Musculoskeletal involvement: COVID-19 and post COVID 19

Comparison of quadriceps muscle strength, functional capacity and fatigue at hospital discharge and after 12 months in COVID-19 hospitalized patients undergoing early rehabilitation: a follow-up study

PURPOSE

To compare quadriceps muscle strength, functional capacity, and fatigue at hospital discharge and after 12 months in hospitalized individuals with coronavirus disease 2019 (COVID-19) who underwent early rehabilitation, and to verify whether quadriceps muscle strength at hospital discharge and functional capacity at 12 months later could be correlated.

METHODS

This was a prospective cohort study. Isometric quadriceps muscle strength, the Short Physical Performance Battery (SPPB), and the Checklist Individual Strength (CIS) scale were assessed at discharge and after 12 months.

RESULTS

Of the 34 individuals, 17 completed the 12-month follow-up. Although the quadriceps muscle strength significantly improved (p = 0.046), 59.0% of individuals stayed below 70% of predicted values. SPPB score also significantly improved (p = 0.001), but some individuals still demonstrated moderate to low performance. CIS scale score did not change. Quadriceps muscle strength at discharge was correlated with the SPPB score 12 months later (r = 0.675; p = 0.006) and explained 45.6% of the variance in SPPB after 12 months (R2=0.456; p = 0.006).

CONCLUSION

Quadriceps muscle strength and SPPB score improved 12 months after hospital discharge due to COVID-19. However, some individuals still present impairments. Moreover, quadriceps muscle strength at discharge explained functional capacity after 12 months. Thus, early rehabilitation is essential for functional improvement.

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.

Eight Weeks of Resistance Training Is Not a Sufficient Stimulus to Improve Body Composition in Post-COVID-19 Elderly Adults

Background: This study sought to assess how body mass (BM) and body composition in post-COVID-19 elderly adults were affected by 8 weeks of resistance training. An additional goal was to determine the agreement between Bioelectrical Impedance Analysis (BIA) and Dual Energy X-Ray Absorptiometry (DXA) in elderly people. Methods: Participants were randomly assigned to an intervention Group, which engaged in 8 weeks of resistance training, and a Control Group, which was advised to maintain their usual activity levels. Before and after the intervention, the body composition was analyzed via the BIA and DXA methods. Results: We found no statistically significant changes in BM or body composition following resistance training. BIA was found to overestimate the participants' baseline BM and fat-free mass (FFM) and to underestimate the fat mass (FM), compared to the DXA method. There were no significant differences in intervention-induced changes in FM and FFM measured by BIA and DXA. Conclusions: Moderate intensity resistance training lasting 8 weeks was not found to be a sufficient stimulus to improve BM and body composition in post-COVID-19 elderly adults. We also conclude that BIA may serve as a viable alternative to DXA for measuring longitudinal changes in body composition in elderly people.

Assessment of the Effectiveness of Educating Elderly Residents in an Urban Community in South India on Managing Post-COVID-19 Musculoskeletal Complications

Objective This study aimed to enhance post-COVID-19 patients' understanding of musculoskeletal issues and their management through a structured educational program in the elderly population. Methodology The study included 60 participants. Each participant was assessed using sociodemographic tools and a structured knowledge questionnaire on post-COVID-19 musculoskeletal complications among elderly individuals. A pretest was conducted on all participants using these tools. Subsequently, a seven-day structured training program was administered, followed by a post-test using the same tools. A comparative analysis was performed to evaluate the difference in understanding between the pretest and post-test results. Results The pretest comprehension levels in the below-average and average groups showed a mean and standard deviation of 3±1.5 and 14.5±2.0, respectively, with a statistically significant p-value of 0.0001 and a t-value of 15.6. In the post-test, proficiency levels in the average and above-average groups demonstrated a mean and standard deviation of 18.2±1.5 and 24.5±3.6, respectively, with a statistically significant t-value of 6.88 and a p-value of 0.0001. Among the elderly participants, there was a substantial improvement in competence between the pre-and post-test scores, with a highly significant p-value of 0.0001. Conclusion Our study concluded that the elderly population was particularly vulnerable to various diseases and complications due to aging, making it essential to provide education on managing post-COVID-19 musculoskeletal issues.

The Impact of Long COVID on the Quality of Life

Background and Objectives: The term long COVID refers to patients with a history of confirmed COVID-19 infection, who present symptoms that last for at least 2 months and cannot be explained by another diagnosis. Objectives: The present study aims to determine the most common symptoms of the long COVID syndrome and their impact on the quality of life. Materials and Methods: A prospective observational study was conducted on patients diagnosed with mild and moderate COVID-19 (based on a positive SARS-CoV-2 molecular diagnostic or rapid antigen test and severity form definition) at the Clinical Hospital of Infectious Diseases, Cluj-Napoca, Romania. Clinical examinations with detailed questions about symptoms were performed at the time of the diagnosis of COVID-19 and the six-month follow-up. Two years after COVID-19 infection, patients were invited to complete an online quality-of-life questionnaire regarding long COVID symptoms. Results: A total of 103 patients (35.92% males) with a mean age of 41.56 ± 11.77 were included in this study. Of the total number of patients, 65.04% presented mild forms of COVID-19. Data regarding the vaccination status showed that 83.5% were vaccinated against SARS-CoV-2. The most common symptoms at diagnosis were cough (80.6%), fatigue (80.4%), odynophagia (76.7%), and headaches (67.6%), with female patients being statistically more likely to experience it (p = 0.014). Patients with moderate forms of the disease had higher levels of both systolic (p = 0.008) and diastolic (p = 0.037) blood pressure at diagnosis, but no statistical difference was observed in the 6-month follow-up. The most common symptoms at 2 years (in 29 respondent subjects) were represented by asthenia (51.7%), headache (34.5%), memory disorders (27.6%), abdominal meteorism (27.6%), and arthralgia (27.6%). In terms of cardiovascular symptoms, fluctuating blood pressure values (20.7%), palpitations (17.2%), and increased heart rate values (17.2%) were recorded. Conclusions: If at the time of diagnosis, the most frequent manifestations of the disease were respiratory, together with headache and fatigue, at re-evaluation, asthenia, decreased effort tolerance, and neuropsychiatric symptoms prevailed. Regarding the cardiovascular changes as part of the long COVID clinical picture, some patients developed prehypertension, palpitations, and tachycardia.

The Long-Term Effect of COVID-19 Infection on Body Composition

BACKGROUND

The effect of COVID-19 infection versus the indirect effect of the pandemic on body composition remains unclear. This study investigates the long-term changes in body composition in COVID-19 survivors compared to a contemporary control group.

METHOD

This is a prospective study involving adults who underwent a pre-pandemic whole-body DXA scan (DXA#1) between 2017 and 2019. Participants were asked to return for a repeat whole-body DXA scan (DXA#2) after the pandemic. Detailed data were collected including their medical and COVID-19 history. Inflammation markers and fasting lipids were measured. For those participants who experienced a COVID-19 infection between the two DXAs, DXA#2 was acquired at least one year after COVID-19 infection.

RESULTS

Overall, 160 adults were enrolled; 32.5% females, 51.8% non-white, with mean age of 43.2 years. Half (n = 80) of the participants experienced a COVID-19 infection between their two DXA scans (COVID-19+ group), and the other half had never had COVID-19. COVID-19-negative participants displayed an increase in annualized trunk fat (g) [922.5 vs. 159.7; p = 0.01], total fat (g) [1564.3 vs. 199.9; p = 0.2], and LBM (g) [974.9 vs. -64.5; p = 0.0002] when compared to the COVID-19+ group. However, among the COVID-19+ group, no differences were seen in annualized trunk fat, total fat mass, or LBM between those with PASC and without (p > 0.05).

CONCLUSION

During the pandemic, both the COVID-19 survivors and the COVID-19-negative group exhibited increases in weight, total fat, and trunk fat, likely associated with pandemic-linked lifestyle modifications. However, only COVID-19 survivors displayed a decline in lean body mass over the same period, regardless of PASC symptoms.

Effects of Pilates Exercises on Core Stability After Recovery from COVID-19: A Randomized Controlled Trial

Purpose

The primary objective was to investigate the effects of Pilates exercises on CS, and the secondary objective was to assess static trunk balance after recovery from COVID-19.

Patients and Methods

145 recovered COVID-19 university students between the ages of 19 and 25 participated in this single-blinded, randomized controlled trial study. The participants were divided into a Pilates group and a control group, each of which received a home exercise program. Core muscle endurance was measured using the five basic endurance tests and static balance using the Prokin system with open eyes (OE) and closed eyes (CE) at baseline and after three months of treatment.

Results

All measured parameters showed improvement within the groups after treatment. Group comparison revealed a significant increase in the Pilates group in all core endurance tests (P<0.001). The Prokin system results showed improvement in the Pilates group after treatment, while perimeter with OE, CE, and ellipse area with EC decreased (P<0.001), but there was no significant difference in ellipse with OE between the groups.

Conclusion

Pilates exercises positively improved core muscle endurance and trunk balance in people infected with COVID-19, which will be reflected in their quality of movement patterns and quality of life.

Difficulties in decision making on a long standing, complicated case of osteoporosis – a real challenge for functional rehabilitation

We aim was to present a case of severe osteoporosis with concern to an adult female who was under specific medication against the condition while she experienced inexplicable weight loss in association with an incidental fracture inconsistent with DXA changes. Challenges of the case management and decision making are further on explained. Real-life-medicine poses multiple issues that require an individual decision while respecting the standard protocols. That is why a generalized decision is rather impractical. Here we introduce the clinical case of a lady in her late 60s with a known 6-year history of osteoporosis that required several difficult decisions along surveillance: at first, zoledronic acid represented an available solution, yet after one year, BMD decreased and adjustment was done by initiating a second sequence according to the teriparatide protocol. DXA-BMD, as well as the spectrum of bone turnover markers, qualified the patient as responsive and she further continued with oral bisphosphonates while being monitored via telemedicine amid COVID-19 pandemic. After 24 more months, a second decision of zoledronic acid was done, despite prior partial response, but digestive complains restricted the oral administration of anti-osteoporotic drugs. After one more year, denosumab was initiated and consecutive follow-up is essential. At this point, another challenging aspect was revealed: the discordance between DXA – based scores increase and the presence of an incidental fracture. A supplementary investigation was considered useful (Tc- whole body scintigraphy) noting the clinical presentation with local pain, dysfunctionality, and mild weight loss that also required rehabilitation management.

Domestic fall – related multiple osteoporotic vertebral fractures: considerations amid late COVID-19 pandemic (a case on point)

Our purpose was to introduce a case on point of a menopausal woman who suffered a domestic fall with consecutive persistent back pain and reduced mobility, and delayed the presentation amid late COVID-19 pandemic. On admission, she was confirmed with osteoporosis according to DXA (lowest T-score of -5.5) and started zoledronate. She refused further orthopedic intervention and remained on non-invasive long term rehabilitation plan while surveillance of anti-osteoporotic medication was offered to her. Fragility vertebral fractures represent increasingly common issues that require prompt intervention to overall a better prognosis. Late presentation and a first diagnosis of 10 vertebral fractures is a part of real life medicine with consequences amid potential lack of compliance to medication and adherence to a rehabilitation plan with short term and long term effects. Transition to post-pandemic reality still represents a concurrent pitfall to delayed hospitalization.