Prevalence of Functional Limitation in COVID-19 Recovered Patients Using the Post COVID-19 Functional Status Scale

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.

The Assessment of Functional Status Among COVID-19 Patients at Three Months Using Pulmonary Function Tests

Introduction The coronavirus disease 2019 (COVID-19) pandemic has impacted the lives of thousands of patients worldwide with many patients having residual symptoms months after the acute infection. The severity of lung involvement ranges from mild asymptomatic to severe acute respiratory distress syndrome (ARDS), which may lead to pulmonary fibrosis. Pulmonary fibrosis increases the long-term morbidity of post-COVID-19 patients in the form of restrictive lung disease. The six-minute walk test (6MWT), Borg scale, and spirometry are simple and low-cost tests used to evaluate a patient's exercise capacity and functional status. This study was conducted to assess the residual symptoms and functional status using spirometry and 6MWT in COVID-19 patients of moderate to severe category after three months of discharge. Methods This was an observational, prospective, and cross-sectional study conducted at a tertiary care center in North India, aiming to enroll a minimum of 50 patients who recovered from COVID-19 pneumonia. These patients were previously hospitalized with moderate to severe disease severity as defined by the Indian Council of Medical Research (ICMR) criteria, and the assessment occurred at least three months after their discharge. Individuals who were under 18 years of age or pregnant or had any respiratory or cardiac illness in the past were excluded from the study. Results A total of 50 patients were included in the study for final analysis. After a three-month follow-up, 40 (80%) patients were still symptomatic. The most commonly reported symptom was exertional dyspnea in 21 (42%), dyspnea at rest in 16 (32%), and fatigue in three (6%) patients. Of the total patients, 37 (74%) covered a distance less than expected in the six-minute walk test. The mean distance covered by patients was 426.1 ± 115.01 m, in contrast to the expected mean distance of 537.22 ± 37.61 m according to standard equations for Indian males and females. A fall in oxygen saturation by more than or equal to 3% was observed in approximately 24 (48%) patients after the six-minute walk test. The mean value of fatigue and dyspnea score was 3.2 ± 1.7 (moderate score). Among patients with moderate disease during their hospital stay, a higher proportion exhibited a normal pattern on pulmonary function tests (PFT) compared to those severely affected, 23 (69.70%) versus two (11.76%), respectively. Conclusion The persistence of symptoms and functional limitation of activities should be anticipated in patients with COVID-19. Spirometry and 6MWT can be a valuable tool in determining the prevalence of functional limitation in recovered patients of COVID-19. It can potentially help in determining and further planning the rehabilitative measures in the management of COVID-19 survivors. It can also be concluded that it is important to have a long-term follow-up in patients with moderate to severe COVID-19.

Post-COVID-19 Intensive Care Unit-Acquired Weakness Compromises Long-Term Functional Status

OBJECTIVE

The objective of this study was to evaluate the impact of intensive care unit (ICU)-acquired weakness (ICUAW) on the functional independence of patients hospitalized for coronavirus disease 2019 (COVID-19) over 6 months after ICU discharge.

METHODS

This was a prospective cohort study that included patients who were admitted to the ICU because of COVID-19 and who were monitored for 6 months after discharge from the ICU via telephone. Patients were evaluated at 3 times (30 days, 3 months, and 6 months after discharge from the ICU) for functional independence for personal care and mobility activities (Barthel Scale), independence for self-care (Katz Index), impact of COVID-19 on functional status (post-COVID-19 Functional Status Scale [PCFS]), and mobility level (ICU Mobility Scale). The existence of some degree of dependence was considered when the Barthel Scale score was <100 points, the Katz Index was ≥1, and the PCFS score was ≥1. A PCFS score of ≥3 indicated moderate or severe dependence. Patients with a Medical Research Council score of <48 at discharge from the ICU were diagnosed with ICUAW.

RESULTS

Sixty-eight patients were included, with a mean age of 51 (SD = 13) years. The ICUAW rate at ICU discharge was 35%. In the evaluation with the PCFS, the values for the presence of any functional limitation at 30 days, 3 months, and 6 months after ICU discharge were 89.7%, 57.4%, and 38.2%, respectively. The rate of persistence of functional limitations after 6 months was higher in patients with ICUAW than in those without ICUAW (66.7% vs 22.8%; P = .000); the same was true for moderate or severe limitations (20.8% vs 4.5%; P = .035). Likewise, functional independence for personal care, mobility, and self-care activities was poorer in patients with ICUAW.

CONCLUSIONS

In patients surviving an ICU stay due to COVID-19, decreased functional independence persists even 6 months after discharge, and patients with ICUAW have worse outcomes.

IMPACT

Patients who survive ICU stays due to COVID-19 continue to have greater functional dependence even 6 months after ICU discharge.

Hospital admission is associated with disability and late musculoskeletal pain in individuals with long COVID

Background

The acute clinical repercussions of SARS-CoV-2 infection have been widely studied. However, the possible late repercussions of long COVID have not yet been well defined in the literature.

Objectives

To identify the presence of pain and musculoskeletal disability in patients with Long COVID and also to identify predictive factors for pain intensity in this population.

Methods

In this cross-sectional and retrospective observational study individuals with Long COVID symptoms were included. It was collected musculoskeletal disability measures, data from patient-related outcome measures and variables from a COVID-19 outpatient service database. Associations and sub-group analyses were performed considering the variables pain, disability and hospitalization. Linear regression was performed to identify predictive factors for pain intensity in Long COVID patients.

Results

We evaluated 195 patients and most of them (57%) presented musculoskeletal pain in one area of the body. Pain sub-group presented worse disability indices and worse clinical course during hospitalization. Hospitalized patients presented worse disability indices comparing to non-hospitalized. Significant correlations were found between pain and days of non-invasive oxygen support (r = 0.21; p = 0.003); days in intensive care unit (r = 0.22; p = 0.002) and days in invasive mechanical ventilation (r = 0.35; p = 0.001). Hospitalized individuals showed a higher chance of presenting late musculoskeletal pain (OR = 1.42: 95%CI 1.09-2.04). Days in intensive care unit (β = 0,234: P = 0,001) and days in invasive mechanical ventilation (β = 0.764: P = 0.001) were predictors of pain intensity [F(2,192) = 18.559; R2 = 0.231; p = 0.001].

Conclusion

Individuals with Long COVID presented musculoskeletal pain and disability. Hospitalized patients showed a greater chance of having musculoskeletal pain. Days in intensive care unit and days in invasive mechanical ventilation were predictors of late musculoskeletal pain intensity.

[Impacto de la dependencia funcional de los pacientes mayores atendidos en los servicios de Urgencias españoles durante la primera ola pandémica de la COVID-19 sobre la mortalidad a 30, 180 y 365 días en función del diagnóstico (COVID versus no COVID).]

OBJECTIVE

Functional assessment is part of geriatric assessment. How it is performed in hospital Emergency Departments (ED) is poorly understood, let alone its prognostic value. The aim of this paper was to investigate whether baseline disability to perform basic activities of daily living (BADL) was an independent prognostic factor for death after the index visit to the ED during the first wave of the COVID-19 pandemic and whether it had a different impact on patients with and without diagnosis of COVID-19.

METHODS

A retrospective observational study of the EDEN-Covid (Emergency Department and Elder Needs during COVID) cohort was carried out, consisting of all patients aged ≥65 years seen in 52 Spanish EDs selected by chance during 7 consecutive days (30/3/2020 to 5/4/2020). Demographic, clinical, functional, mental and social variables were analyzed. Dependence was categorized with the Barthel index (BI) as independent (BI=100), mild-moderate dependence (100>BI>60) and severe-total dependence (BI<60), and their crude and adjusted association was evaluated with mortality at 30, 180 and 365 days using COX proportional hazards models.

RESULTS

Of 9,770 enrolled patients with a mean age of 79 years, 51% were men, 6,305 (64.53%) were independent, 2,340 (24%) had mild-moderate dependence, and 1,125 (11.5%) severe-total dependence. The number of deaths at 30 days in these three groups was 500 (7.9%), 521 (22.3%) and 378 (33.6%), respectively; at 180 days it was 757 (12%), 725 (30.9%) and 526 (46.8%); and at 365 days 954 (15.1%), 891 (38.1%) and 611 (54.3%). In relation to independent patients, the adjusted risks (hazard ratio) of dying within 30 days associated with mild-moderate and severe-total dependency were 1.91 (95% CI: 1.66-2.19) and 2.51. (2.11-2.98); at 180 days they were 1.88 (1.68-2.11) and 2.64 (2.28-3.05); and at 365 days they were 1.82 (1.64-2.02) and 2.47 (2.17-2.82). This negative impact of dependency on mortality was greater in patients diagnosed with COVID-19 than in non-COVID-19 (p interaction at 30, 180 and 365 days of 0.36, 0.05 and 0.04).

CONCLUSIONS

The functional dependence of older patients who attend Spanish EDs during the first wave of the pandemic is associated with mortality at 30, 180 and 365 days, and this risk is significantly higher in patients treated for COVID-19.

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

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

Is Central Sensitisation the Missing Link of Persisting Symptoms after COVID-19 Infection?

Patients recovered from a COVID-19 infection often report vague symptoms of fatigue or dyspnoea, comparable to the manifestations in patients with central sensitisation. The hypothesis was that central sensitisation could be the underlying common aetiology in both patient populations. This study explored the presence of symptoms of central sensitisation, and the association with functional status and health-related quality of life, in patients post COVID-19 infection. Patients who were previously infected with COVID-19 filled out the Central Sensitisation Inventory (CSI), the Post-COVID-19 Functional Status (PCFS) Scale and the EuroQol with five dimensions, through an online survey. Eventually, 567 persons completed the survey. In total, 29.73% of the persons had a score of <40/100 on the CSI and 70.26% had a score of ≥40/100. Regarding functional status, 7.34% had no functional limitations, 9.13% had negligible functional limitations, 37.30% reported slight functional limitations, 42.86% indicated moderate functional limitations and 3.37% reported severe functional limitations. Based on a one-way ANOVA test, there was a significant effect of PCFS Scale group level on the total CSI score (F(4,486) = 46.17, p < 0.001). This survey indicated the presence of symptoms of central sensitisation in more than 70% of patients post COVID-19 infection, suggesting towards the need for patient education and multimodal rehabilitation, to target nociplastic pain.