and satisfaction in daily activities.

Methods

By leveraging technology such as accelerometers and pulse oximeters alongside assessment tools like the SF-12 Health Survey, the Canadian Occupational Performance Measure, and the Borg Scale, this research provides a comprehensive analysis that advances the field of occupational therapy.

Results

An analytical observational study with 10 participants with long COVID and 10 healthy controls revealed that individuals with long COVID took significantly longer to complete tasks such as setting the table, sweeping, and climbing stairs, compared to the control group. Participants with long COVID also reported higher perceived exertion during all activities, as well as significantly worse physical health-related quality of life and lower satisfaction and performance in daily activities. Notably, perceived exertion correlated with reduced physical quality of life and diminished satisfaction and accomplishment in occupational tasks.

Discussion

These findings emphasize the critical need for occupational therapy interventions to reduce perceived exertion, which could improve physical quality of life and enhance performance and satisfaction in daily activities for individuals with long COVID.

Assessment of psychosocial aspects in adults in post-COVID-19 condition: the EURONET-SOMA recommendations on core outcome domains for clinical and research use

BACKGROUND

Harmonizing core outcome domains allows for pooling data, comparing interventions, and streamlining research evaluation. At the same time clinicians require concise and feasible measures for routine practice. Considering the heterogeneity of post-COVID-19 condition, a biopsychosocial approach requires sufficient coverage of the psychosocial dimension with assessments. Previous recommendations for core outcome sets have serious limitations regarding the psychosocial aspects of post-COVID-19 condition. This paper specifically focuses on psychosocial outcomes for adults with post-COVID-19 condition, providing both a comprehensive set of outcome domains for research and a streamlined clinical core set tailored for routine clinical use.

METHODS

In a structured Consensus Development Approach, the European Network to improve diagnostic, treatment, and healthcare for patients with persistent somatic symptoms (EURONET-SOMA) developed psychosocial core outcome domains and assessments regarding post-COVID-19 condition. The experts identified variables and instruments which should be considered in studies on adults suffering from post-COVID-19 condition, and which are feasible in the clinical setting and relevant for research.

RESULTS

We identified three higher-order dimensions with each encompassing several domains: The first higher-order dimension, "outcomes", encompasses (1) the classification/ diagnostics of post-COVID-19 condition, (2) somatic symptoms (including fatigue), (3) the psychopathological status and mental comorbidities, (4) the physical status and somatic comorbidities, (5) neurocognitive symptoms, and (6) illness consequences. The second higher-order domain "mechanisms" encompasses (7) cognitive components, (8) affective components, (9) behavioral components, (10) social components, and (11) psychobiological bridge markers (e.g., neuroimmunological and psychoneuroendocrinological variables). The third higher-order domain, "risk factors", includes factors such as (12) socioeconomic status and sociocultural factors, (13) pre-existing mental and somatic health issues, (14) personality factors (e.g., neuroticism), (15) adverse childhood experiences, (16) ongoing disability or pension claim, and (17) social media use. For each domain, specific instruments are suggested for research purposes and clinical use.

CONCLUSIONS

The recommended core domains help to increase consistency in a biopsychosocial approach to post-COVID-19 condition across investigations, improve synergies, and facilitate decision-making when comparing different interventional approaches. It allows to better identify relevant subgroups in heterogeneous post-COVID-19 condition populations offering practical tools for routine clinical practice through the clinical core set.

Profiling the persistent and episodic nature of long COVID symptoms and the impact on quality of life and functional status: a cohort observation study

Background

Post-viral issues following acute infection with coronavirus disease 2019 (COVID-19), referred to widely as long COVID, are associated with episodic, persistent, and disabling symptoms affecting quality of life and functional status. Evidence demonstrates a significant impairment and long disease course, but there remains limited empirical data to profile and determine the fluctuating symptom profile of long COVID.

Methods

We devised a 16-week, multicentre prospective cohort observation study to profile changes in patient-reported outcomes, and biological, physiological, psychological, and cognitive parameters following diagnosis and/or referral to an established long COVID clinic. Following baseline assessments, participants completed four face-to-face visits interspersed with telephone consultations. Face-to-face visits included physiological assessment, patient-reported outcome measures (PROMs), functional status, and respiratory function. Telephone consultations involved PROMs and symptom profiling.

Results

Patient-reported outcomes improved from baseline to week sixteen, but demonstrated between visit fluctuations in frequency and severity. Further findings highlight the severity and frequency of long COVID symptom profiles and the extent of quality of life and functional status impairment.

Conclusions

The data presented here highlight the episodic and relapsing nature and should be used to help characterise long COVID disability. They can inform the development of long COVID-specific guidelines and support services that can adequately respond to the reductions in patient well-being.

Exercise rehabilitation in post COVID-19 patients: a randomized controlled trial of different training modalities

BACKGROUND

Long-lasting symptoms (>12 weeks) following a COVID-19 infection are defined as the post-COVID-19 syndrome (PCS), often manifesting as fatigue and reduced exercise capacity. Thus, exercise has been suggested as a non-pharmacological therapy.

AIM

To investigate the effects of endurance vs. concurrent exercise on physical function, symptoms and quality of life in individuals with PCS, that did not need hospital admission during acute COVID-19.

DESIGN

Parallel-group, single-center, randomized controlled trial.

SETTING

This study was conducted at the University of Vienna.

POPULATION

Adult individuals with a SARS-CoV-2 infection at least 12 weeks prior to enrollment who reported at least one symptom specific to PCS and did not experience post-exertional malaise.

METHODS

Participants were randomized to either 12 weeks of supervised endurance training (ED) or concurrent training (CT), or a non-exercising control group (C). As the primary outcome, VO2peak was assessed pre and post intervention. Secondary outcomes were handgrip and lower body strength, heart rate variability, symptoms, health-related quality of life (HRQoL) and concentration performance. The main effects for time and group as well as the time*group interaction were assessed via a 2x2 analysis of variance. Additionally, within-group pre-post testing was performed.

RESULTS

Taking the study protocol into account, 42 subjects could be included in the analysis (N.=14 in each group). A significant time*group interaction favoring both exercise conditions was found for VO2peak (partial Eta2=0.267; ED: +3.9 mL/min/kg; CT: +3.2 mL/min/kg). The Fatigue Severity Score significantly decreased in ED (Hedges' g=0.63) and CT (Hedges' g=0.82) from pre to post, but not in C. Breathlessness and lower body strength improved most in CT. Significant within-group improvements in HRQoL and the number of PCS symptoms occurred in all groups.

CONCLUSIONS

Both exercise regimes led to increases in VO2peak and lower fatigue scores in subjects with PCS. Improvements in HRQoL occurred in all groups, however more pronounced after the exercise interventions. No definite conclusion about the superiority of either training modality can be drawn.

CLINICAL REHABILITATION IMPACT

The results show that in this population both exercise regimes are feasible and safe and lead to improvements in various health domains.

Effects of Cardiopulmonary Rehabilitation on Cardiorespiratory Fitness and Clinical Symptom Burden in Long COVID: Results From the COVID-Rehab Randomized Controlled Trial

OBJECTIVE

The aim of the study is to investigate the effectiveness of an 8-wk cardiopulmonary rehabilitation program on cardiorespiratory fitness (VO 2 peak) and key cardiopulmonary exercise test measures, quality of life, and symptom burden in individuals with long COVID.

DESIGN

Forty individuals with long COVID (mean age 53 ± 11 yrs), were randomized into two groups: (1) rehabilitation group: center-based individualized clinical rehabilitation program (8 wks, 3 sessions per week of aerobic and resistance exercises, and daily inspiratory muscle training) and (2) control group: individuals maintained their daily habits during an 8-wk period.

RESULTS

There was a significant difference between groups in mean VO 2 peak improvement ( P = 0.003). VO 2 peak improved significantly in the rehab group (+2.7 mL.kg.min; 95% CI = +1.6 to +3.8; P < 0.001) compared to the control group (+0.3 mL.kg.min; 95% CI = -0.8 to +1.3 P = 0.596), along with VE/VCO 2 slope ( P = 0.032) (-2.4; 95% CI = -4.8 to +0.01; P = 0.049 and +1.3; 95% CI = -1.0 to +3.6; P = 0.272, respectively) and VO 2 at first ventilatory threshold ( P = 0.045). Furthermore, all symptom impact scales improved significantly in the rehabilitation group compared to the control group ( P < 0.05).

CONCLUSIONS

An individualized and supervised cardiopulmonary rehabilitation program was effective in improving cardiorespiratory fitness, ventilatory efficiency, and symptom burden in individuals with long COVID. Careful monitoring of symptoms is important to appropriately tailor and adjust rehabilitation sessions.

Comparison of the muscle oxygenation during submaximal and maximal exercise tests in patients post-coronavirus disease 2019 syndrome with pulmonary involvement

INTRODUCTION

Pulmonary involvement is prevalent in patients with coronavirus disease 2019 (COVID-19). Arterial hypoxemia may reduce oxygen transferred to the skeletal muscles, possibly leading to impaired exercise capacity. Oxygen uptake may vary depending on the increased oxygen demand of the muscles during submaximal and maximal exercise.

OBJECTIVE

This study aimed to compare muscle oxygenation during submaximal and maximal exercise tests in patients with post-COVID-19 syndrome with pulmonary involvement.

METHODS

Thirty-nine patients were included. Pulmonary function (spirometry), peripheral muscle strength (dynamometer), quadriceps femoris (QF) muscle oxygenation (Moxy® device), and submaximal exercise capacity (six-minute walk test (6-MWT)) were tested on the first day, maximal exercise capacity (cardiopulmonary exercise test (CPET)) was tested on the second day. Physical activity level was evaluated using an activity monitor worn for five consecutive days. Cardiopulmonary responses and muscle oxygenation were compared during 6-MWT and CPET.

RESULTS

Patients' minimum and recovery muscle oxygen saturation were significantly decreased; maximum total hemoglobin increased, heart rate, blood pressure, breathing frequency, dyspnea, fatigue, and leg fatigue at the end-of-test and recovery increased in CPET compared to 6-MWT (p < .050). Peak oxygen consumption (VO2peak) was 18.15 ± 4.75 ml/min/kg, VO2peak; percent predicted < 80% was measured in 51.28% patients. Six-MWT distance and QF muscle strength were less than 80% predicted in 58.9% and 76.9% patients, respectively.

CONCLUSIONS

In patients with post-COVID-19 syndrome with pulmonary involvement, muscle deoxygenation of QF is greater during maximal exercise than during submaximal exercise. Specifically, patients with lung impairment should be evaluated for deoxygenation and should be taken into consideration during pulmonary rehabilitation.

The Impact of the COVID-19 Pandemic in the Interrelationships Among Mental Health, Nutritional Status and Lifestyle Factors of Older Adults: A Cross-Sectional Study in the Pre- and Post-Covid Periods

BACKGROUND/OBJECTIVES

The COVID-19 pandemic has led to detrimental effects on diverse aspects of the mental and physical health of the general population worldwide. The elderly are more susceptible to COVID-19 infection compared to younger age groups. In this aspect, the purpose of the current survey is to evaluate the effect of the COVID-19 pandemic on the interrelationships among the sociodemographic and anthropometric characteristics, depressive behavior, quality of life, cognition status, physical activity and nutritional status of older adults.

METHODS

The present study constitutes a comparative, cross-sectional study of 4162 older adults (mean age ± standard deviation: 72.13 ± 8.1 years and 75.22 ± 8.2 years in the pre- and post-COVID-19 periods, respectively, and a male/female ratio of almost 1:1). We used validated questionnaires to assess depression, cognition function, quality of life, physical activity and nutritional status of the elderly in the pre-Covid and post-Covid periods. Relevant questionnaires were also used for collecting sociodemographic data, while anthropometric data were measured using standard protocols.

RESULTS

The present study finds that the COVID-19 pandemic influenced, in an independent manner, residence location, smoking status, overweight/obesity and abdominal obesity, depressive behavior, quality of life, cognition behavior, physical activity levels and nutritional status of the elderly. The COVID-19 pandemic was also related to employment and living status as well as family economic status. Nevertheless, the above three relationships were insignificant in the multivariate analysis.

CONCLUSIONS

The COVID-19 pandemic exerted deleterious effects on several aspects of the mental and physical health of the elderly, which appeared to strongly persist in the post-Covid period. Future prospective population-based and well-organized surveys should be conducted to establish whether there is a causality long-term effect of the COVID-19 pandemic on diverse aspects of the mental and physical health of the elderly.

Real-world evidence of remdesivir in formerly hospitalized COVID-19 patients: patient-reported and functional outcomes

BACKGROUND

Post-COVID condition (PCC) is characterized by persisting symptoms after the resolution of acute COVID-19. Remdesivir (RDV), a broad-spectrum antiviral drug, has been widely used in patients hospitalized with COVID-19 requiring oxygen therapy. We aimed to evaluate the effects of RDV on PCC by assessing patient-reported and functional outcomes.

METHODS

We used the data from a single-center registry, including formerly hospitalized post-COVID patients (N = 293). Propensity score matching (PSM) was used (16 criteria, 1:1 ratio) to obtain two comparable groups: those who received standard-of-care (SOC, N = 94) and those treated with RDV in addition to SOC (SOC + RDV, N = 94). Primary outcomes were asymptomatic status and at least 50% symptom score reduction at post-COVID follow-up. Secondary outcomes included results of pulmonary function (PF) tests, 6-minute walk test (6MWT), and quality-of-life (QoL) questionnaires.

RESULTS

After PSM, baseline patient characteristics showed no significant differences between the two groups. Most patients were still symptomatic (60% vs. 66%). In the SOC + RDV group, the use of oxygen supplementation (94 vs. 80%, p = 0.005) and steroids (97 vs. 88%, p = 0.027) during infection were higher, while patients presented at their post-COVID visits earlier (median 68 vs. 97 days, p = 0.003). Complete or at least 50% symptom resolution were reported at a significantly earlier stage after infection in the SOC + RDV group compared to the SOC group (multivariable-adjusted HR = 2.28, 95% CI = 1.33-3.92, p = 0.003; and HR = 2.08, 95% CI = 1.43-3.02, p < 0.001; respectively). In the SOC + RDV group, fewer patients experienced sleep disturbances at PCC, and sleep-related questionnaires (Pittsburg Sleep Quality Index, PSQI) results showed significantly better sleep quality (14 vs. 27% and 5.9 vs. 7.7 points, respectively). There were no notable differences in results of PF tests, 6MWT, and other QoL questionnaires.

CONCLUSION

In this propensity score matched cohort, the use of RDV was associated with earlier patient reported symptom resolution during the PCC period, while there were no notable differences in functional outcomes. Our results indicate a possible beneficial effect of RDV in terms of faster symptom resolution after COVID19 infection.

Self-reported health, persistent symptoms, and daily activities 2 years after hospitalization for COVID-19

Introduction

Since the onset of the COVID-19 pandemic, 775 million cases have been reported globally. While many individuals recover fully, a significant proportion develop persistent symptoms. Numerous studies have investigated the long-term symptoms of COVID-19; however, the full extent and impact of these symptoms remain inadequately understood. The aim of this study was to investigate the prevalence of self-reported persistent symptoms, focusing on respiratory symptoms and fatigue and the impact on functional status 2 years after hospitalization for COVID-19.

Methods

This study is prospective and includes participants from a longitudinal multi-center cohort that follows patients previously hospitalized due to COVID-19 (n = 211). The current study encompasses the 2-year follow-up, using post-hospitalization questionnaire surveys. Analyzed data were collected before discharge and at the 2-year follow-up. Participants were grouped by age, sex and COVID-19 severity and group comparisons where conducted. Logistic regression analysis was used to study functional impairment.

Results

Two years after hospital discharge due to COVID-19, 125 participants completed the 2-year follow-up. The mean age of participants was 66 years (SD 12.2), and 68% were male. The majority of participants reported present respiratory symptoms (n = 83, 69%) and fatigue (n = 98, 78%) at the 2-year follow-up. Persistent respiratory symptoms and fatigue impacted functional status substantially (p = <0.001, p = 0.028, respectively). No significant differences were observed among groups depending on age, sex, or severity of COVID-19.

Conclusion

For some individuals regardless of age, sex or COVID-19 severity, respiratory symptoms and fatigue may persist for up to 2 years following COVID-19. Hence, having available support from professionals knowledgeable about COVID-19 is imperative. Further research is important to unravel the mechanisms of long-term symptoms following COVID-19 and to develop effective therapeutic and rehabilitative interventions.

Tackling persistent neurological symptoms in patients following acute COVID-19 infection: an update of the literature

INTRODUCTION

The COVID-19 pandemic has taught myriad lessons and left several questions we are yet to comprehend. Initially, the scientific community was concerned with the management of acute disease and immunization. Once the peak of the pandemic receded, it became clear that a proportion of patients were far from fully recovered. Researchers started to recognize those persisting symptoms as a new entity termed 'Long COVID,' where neurological symptoms are evident and have a major impact on quality of life.

AREAS COVERED

The main purpose of this narrative review is to analyze and synthesize the current literature regarding Long COVID, its relation to the nervous system, and to explore the evidence on treatments for persistent neurological symptoms. The most common reported and observed neurologic manifestations include fatigue, cognitive impairment, pain, polyneuropathy, and neuropsychiatric disorders. A variety of pharmacologic and non-pharmacologic therapies have been evaluated and yielded mixed results. Many of them focused on immunomodulation and none currently have U.S. FDA approval.

EXPERT OPINION

Challenges remain in terms of clinical characterization and prognosis of Long COVID, besides understanding its pathophysiology. Standardization of biomarkers and diagnostic criteria will allow the use of common nomenclature and data elements in the design of future clinical studies.

[Post-COVID-19 Functional status scale: Concordance between evaluator-administered versus self-assessed version in patients with post-COVID-19 syndrome]

INTRODUCTION

Patients diagnosed with COVID-19 may present sequelae which are called Post COVID-19 Syndrome or Long COVID in which physical, psychological and/or social complications are evident. The objective of this study was to evaluate the agreement of the Post-COVID-19 Functional Status Scale (PCFS) of the evaluator-administered version vs patient self-assessed in post-COVID-19 patients.

METHODS

Observational study in patients diagnosed with COVID-19 with subsequent recovery. Once the project was approved by the ethics committee and the patients signed the informed consent, a survey was carried out to collect sociodemographic and clinical data and the application of the PCFS scale, in its two forms, self-administered and by an evaluator.

RESULTS

97 patients entered the study, 57.7% being women. The agreement analysis determined a concordance index of 0.857 95% CI (0.7-0.934) (almost perfect agreement). The agreement for women was 0.817 95% CI 0.700-0.934 and for men 0.907 95% CI (0.806-1).

CONCLUSION

The use of the Spanish version of the PCFS scale carried out by the health professional compared to the version self-assessed by patients, demonstrates adequate agreement.

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.

Patient-reported outcome measures for post-COVID-19 condition: a systematic review of instruments and measurement properties

OBJECTIVES

Post-COVID-19 condition (PCC), also referred to as Long COVID, has become an emerging public health issue requiring adequate prevention, treatment and management strategies. Evaluating these strategies from the patients' perspective using patient-reported outcome measures (PROMs) is critical. In this systematic review, we aimed to critically appraise and summarise the quality of existing PROMs for PCC, and to identify PROMs that can be recommended for use in future research.

DESIGN

Systematic review using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology.

DATA SOURCES

PubMed and Web of Science were searched on 16 January 2023 and again on 23 July 2024.

ELIGIBILITY CRITERIA

We included studies reporting on the development and/or validation of any disease-specific PROMs for PCC.

DATA EXTRACTION AND SYNTHESIS

Two independent reviewers screened the results for eligibility. The methodological quality of each included study was assessed using the COSMIN Risk of Bias Checklist. We further evaluated the quality of measurement properties per PROM and study according to the criteria for good measurement properties as outlined in the COSMIN manual, and graded the evidence of the synthesised results. Based on the overall evidence, we derived recommendations for the use of the identified instruments.

RESULTS

We identified 23 studies reporting on 11 PROMs measuring functional status (COVID-19 Yorkshire Rehabilitation Scale, C19-YRS; Modified COVID-19 Yorkshire Rehabilitation Scale, C19-YRSm; Functional Impairment Checklist, FIC; Post-COVID-19 Functional Status Scale, PCFS), symptom burden and impact (Long COVID Symptom and Severity Score, LC-SSS; Long COVID Symptom Tool, LCST; Long COVID Impact Tool, LCIT; Symptom Burden Questionnaire Long COVID, SBQ-LC), quality of life (Post-acute COVID-19 Quality of Life instrument, PAC-19QoL) and stigma (Long COVID Stigma Scale, LCSS; Post-COVID-19 Condition Stigma Questionnaire, PCCSQ). Sample sizes of the included studies ranged from 29 to 1969 participants. Overall, 95 single studies on measurement properties were evaluated. Among the identified instruments, the Long Covid Stigma Scale (LCSS) showed sufficient content validity and internal consistency and can be recommended for use according to COSMIN criteria. Our assessment of measurement properties revealed significant evidence gaps for all PROMs, indicating the need for further validation studies to make an adequate decision on the recommendation for their use. Content validity is a major shortcoming of all included instruments.

CONCLUSION

The LCSS measuring stigma can be recommended for use in future research. For the assessment of PCC symptoms and impact, no instrument with sufficient measurement properties is currently available. Further validation of all identified PROMs is indicated, in particular comprehensive assessments of content validity involving experts and patients.

PROSPERO REGISTRATION NUMBER

CRD42023391238.

Effects of a symptom-titrated exercise program on fatigue and quality of life in people with post-COVID condition - a randomized controlled trial

Fatigue is the most prevalent symptom within the post-COVID condition (PCC). Furthermore, many patients suffer from decreased physical performance capacity and post-exertional malaise. Although exercise has been proposed as an effective therapeutic strategy for PCC, there is limited evidence on individualised and symptom-titrated exercise interventions in patients with fatigue and PEM. Therefore, we conducted a multi-centre randomised controlled trial to investigate the effectiveness of an individualised and symptom-titrated exercise program. We measured fatigue, health-related quality of life, hand-grip strength, endurance capacity and PEM before and after the 10-week intervention. A total of 118 individuals with PCC were included in the final intention-to-treat analysis. All tests and training sessions took place in commercial fitness and health facilities. We found significant effects on fatigue severity, health-related quality of life and physical performance capacity. Adjusting the individual exercise load to daily fatigue has proven to be an effective and safe strategy in PCC patients with fatigue. Under the guidance of qualified professionals and by utilising symptom-titrated training recommendations, commercial fitness and health facilities present an appropriate setting for outpatient exercise rehabilitation in PCC.

Incidence and predictive factors of hyperventilation syndrome in patients after COVID 19 pneumonia: a prospective cohort study

Background

This study investigates the incidence and predictive factors of Hyperventilation Syndrome (HVS) in patients after COVID 19 pneumonia, addressing the clinical overlap between these conditions.

Methods

A one-month prospective study was conducted, tracking survivors of COVID-19 pneumonia. Patients were evaluated for ongoing clinical status, including HVS and post-traumatic syndrome disorder (PTSD), using clinical questionnaires, mMRC, Post-COVID-19 Functional Status (PCFS) Score, Nijmegen score, and PTSD Checklist for DSM-5 questionnaire.

Results

Our study included 222 patients (median age: 57 years, male predominance 62.6%). Somatic comorbidities, primarily metabolic disorders, were reported in 71.2% of cases. The majority had severe or critical infection forms (78.4%), and 91.9% experienced acute symptoms, with 86.5% having three or more symptom clusters. At one month follow-up, dyspnea (52.9%) and asthenia (21.7%) persisted. Functional limitations (PCFS Grade > 2) were observed in 19.6% of patients. The overall incidence of HVS was 158 per 1000 patients, and PTSD was 445 per 1000 patients. Multivariate logistic regression identified cognitive impairment (acute phase), persistent weight loss (post-COVID-19 phase), PCFS grade > 2, and PTSD as independent factors for developing HVS, with relative risks (RRs) of 3.47 (95%CI [1.48-8.31]; p = 0.004), 11.87 (95%CI [1.25-112.88]; p = 0.031), 3.24 (95%CI [1.34-7.86]; p = 0.009), and 5.98 (95%CI [2.27-15.77]; p < 0.001), respectively.

Conclusion

HVS is prevalent in the post-COVID-19 phase, affecting 15.6 % of survivors. Identified predictive factors suggest the convergence of psychosomatic pathophysiological mechanisms. Further research is crucial for a detailed understanding of these mechanisms in long COVID-19 patients.

Substantial differences in perception of disease severity between post COVID-19 patients, internists, and psychiatrists or psychologists: the Health Perception Gap and its clinical implications

Patient-reported outcome measures (PROMs) such as the Numeric Pain Rating Scale (NPRS) or Likert scales addressing various domains of health are important tools to assess disease severity in Post COVID-19 (PC) patients. By design, they are subjective in nature and prone to bias. Our findings reveal substantial differences in the perception of disease severity between patients (PAT), their attending internists (INT) and psychiatrists/psychologists (PSY). Patients rated almost all aspects of their health worse than INT or PSY. Most of the differences were statistically highly significant. The presence of fatigue and mood disorders correlated negatively with health perception. The physical health section of the WHO Quality of Life Assessment (WHOQoL-BREF) and Karnofsky index correlated positively with overall and mental health ratings by PAT and INT. Health ratings by neither PAT, PSY nor INT were associated with the number of abnormal findings in diagnostic procedures. This study highlights how strongly perceptions of disease severity diverge between PC patients and attending medical staff. Imprecise communication, different experiences regarding health and disease, and confounding psychological factors may explain these observations. Discrepancies in disease perception threaten patient-physician relationships and pose strong confounders in clinical studies. Established scores (e.g., WHOQoL-BREF, Karnofsky index) may represent an approach to overcome these discrepancies. Physicians and psychologists noting harsh differences between a patient's and their own perception of the patient's health should apply screening tools for mood disorders (i.e., PHQ-9, WHOQoL-BREF), psychosomatic symptom burden (SSD-12, FCV-19) and consider further psychological evaluation. An interdisciplinary approach to PC patients remains imperative. Trial Registration Number & Date of Registration: DRKS00030974, 22 Dec 2022, retrospectively registered.

Functional disabilities and adverse well-being by COVID-19 and Long COVID history and employment status: 2022 Behavioral Risk Factor Surveillance System

BACKGROUND

Long COVID can lead to functional disabilities and decreased well-being and limit the ability to work. No study has yet assessed associations of SARS-CoV-2-infection and Long COVID with specific measures of well-being and functional disabilities among workers by employment status.

METHODS

Using data from the U.S. Behavioral Risk Factor Surveillance System, we assessed the prevalence of functional disabilities and well-being measures among adults of prime working age (25-54 years) by employment status and self-reported COVID-19 and Long COVID history. Within each employment status, we generated adjusted prevalence ratios (aPRs) comparing respondents from each 2022 COVID-19/Long COVID category to respondents in that employment status before the pandemic (2019).

RESULTS

In 2022, prevalences of each functional disability except vision and all adverse well-being measures were highest among the 9.2% of respondents reporting a history of Long COVID. For each outcome, prevalences were lowest for workers and highest among those unable to work. 2022 prevalence of cognitive disability (16.4% of employees, 21.4% of the self-employed) and depression (31.2% and 36.4%, respectively) among workers reporting a history of Long COVID were more than double 2019 levels. Increases in cognitive disability and depression were lower but statistically significant among workers not reporting a history of Long COVID.

CONCLUSIONS

The high prevalence of functional disabilities and adverse well-being among workers reporting a history of Long COVID have implications for workers and employers. Also concerning are smaller increases among workers not reporting a history of Long COVID, given the large number of affected workers. Mitigating the effects of Long COVID on workers will involve efforts in multiple domains: reducing incidence, increasing healthcare practitioner awareness, improving diagnosis and treatments, and increasing employer awareness of best practices for accommodating workers with Long COVID.

Pulmonary Function Test: A Mainstay for Evaluating Respiratory Health in Patients Recovered from COVID-19 Infection

Background

Despite of millions of people who suffered from coronavirus disease 2019 (COVID-19) infection, pulmonary functions of these patients are sparsely reflected in the literature. Although few researchers have performed pulmonary function tests to evaluate the respiratory function of COVID-19 patients after recovery from acute illness, the sample size was too limited. The present study was conducted in a tertiary care hospital with an aim to determine pulmonary functions of COVID-19 patients recovered from acute illness.

Methods

A total of 250 COVID-19 patients who recovered from acute illness were included in the study. Pulmonary function test of these patients was performed; the indices of PFT studied included, forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio.

Results

Even after >3 months of recovery from the COVID-19 acute illness, patients had respiratory complaints like cough and shortness of breath. These convalescent patients also reported to have certain psychological issues like feeling of loneliness, fear, anxiety, and depression. It was noted that all the respiratory parameters of patients even after >3 months of recovery from the COVID-19 acute illness were compromised.

Conclusion

The pulmonary functions of the patients recovered from COVID-19 infection should be evaluated before discharge of the patient from hospital followed by periodic evaluation post discharge, so that necessary therapeutic interventions can be initiated. Breathing exercises and pranayama can augment the better outcome of these patients. Pulmonary function tests are not only recommended but also are necessary for monitoring of patients who have recovered from COVID-19 infection.

Multidisciplinary rehabilitation with a focus on physiotherapy in patients with Post Covid19 condition: an observational pilot study

There is a lack of interventions that treat the Post-Covid-19 Condition (PCC) itself. Accordingly, treatment guidelines recommend physiotherapy interventions to alleviate symptoms and enhance functioning. In cases where unimodal treatments prove ineffective, non-organ-specific multidisciplinary bio-psycho-social rehabilitation (MBR) programs are a suitable option. In a pilot observational study with assessments at the entry and end of treatment we aimed to evaluate the feasibility of a 3-week day clinic MBR program and explore its effects on physical functioning in PCC patients with fatigue and reduced physical capacity. Patient selection was based on an interdisciplinary assessment involving a physician, a psychologist and a physiotherapist. Feasibility was determined based on full participation (≥ 8 of 9 days) and maintenance of stable endurance in the 6-Minute Walk Test (6MWT). From 37 patients included in the study, 33 completed the MBR (mean age: 43 ± 12 years, 73% female). Four patients discontinued the MBR, with two of them having reported deterioration of PCC symptoms. The 6MWT showed a numerical improvement from 501 ± 97 m to 512 ± 87 m, although it did not reach statistical significance. These results support the feasibility of outpatient MBR with a focus on active physiotherapy interventions in PCC patients with fatigue. This study aligns with previous research supporting the effectiveness of physiotherapy and rehabilitation in PCC patients. However, further research is needed to address possible different treatment responses and varying treatment approaches in subgroups of PCC patients.

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.

A Narrative Review of Impact of Incentive Spirometer Respiratory Training in Long COVID

Long COVID refers to symptoms that appear 3 months after initial infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative virus of Coronavirus disease 2019 (COVID-19), and last for at least 2 months, not attributable to other diagnoses. This health issue significantly burdens patients' quality of life, the economy, and society. Improving the af-termath of COVID-19 is a crucial global health issue in the post-pandemic era. According to current results, it is evident that developing a simple, low-cost respiratory training method that can be easily used at home by themselves with long Coronavirus disease 2019 symptoms (long COVID) is an important and urgent issue. The incentive spirometer is widely used in physical, speech, and respiratory therapy, as well as in preventing postoperative pulmonary infections and improving sputum clearance. However, to date, the role of incentive spirometer respiratory training in long COVID symptoms is still limited. In this literature review is presented to explore the effectiveness of incentive spirometer respiratory training in alleviating symptoms among individuals recovering from long COVID. We also compile non-invasive assessment methods, with the aim to enable individuals to undergo training and assessments conveniently at home or in the community. In this review, a literature review approach was utilized to explore the effectiveness of incentive spirometer intervention in alleviating long-term COVID symptoms. This study is to synthesize the findings of articles published during January 2019 and December 2023 retrieved from PubMed/CINAHL/MEDLINE/ Google Scholar without re-strictions on study type. We ultimately identified seven articles and have summarized similar past studies. This review could contribute to improving symptoms related to long COVID by incentive spirometer respiratory training and serve as practical reference material for clinical medical staff and provide insights for healthcare policymakers in de-veloping guidelines for future research directions, clinical guidance, and educational strategies in the context of nursing care.

Burden of post-acute COVID-19 sequelae in healthcare workers and its course over a 30-month period-results from a prospective multicentre cohort

PURPOSE

As healthcare workers (HCW) have been disproportionally affected by COVID-19, its post-acute sequelae (PASC) in HCW can impact healthcare systems. We assessed the burden and course of PASC in HCW over a 30-month period.

METHODS

In a prospective multicentre HCW cohort in Switzerland, PASC surveys were conducted in 03/2021, 09/2021, 06/2022, 04/2023, and 10/2023. Stratified by viral variant at first infection, the prevalence of PASC symptoms, self-experienced PASC and the Post-COVID Functional Status (PCFS) were analysed cross-sectionally in 10/2023, self-perceived success of therapeutic measures used was assessed. The evolution of PASC symptoms and PCFS in Wild-type and non-Wild-type infected HCW compared to uninfected controls was analysed longitudinally across all surveys.

RESULTS

In cross-sectional analysis, 1704 HCW (median age 47 years, 82.2% female) were included. Thereof, 30.7% reported ≥ 1 PASC symptom in 10/2023, with 115 (6.7%) stating to have or have had PASC. Both were most common after Wild-type infection compared to other variants. Overall, 17/115 (15%) indicated relevant/severe restrictions in their daily activities and of 85 (74%) that tried ≥ 1 measure against their symptoms, 69 (81%) reported having benefitted. Longitudinal analysis (n = 653) showed a significantly higher proportion of Wild-type infected HCW to report PASC symptoms compared to controls in 03/2021 (+ 21%, 95% CI 4-39), with decreasing trend (+ 7%, 95%CI -10-25 in 10/2023). This effect was not evident for non-Wild-type infected HCW.

CONCLUSIONS

Over a 30 month period, overall PASC burden in our HCW cohort decreased, although 1% still experience relevant restrictions in their daily life; Wild-type infected individuals show the highest disease burden.

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.

Elevating care: assessing the impact of telemonitoring on diabetes management at a cutting-edge quaternary hospital

OBJECTIVE

To assess whether post-discharge telemonitoring reduces hospital readmission in patients participating in the diabetes care program.

METHODS

This retrospective cohort study was conducted from June 2021 to December 2022 and included patients who were enrolled in the Diabetes Program under a hyperglycemia treatment protocol and eligible for post-discharge telemonitoring. The variables included age, sex, diagnosis, hospital stay, LACE Score, and readmission rate.

RESULTS

Among 165 patients who underwent telemonitoring, significant differences emerged in hospital readmission rates between those with and without telemonitoring (p=0.015), with a 15.4% lower readmission rate in the telemonitoring group (95%CI= 3.0-27.9%). Subgroup analyses revealed higher readmission rates in men without telemonitoring (15.2% difference; 95%CI= 0.4-30.0%; p=0.045), and in age groups ≤60 and ≥75 years without telemonitoring (24.2% difference; 95%CI= 4.5-43.9%; p=0.016 for ≤60 years; 37.1% difference; 95%CI= 9.9% to 64.2%; p=0.007 for ≥75 years). Additionally, patients with prolonged hospital stays (>7 days) without telemonitoring had higher readmission rates (19.5% difference; 95%CI= 4.5%-34.5%; p=0.011).

CONCLUSION

This study suggests that post-discharge telemonitoring can effectively lower hospital readmission rates in diabetes management programs, potentially offering improved health outcomes, cost savings, and enhanced healthcare delivery to patients.

Changes in thalamic functional connectivity in post-Covid patients with and without fatigue

BACKGROUND

Functional brain alterations in post-Covid-19 condition have been minimally explored to date. Here, we investigate differences in resting-state thalamic functional connectivity among post-Covid patients with and without fatigue, alongside structural brain changes and cognition.

METHODS

Thirty-nine post-Covid patients (n = 15 fatigued, n = 24 non-fatigued) participated in our study, undergoing comprehensive cognitive assessments, as well as functional and structural neuroimaging. We conducted a seed-based functional connectivity analysis using the thalamus as a seed region, exploring its connectivity with the entire brain. To further elucidate our findings, correlation analyses were performed using the functional coupling between the thalamus and regions showing different connectivity between the two patient groups.

RESULTS

Our results reveal that patients experiencing fatigue exhibit anti-correlated functional coupling between the thalamus and motor-associated regions, including the motor cortex (M1), supplementary motor area (SMA), and anterior cingulate cortex (ACC), compared to non-fatigued patients, who are showing positive functional coupling. Furthermore, this observed coupling was found to correlate with both the fatigue scores obtained from a fatigue questionnaire and performance on the Trail Making Test, Part A, which represents a measure of processing speed.

CONCLUSIONS

Our study highlights significant differences in resting-state functional connectivity between post-Covid patients with and without fatigue, particularly within motor-associated brain regions. These findings suggest a potential neural mechanism underlying post-Covid fatigue and underscore the importance of considering both functional and structural brain changes in understanding the symptomatic sequelae of post-Covid-19 condition. Further research is warranted to provide insight into the longitudinal trajectories of these neural alterations.

Sex-related differences concerning the profile and evolution of cardiovascular complications in patients with post-acute COVID-19 syndrome

BACKGROUND

During the COVID-19 pandemic sex-related differences concerning the spectrum of cardiovascular complications have been observed in the acute infection, and during recovery. This study aims to emphasize sex-related disparities regarding left ventricular systolic function (LVSF), right ventricular function (RVF), diastolic dysfunction (DD), and pericardial pathologies during the post-COVID-19 syndrome.

METHODS

274 patients with post-acute COVID-19 syndrome, 127 men and 147 women, aged under 55, were evaluated within 90 days after the acute illness and followed at 3 and 6 months.

RESULTS

Based on detailed transthoracic echocardiography (TTE), we identified significantly more frequently (p˂0.001) altered LVSF in men, while in women impaired RVF, and DD were significantly more common (p˂0.001). Pericardial impairment did not seem to be influenced by gender. The TTE parameters characterizing these patterns were correlated with the severity of the initial infection and the time elapsed since and alleviated in time. The multivariate regression analysis confirmed these sex-related associations and their impact on patients' functional status.

CONCLUSIONS

Male patients had a higher tendency to develop altered LVSF, while female subjects had more frequently impaired RVF and DD. These abnormalities alleviated in time and exerted a significant influence on patients' functional status.

Side-effect expectations are associated with disability, physical fitness, and somatic symptoms 3 months after post-COVID neurological inpatient rehabilitation

INTRODUCTION

The COVID-19 pandemic, caused by SARS-CoV-2, has led to long-term health issues known as post-COVID-19 condition, including fatigue and cognitive disruptions. Despite its recognition as a public health concern, the efficacy of therapeutic interventions, especially in neurological rehabilitation, remains unclear. This study examines how treatment expectations are associated with psychological and physical outcomes in post-COVID-19 condition neurological rehabilitation.

METHODS

In an observational cohort study 61 patients with confirmed post-COVID-19 condition were included. Baseline (T0) data on treatment and side effect expectations were collected, before participants underwent a 4-6 week multidisciplinary rehabilitation program. Primary outcome was illness-related disability (Pain Disability Index). Secondary outcomes included depressive symptoms (PHQ-9), anxiety levels (GAD-7), functional status (PCFS), fatigue (CFS), and physical fitness (6MWT). Regression models analyzed the associations of baseline expectations with outcomes at the end of rehabilitation (T1) and three months post-rehabilitation (T2).

RESULTS

After adjusting for multiple testing, higher baseline side-effect expectations were associated with greater illness-related disability (β = 0.42, p = 0.007), reduced physical fitness (β = - 0.24, p = 0.04), and more somatic symptoms (β = 0.33, p = 0.006) at follow-up (T2). Positive treatment expectations were associated with poorer functional status (β = 0.35, p = 0.011) at T2.

CONCLUSION

This study highlights the associations of side-effect expectations with post-COVID-19 condition rehabilitation outcomes. Higher side-effect expectations were associated to poorer outcomes, indicating a nocebo effect. Surprisingly, positive expectations were linked to worse outcomes, possibly due to unrealistic optimism. Managing patient expectations realistically and addressing side-effect concerns seems crucial for optimizing rehabilitation outcomes.

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.

[Health Literacy, Contact Points, Unmet Subjective Needs and Treatment Satisfaction of those Affected by Long Covid with Long-Lasting Neuropsychiatric Symptoms]

OBJECTIVE

The bejective was to determine health literacy (HL) and care aspects of those affected by Long-COVID.

METHOD

407 patients with Long-COVID and long-term neuropsychiatric symptoms were interviewed in the LIFE study center. In addition to descriptive analyses, regression models were calculated to examine the relationships between health literacy (HLS-EU-Q16) and various aspects of care (RehaQ-N1).

RESULTS

The results show that 35.8% had problematic and 17.9% had inadequate HL. The majority of subjective needs were unmet and 47.7% of those affected were dissatisfied with the therapy they received.

DISCUSSION

Among those affected by Long-COVID, subjective HL is rather reduced. The healthcare system appears to be unprepared for these patients, which is reflected in unmet needs and low treatment satisfaction. This was even more pronounced among those exhibiting lower HL.

Remote administration of the short physical performance battery, the 1-minute sit to stand, and the Chester step test in post-COVID-19 patients after hospitalization: establishing inter-reliability and agreement with the face-to-face assessment

PURPOSE

To assess the inter-reliability of the Short Physical Performance Battery (SPPB), the 1-min Sit to Stand test (1-MSTS), and the Chester Step Test (CST) via remote assessment in post-COVID-19 patients after hospitalization.

METHODS

Twenty-five post-COVID-19 patients randomly performed the functional tests via remote assessment using a software platform at home and via face-to-face assessment at the rehabilitation center 24-72 h apart. One day before the remote assessment, all participants had a 1-h guidance session regarding the platform use, safety instructions, and home equipment preparation.

RESULTS

Participants completed all tests for both assessment procedures without experience of adverse events. The mean age was 53 (SD = 10) years old, and the median days of hospitalization were 23 (IQR = 10-33). The inter-reliability was moderate for the total score in the SPPB: Cohen's kappa = 0.545 (95% CI: 0.234 to 0.838), excellent for the number of repetitions in the 1-MSTS: ICC = 0.977 (95% CI: 0.948 to 0.990) and good for the total number of steps in the CST: ICC = 0.871 (95% CI: 0.698 to 0.944).

CONCLUSION

Remote functional assessments for SPPB, 1-MSTS, and CST indicated moderate to excellent inter-reliability in post-COVID-19 patients after hospitalization.

Functional status and quality of life after ICU discharge in severe COVID-19 patients

PURPOSE

To assess the health status of individuals affected by COVID-19 after discharge from the ICU.

METHOD

Cross-sectional study, with patients discharged from the ICU due to severe COVID-19, in which Quality of Life (QoL) was assessed using the 12-Item SFHF, functionality using the Post-COVID-19 FSS, and the level of physical activity using the IPAQ.

RESULTS

Of the sixty patients, 51.7 % were male, with a mean age of 58 years. The physical component of QoL scored worse than the mental component and older patients had worse QoL in the physical component. These patients were shown to have low functionality scores and an irregularly active level of physical activity B. A lower level of physical activity was associated with individuals who remained in the prone position during hospitalization, while worse functionality was associated with the 70+ age group, although all age groups had functional losses. There was no association between QoL, functionality and level of physical activity and the clinical characteristics of the patients during hospitalization or the time they were discharged.

CONCLUSION

The majority of patients discharged from the ICU after severe COVID-19 have altered functional capacity, QoL and physical activity levels, which is not associated with the clinical characteristics during hospitalization.

Two-day cardiopulmonary exercise testing in long COVID post-exertional malaise diagnosis

BACKGROUND

Long COVID patients present with a myriad of symptoms that can include fatigue, exercise intolerance and post exertional malaise (PEM). Long COVID has been compared to other post viral syndromes, including myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), where a reduction in day 2 cardiopulmonary exercise test (CPET) performance of a two-day CPET protocol is suggested to be a result of PEM. We investigated cardiopulmonary and perceptual responses to a two-day CPET protocol in Long COVID patients.

METHODS

15 Long COVID patients [n=7 females; mean (SD) age: 53(11) yr; BMI = 32.2(8.5) kg/m2] performed a pulmonary function test and two ramp-incremental CPETs separated by 24 hr. CPET variables included gas exchange threshold (GET), peak oxygen uptake (V̇O2peak) and peak work rate (WRpeak). Ratings of perceived dyspnoea and leg effort were recorded at peak exercise using the modified 0-10 Borg Scale. PEM (past six months) was assessed using the modified DePaul Symptom Questionnaire (mDSQ). One-sample t-tests were used to test significance of mean difference between days (p<0.05).

RESULTS

mDSQ revealed PEM in 80 % of patients. Lung function was normal. Responses to day 1 CPET were consistent with the presence of aerobic deconditioning in 40 % of patients (V̇O2peak <80 % predicted, in the absence of evidence of cardiovascular and pulmonary limitations). There were no differences between day-1 and day-2 CPET responses (all p>0.05).

CONCLUSION

PEM symptoms in Long COVID patients, in the absence of differences in two-day CPET responses separated by 24 hours, suggests that PEM is not due to impaired recovery of exercise capacity between days.

Memory complaints after COVID-19: a potential indicator of primary cognitive impairment or a correlate of psychiatric symptoms?

Cognitive impairment and symptoms of psychiatric disorders have been reported frequently as features of post-acute sequelae of SARS-CoV-2 infection. This study aims to investigate subjective memory complaints in COVID-19 survivors and determine if these are more strongly associated with objective cognitive impairment related to sequelae of SARS-CoV-2 infection or with symptoms of psychiatric conditions. A total of 608 COVID-19 survivors were evaluated in-person 6-11 months after hospitalization, with 377 patients assigned to a "no subjective memory complaint (SMC)" group and 231 patients assigned to an SMC group based on their Memory Complaint Scale scores. Follow-up evaluations included an objective cognitive battery and scale-based assessments of anxiety, depression, and post-traumatic stress symptoms. We found the perception of memory impairment in COVID-19 survivors to be more strongly associated to core symptoms of psychiatric conditions rather than to primary objective cognitive impairment. Univariate analysis indicated significant differences between the "no SMC" and SMC groups, both for the psychiatric symptom evaluations and for the cognitive evaluations (p < 0.05); however, the psychiatric symptoms all had large partial eta-squared values (ranging from 0.181 to 0.213), whereas the cognitive variables had small/medium partial eta-squared values (ranging from 0.002 to 0.024). Additionally, multiple regression analysis indicated that only female sex and depressive and post-traumatic stress symptoms were predictors of subjective memory complaints. These findings may help guide clinical evaluations for COVID-19 survivors presenting with memory complaints while also serving to expand our growing understanding of the relationship between COVID-19, subjective memory complaints, and the risk of cognitive decline.

Rehabilitation Is Associated With Improvements in Post-COVID-19 Sequelae

BACKGROUND

Post-COVID-19 syndrome has affected millions of people, with rehabilitation being at the center of non-pharmacologic care. However, numerous published studies show conflicting results due to, among other factors, considerable variation in subject characteristics. Currently, the effects of age, sex, time of implementation, and prior disease severity on the outcomes of a supervised rehabilitation program after COVID-19 remain unknown.

METHODS

This was a non-randomized case-control study. Subjects with post-COVID-19 sequelae were enrolled. Among study participants, those who could attend an 8-week, supervised rehabilitation program composed the intervention group, whereas those who couldn't the control group. Measurements were collected at baseline and 8 weeks thereafter.

RESULTS

Study groups (N = 119) had similar baseline measurements. Participation in rehabilitation (n = 47) was associated with clinically important improvements in the 6-min walk test (6MWT) distance, adjusted (for potential confounders) odds ratio (AOR) 4.56 (95% CI 1.95-10.66); 1-min sit-to-stand test, AOR 4.64 (1.88-11.48); Short Physical Performance Battery, AOR 7.93 (2.82-22.26); health-related quality of life (HRQOL) 5-level EuroQol-5D (Visual Analog Scale), AOR 3.12 (1.37-7.08); Montreal Cognitive Assessment, AOR 6.25 (2.16-18.04); International Physical Activity Questionnaire, AOR 3.63 (1.53-8.59); Fatigue Severity Scale, AOR 4.07 (1.51-10.98); Chalder Fatigue Scale (bimodal score), AOR 3.33 (1.45-7.67); Modified Medical Research Council dyspnea scale (mMRC), AOR 4.43 (1.83-10.74); Post-COVID-19 Functional Scale (PCFS), AOR 3.46 (1.51-7.95); and COPD Assessment Test, AOR 7.40 (2.92-18.75). Time from disease onset was marginally associated only with 6MWT distance, AOR 0.99 (0.99-1.00). Prior hospitalization was associated with clinically important improvements in the mMRC dyspnea scale, AOR 3.50 (1.06-11.51); and PCFS, AOR 3.42 (1.16-10.06). Age, sex, and ICU admission were not associated with the results of any of the aforementioned tests/grading scales.

CONCLUSIONS

In this non-randomized, case-control study, post-COVID-19 rehabilitation was associated with improvements in physical function, activity, HRQOL, respiratory symptoms, fatigue, and cognitive impairment. These associations were observed independently of timing of rehabilitation, age, sex, prior hospitalization, and ICU admission.

Individualized and Controlled Exercise Training Improves Fatigue and Exercise Capacity in Patients with Long-COVID

(1) Background: Long-term health effects after SARS-CoV-2 infections can manifest in a plethora of symptoms, significantly impacting the quality of life of affected individuals. (2) Aim: The present paper aimed to assess the effects of an individualized and controlled exercise intervention on fatigue and exercise capacity among Long-COVID (LC) patients in an ambulatory setting. (3) Methods: Forty-one (n = 41) LC patients performed an exercise protocol with an individualized control of the patients' training intensity during the study period based on the individual's ability to achieve the target criteria. The program was carried out two to three times a week, each session lasted 30 min, and the study parameters were recorded at the beginning of the program, as well as after 6 and 12 weeks, respectively. These included both patient-reported (PCFS questionnaire, FACIT-Fatigue questionnaire) and objective (one-minute sit-to-stand test (1MSTST), workload) outcomes. (4) Results: The exercise training intervention resulted in significant improvements in the FACIT-Fatigue (F(2, 80) = 18.08, p < 0.001), 1MSTST (χ2(2) = 19.35, p < 0.001) and workload scores (χ2(2) = 62.27, p < 0.001), while the PCFS scores remained unchanged. Changes in the workload scores were dependent on the frequency of the completed exercise sessions and were higher in the LC patients with a moderate Post COVID Syndrome Score (PCS) compared to a severe PCS. (5) Conclusions: The individualized and controlled training approach demonstrated efficacy in reducing fatigue and enhancing exercise capacity among outpatient LC patients. However, for complete regeneration, a longer, possibly indefinite, treatment is required, which in practice would be feasible within the framework of legislation.

Online and Face-to-Face Mat Pilates Training for Long COVID-19 Patients: A Randomized Controlled Trial on Health Outcomes

This study investigated the impacts of online and face-to-face Mat Pilates training in adults with persistent symptoms of long COVID on health outcomes. Forty-nine patients (52 ± 5.85 yr.) diagnosed with long COVID related to fatigue symptoms were randomly included in three groups: online Mat Pilates training (n = 16), face-to-face Mat Pilates training (n = 15), and a control group (n = 18) without training. Mat Pilates training was conducted three times a week for 12 weeks. Fatigue, functional capacity, anthropometrics, body composition, and cardiometabolic markers were assessed before and after the interventions. Two-factor Generalized Estimating Equation analyses identified significant differences with Bonferroni post hoc testing (p < 0.05). After the intervention, only the face-to-face Mat Pilates training group had an improved total, physical and mental fatigue, trunk isometric strength, upper limb muscle endurance strength, and aerobic capacity (p < 0.05). No changes were found in fat mass, muscle mass, free fat mass, % of fat, body mass, body mass index, or waist and hip circumferences. No significant changes were observed in blood glucose, glycated hemoglobin, triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, or blood pressure (p > 0.05). Our results highlight the potential of face-to-face Mat Pilates training as an effective intervention to mitigate persistent symptoms of long COVID related to fatigue and functional capacities.

Impact of post-COVID symptoms on activity and participation of women and men

Post-COVID syndrome is affecting many organ systems and arises as a major public health problem with millions of cases worldwide. The primary aim of this study is the analysis of health problems, activity limitations and participation restrictions (ALPR) of participants with post-COVID symptoms and the investigation of correlations between these elements to derive statements about the rehabilitation need, also depending on sex. A retrospective cohort study was performed to collect longitudinal data from January 2022 to January 2023 using the Covid-19 Rehabilitation Needs Questionnaire (RehabNeQ). Patients completed the questionnaire at the Department of Rehabilitation- and Sports Medicine at Hannover Medical School. The 1st assessment included 307 study participants, of whom 54 showed up for the 2nd, 7 for the 3rd and one for the 4th assessment. Study participants with post-COVID symptoms also experience ALPR. The results show no significant difference in symptom intensity in women and men, but in intensity of ALPR. We found many correlations of varying degrees between various factors with ALPR. We found frequent correlations between fatigue and several ALPR. While these correlations apply to both sexes, we also found different correlations in women and men, indicating the different rehabilitation need of women and men.

Mitochondrial dysfunction in long COVID: mechanisms, consequences, and potential therapeutic approaches

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has introduced the medical community to the phenomenon of long COVID, a condition characterized by persistent symptoms following the resolution of the acute phase of infection. Among the myriad of symptoms reported by long COVID sufferers, chronic fatigue, cognitive disturbances, and exercise intolerance are predominant, suggesting systemic alterations beyond the initial viral pathology. Emerging evidence has pointed to mitochondrial dysfunction as a potential underpinning mechanism contributing to the persistence and diversity of long COVID symptoms. This review aims to synthesize current findings related to mitochondrial dysfunction in long COVID, exploring its implications for cellular energy deficits, oxidative stress, immune dysregulation, metabolic disturbances, and endothelial dysfunction. Through a comprehensive analysis of the literature, we highlight the significance of mitochondrial health in the pathophysiology of long COVID, drawing parallels with similar clinical syndromes linked to post-infectious states in other diseases where mitochondrial impairment has been implicated. We discuss potential therapeutic strategies targeting mitochondrial function, including pharmacological interventions, lifestyle modifications, exercise, and dietary approaches, and emphasize the need for further research and collaborative efforts to advance our understanding and management of long COVID. This review underscores the critical role of mitochondrial dysfunction in long COVID and calls for a multidisciplinary approach to address the gaps in our knowledge and treatment options for those affected by this condition.