Clinical aspects, persistent symptoms, physical functionality, and quality of life 24 months after COVID-19

doi:10.21203/rs.3.rs-5242403/v1

Introduction Patients affected by SARS-CoV-2 may experience sequelae and symptoms such as fatigue, abnormalities in lung function and decreased quality of life scores.

Objective To evaluate the clinical, functional aspects, and quality of life post-COVID-19 recovery.

Methods This study comprised 43 patients from São Luís, Maranhão, Brazil. Were collected manovacuometry, Fatigue Assessment Scale (FAS), Post-COVID-19 Functional Scale (PCFS), EuroQol-5D Quality of Life Questionnaire (EQ-5D-5L), and anthropometry.

Results Predominated females, age of 55±12.3 years; 93.0% reported tiredness and fatigue. Women exhibited a higher percentage of normal maximum inspiratory pressure (MIP) (60.5%) and maximum expiratory pressure (MEP), moderate (36.8%). Moderate functional limitation was reported by 51.2%, and 48% experienced fatigue. The EQ-5D-5L averaged 60, with 46.5% at high cardiovascular risk based on waist-hip ratio, 16.3% identified as sarcopenic. Unsupervised machine learning correlated higher MIP and MEP with lower fatigue and sarcopenia. The main components in the multivariate analysis were: waist, hip, calf circumference and MIP.

Conclusion Anthropometry negatively impact functionality and quality of life. Symptoms as fatigue, joint pain, and dyspnea, persisted approximately 24 months post-COVID-19.

COVID-19

Long COVID

Functionality

Quality of life.

The viral disease caused by the novel coronavirus, SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), has led to significant morbidity and mortality worldwide since the initial cases were identified in Wuhan, China, in December 2019. In Brazil, COVID-19 (Coronavirus Disease 2019) has accounted for over 700,000 deaths. However, it’s noteworthy that the recovery rate surpasses 95% for most cases [1, 2].

Despite the fact that the majority of these patients fully recover without any lasting effects, a notable proportion reports persistent health issues. The exact count of individuals experiencing lingering symptoms after the acute episode of COVID-19 remains unknown; however, it appears to be more prevalent among those with pre-existing comorbidities, advanced age, and obesity [3].

Among the main persistent complications found in these individuals after recovery from the disease include fatigue, dyspnea, reduced lung capacity, respiratory and peripheral muscle weakness, pain, among others that can impact functionality and decrease the quality of life of survivors [4].

This phase of the disease is classified as post-COVID-19 syndrome, that is, a set of clinical symptoms persistent beyond four weeks developed by individuals with a history of SARS-CoV-2 infection, as long as there is no other intercurrent process that could explain it. Them [5].

Studies indicate that a considerable portion of individuals recovering from COVID-19 exhibit low physical fitness and impaired performance in daily activities. This often leads to increased dependence on others for personal care adversely affecting their quality of life [6].

While these consequences are more pronounced in patients who experienced severe forms of the disease, Jacobson et al. [7] describe similar symptoms in both hospitalized and non-hospitalized patients 3 to 4 months post-diagnosis. Functional impairment was notably higher in hospitalized patients but also prevalent in those who did not require hospitalization during the acute phase of the disease. Previous studies with other coronaviruses, such as severe acute respiratory syndrome (SARS) in 2003 and Middle East Respiratory Syndrome (MERS) in mid-2012, highlighted persistent cardiovascular and muscular impairment with an impact on quality of life for up to 2 years after the symptom onset [8].

It is important to highlight that vaccination has proven effective in preventing SARS-CoV-2 infection, reducing the rates of death and hospitalization following COVID-19 illness. However, its efficacy in preventing the sequelae resulting from the disease, namely a significant reduction in persistent symptoms after the acute phase, has not been pronounced [9]. In this context, this study aims to assess the clinical, functional aspects, and quality of life in individuals’ post-recovery from COVID-19.

2.1 Study design and population

This is a descriptive observational study applied to 43 individuals (35 women and 8 men) with post-COVID-19 syndrome in the Brazilian public network, diagnosed by the medical team with post-COVID-19 syndrome, clinically stable, immunized, hospitalized or not during the acute phase of the disease, with voluntary and consented participation, without distinction of race or ethnicity and who were in the process of rehabilitation.

Patients were not included if they had a diagnosed cognitive impairment that prevented them from understanding the instructions presented and carrying them out safely, those under 18 years of age, presence of pre-COVID-19 symptoms, use of a tracheostomy, musculoskeletal and neurological conditions that prevented the performance of all stages of the study.

2.2 Instruments and procedures

Patients were submitted to an anamnesis using an assessment questionnaire, containing clinical history of the disease, data such as sex, age, presence of comorbidities, persistent symptoms, immunization, among others.

Respiratory muscle strength was assessed using manovacuometry. The analog manometer − 150/+150cmH20 from the Brazilian manufacturer VENTBRAS (São Paulo, SP, Brasil) was used, in which the patient took three measurements for each respiratory phase in a sitting position, with only the one with the highest value being considered [10].

We then assessed functionality using the Post Covid-19 Functional Scale (PCFS). This scale already has a validated measurement adaptation for the Brazilian population and its version presented content validity, reliability, internal consistency and convergent validity suitable for the functional assessment of individuals affected by COVID-19 [11].

Quality of life was measured using the EuroQol-5 Dimensions Questionnaire (EQ-5D-5L) score. Values closer to 0 correspond to the worst health status and closer to 100 indicate better health status [12]. It is worth noting that this questionnaire already has translation and cross-cultural validation into Brazilian Portuguese [13] and currently, this questionnaire is recommended in international guidelines for the initial assessment of patients undergoing post-COVID-19 rehabilitation [14].

The Fatigue Assessment Scale (FAS) was used to assess fatigue. This instrument consists of 10 items, answered on a five-point scale, ranging from 1 (Never) to 5 (Always) [15]. After its application, the values found in each item are added and the result is compared with the following reference values brought by the scale: below 22 there are no signs of fatigue, above 22 there are signs of fatigue, while above 35 there is the presence of intense fatigue [16]. In Brazil, this scale was adapted by Oliveira et al., [17] which provides evidence of their factorial validity and internal consistency.

Cardiovascular risk was verified based on the waist-hip ratio (WHR), obtained by dividing the waist (cm) and hip (cm) perimeters [18]. To measure calf circumference, values below 33 cm in women and 34 cm in men were considered, characterizing reduced muscle mass [19].

2.3 Statistical analysis

Data was tabulated in Microsoft Office Excel (version 2016, Redmond, WA, USA) and analyzed in SPSS (version 21, Chicago, IL, USA). Data presentation was performed using the mean and standard deviation of parametric variables, median and range (minimum and maximum) in non-parametric and categorical variables, in absolute (n) and relative frequency (%). Normality was verified using the Shapiro-Wilk test.

To investigate the relationships and patterns present in the data, we applied Principal Component Analysis (PCA), with subsequent creation of biplots to evaluate the distribution of observations and variables in the principal component space. These analyzes were stratified based on different groups of post-COVID symptoms and classifications related to muscle function, providing a comprehensive understanding of the associations present in the data. After indicating the main variables by PCA, we calculated the correlation matrix between the variables and visualized the correlation structure through a correlation graph according to the levels of fatigue and functionality.

The sample consisted of 43 participants, 35 females (81.4%) and 8 males (18.6%), with a mean age of 55 ± 12.3 years. The sociodemographic and clinical characteristics are described in Table 1.

Table 1

Sociodemographic characterization.
Variables	n	%
Gender
Female	35	81.4
Male	8	18.6
Age (years) ^a	55.0 ± 12.3
Education
Incomplete Elementary	6	14.0
Complete Elementary	2	4.7
Incomplete High School	1	2.3
Complete High School	18	41.9
Incomplete Graduation	3	7.0
Complete Graduation	13	30.2
Height (m) ^b	1.6 (1.4–1.8)
Weight (kg)	71.0 ± 10.8
Year of COVID-19 diagnosis
2020	21	48.8
2021	17	39.5
2022	5	11.6
Vaccine (dose)
1	1	2.3
2	7	16.3
3	18	41.9
4	17	39.5
Form of treatment
Required hospitalization (no ICU)	8	19.0
Did not require hospitalization	34	81.0
Comorbidities
Hypertension	18	41.9
Diabetes	8	18.6
Neurological diseases	3	7.0
^a Mean ± standard deviation; ^b Median (Minimum-Maximum).

Using the Fatigue Assessment Scale (FAS), it was found that 48.8% of participants were fatigued and 18.6% had severe fatigue, however 32.6% did not manifest this symptom (Fig. 1A). According to Fig. 1B, which presents the Post Covid-19 Functional Scale (PCFS), after COVID-19, 51.2% of participants had moderate functional limitation (grade 3), 27.9% reported mild functional limitation (grade 2) and around 14.0% very mild functional limitation (grade 1). Therefore, the majority of participants presented some degree of functional impairment, which could have negative impacts on activities of daily living.

The correlation matrix demonstrates significant associations between different characteristics, providing insights into the interdependence of the evaluated parameters (Fig. 2A and Fig. 2B). Noteworthy, for example, is the strong positive correlation between the waist and hip circumference (r = 0.81), weight and calf circumference (r = 0.577) and other significant correlations can be seen in Fig. 3B. On the other hand, the negative correlation observed between the age and calf variables (r = -0.409) suggests an inverse association (Fig. 2B). These results provide an initial understanding of the interactions present in the data, fundamental for the interpretation and deeper understanding of the phenomenon under study. Correlation analysis revealed patterns in the relationships between the studied variables.

PCA revealed a unique visual representation of the structure underlying our multidimensional data (Fig. 2C to Fig. 2H). The generated biplots illustrate the distribution of observations and variables in the principal component space. Notably, nearby observations on the graph indicate similarities in terms of patterns, while the orientation of the variables indicates the relative contribution of each to the total variation. We observed that most variables tend to cluster in a specific region of the biplot, indicating a common trend in this subset of data. This approach provides a compact and informative view of the data structure, making it easier to interpret and identify underlying patterns. Furthermore, the main variables that contribute to the observed phenomenon are: waist circumference, calf circumference, hip circumference, body weight and MIP (maximum inspiratory pressure).

The Figs. 4 and 5 describe the correlations of the variables indicated by the PCA stratified according to the fatigue and functionality classifications, respectively.

This study highlights the presence of fatigue, functional limitations and low quality of life scores in patients with more than two years post diagnosis to COVID-19. These manifestations were more present in individuals with anthropometric changes. Regarding our sample, the average age of 55 years, women and the presence of previous comorbidities such as Diabetes Mellitus and Arterial Hypertension stand out. These variables were also the most present in a Brazilian cohort carried out by Visconti et al. [20] with 88 adult patients monitored 2, 6 and 12 months after the onset of COVID-19 symptoms. Furthermore, they reported that more severe illness during hospitalization was associated with worse long-term outcomes. However, in the present study, the majority of participants did not require hospitalization and were more than 2 years post-recovery from COVID-19.

Furthermore, it was seen that the persistence of symptoms after recovery from COVID-19 was more present in individuals with anthropometric changes. This is in line with Nakayama et al., [21] who report in their studies that obesity was associated with a 2.45 times greater chance (95% CI: 0.44; 1.34; p > 0.001) for developing persistent symptoms.

Ota et al. [22] in their research with patients 6 months after recovery from the disease, showed that 50% of their sample reported that they often feel fatigue and that it is easier to get tired after activity today, when compared to the period before COVID-19. However, our findings have been around for longer than the aforementioned study, which demonstrates that there are still many patients in need of multidisciplinary assistance.

Moreira et al. [23] report that individuals who underwent home treatment for COVID-19 had a MIP of 108.0 ± 63.79 cmH2O, higher than the predicted value of 10137 ± 14.41 cmH2O. Furthermore, these participants obtained a MEP (Maximum Expiratory Pressure) also higher than predicted, having an average of 134.0 ± 86.19 cmH2O, while the expected was 104.45 ± 18.15 cmH2O. However, Ricotta et al., [24] mention a decrease in MIP and MEP values in these individuals when compared to the values predicted by Neder et al. [25]. In our study, it can be seen that there was a predominance of greater impairment of MEP in both sexes.

Furthermore, it is worth highlighting that in previous infections with other coronaviruses, such as SARS and MERS, lung and respiratory muscle strength were found to be compromised for months and even years after hospital discharge, which agrees with our results in patients affected by SARS-CoV-2, in which persistent symptoms were seen for more than two years from the onset of the disease [8].

Schmidt et al. [26] used the PCFS to evaluate the functionality of individuals after COVID recovery and reported the presence of some functional limitation at 30 days, 3 months and 6 months in the proportions of 89.7%, 57.4% and 38 .2%, respectively. Furthermore, functional independence for personal care, mobility and self-care activities were evidenced in these individuals, which corroborates with our research.

A cohort carried out by Kingery et al. [27] with 530 patients in a post-COVID-19 situation who had recovered from the disease for more than a year, showed that more than 35% of the participants had moderate limitations in carrying out activities of daily living, even in those who did not require hospitalization in the acute phase of the disease. We observed moderate functional limitation in 51.2% of individuals with an average age similar to the study above, however more than two years after recovery from the disease, in most cases.

In addition, Nielsen et al. [28] reported that the daily lives of COVID-19 survivors were highly influenced by long-lasting symptoms. The majority of individuals had mild to moderate functional limitations, generating negative impacts on activities of daily living and quality of life. In this research, moderate functional limitations were observed, in most patients, which could have negative impacts on usual activities and quality of life.

A systematic review demonstrated that COVID-19 survivors had reduced levels of physical function, activities of daily living, and health-related quality of life. Furthermore, incomplete recovery of physical function and performance in activities of daily living was observed 1 to 6 months after infection [29]. Regarding quality of life, our results in relation to pain/discomfort, mobility and usual activities are in line with the findings of Qorolli et al., [30] who described these domains as being among the most frequently reported by post-COVID-19 patients between 1 and 6 months after discharge. Furthermore, the least affected domain reported in our survey was self-care, which corresponds to existing literature. Similarly, Tarazona et al. [31] reported that 47.9% of individuals had problems in at least one of the dimensions of the EQ-5D-5L, even in patients who did not require hospital treatment during the infectious process, which corroborates our findings. However, the post-COVID-19 evaluation period was much shorter (between 1 and 3 months), whereas in our research, the majority of volunteers were more than two years after the onset of infection.

Furthermore, research carried out by Walker et al. [32] in which they evaluated the impact of persistent COVID-19 symptoms on health-related quality of life (HRQoL), found that 51% of individuals reported losing ≥ 1 day of work in the last 4 weeks and 20% reported being unable to work. Another study carried out in China by Huang et al., [33] showed that 88% of individuals returned to work 12 months after recovering from the disease; however, 24% were unable to return to the same level of work before COVID-19.

Regarding vaccination, Al-Aly et al. [34] report that individuals immunized against COVID-19 have a 15% less chance of suffering the persistent effects of the disease. However, the severity of the symptoms of sequelae did not change between those vaccinated and those not vaccinated, which is in line with our findings, given that our sample was all immunized. It is important to highlight that the conclusions that vaccination against SARS-CoV-2 does not protect against some persistent symptoms of COVID-19 should not obscure its importance in protecting against these outcomes, since the best way to prevent it is, in First, avoid SARS-CoV-2 infection [9].

This study has limitations as it was carried out in a single center and had a small sample size, which, in part, may be related to the remission period of the COVID-19 pandemic, where the number of Long COVID cases potentially decreased. Furthermore, it is worth highlighting that our sample was mostly made up of women, and this can be explained because women seek more health care than men, in addition to some studies have shown that women suffer from Long COVID more than men. The number of COVID-19 infections after the first diagnosis was not monitored, which may influence, to some degree, the prevalence of symptoms. However, our findings are important, as they expose the need to develop prevention strategies and interventions for the population studied. More research needs to be carried out with a larger number of patients

It was evidenced that survivors of COVID-19, regardless of the clinical spectrum of the disease, showed a marked reduction in functionality and quality of life, especially in those with anthropometric changes. Furthermore, musculoskeletal disorders, presence of fatigue, joint pain and dyspnea were the main persistent symptoms. Therefore, understanding these aspects is necessary for an adequate approach to the main patient care needs beyond the acute phase, providing important information for individualized care within a multidisciplinary team, especially considering that the majority of those assessed had already recovered from COVID-19 for at least 24 months.

SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus 2; COVID-19: Coronavirus Disease 2019; SARS: Severe Acute Respiratory Syndrome; MERS: Middle East Respiratory Syndrome; CNS: National Health Council; PCFS: Post Covid-19 Functional Scale; EQ-5D-5L: EuroQol-5 Dimensions Questionnaire; FAS: Fatigue Assessment Scale; WHR: Waist-Hip Ratio; PCA: Principal Component Analysis; PCFS: Functional Status Scale; MIP: Maximum Inspiratory Pressure; MEP: Maximum Expiratory Pressure; EQ-5D-5L: EuroQol-5D Quality of Life Questionnaire.

Funding

The research was carried out with resources from the National Council for Scientific and Technological Development (CNPq) under grant process number 403457/2021-1.

Conflicts of interest

The authors declare that they have no conflict of interest.

Data availability

Data are available from the authors upon reasonable request.

Ethics approval

All procedures performed in studies involving human participants were under the ethical standards of the institutional, national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee of the Dom Bosco Higher Education Unit, with CAAE:59074522.9.0000.8707, opinion no. 5.571.687, on 9^th August 2022.

Consent

Informed consent was obtained in write from all participants included in the study.

Authors' contributions

MMS, FSdeSS, GBBL, TCSJ, DLB, PMSDS: Conception, work design, acquisition, analysis and interpretation of data; DLB, AVDF, HdeLC: data interpretation and substantial review; CENE, AVDF, HdeLC; conception, study design, data analysis and interpretation, review and final approval.

OPAS. Organização Pan-Americana da Saúde. Histórico da pandemia de COVID-19 - OPAS/OMS. https://www.paho.org/pt/covid19/historico-da-pandemia-covid-19. Accessed 02 Sept 2024.
SUS. Sistema Único de Saúde. Coronavírus Brasil. https://covid.saude.gov.br/?snax_login_popup%3Fsnax_login_popup=forgot_password&mode=list. Accessed 02 Sept 2024.
Thompson EJ, Williams DM, Walker AJ, Mitchell RE, Niedzwiedz CL, Yang TC, Huggins CF, Kwong ASF, Silverwood RJ, Di Gessa G, Bowyer RCE, Northstone K, Hou B, Green MJ, Dodgeon B, Doores KJ, Duncan EL, Williams FMK; OpenSAFELY Collaborative; Steptoe A, Porteous DJ, McEachan RRC, Tomlinson L, Goldacre B, Patalay P, Ploubidis GB, Katikireddi SV, Tilling K, Rentsch CT, Timpson NJ, Chaturvedi N, Steves CJ. Risk factors for long COVID: analyses of 10 longitudinal studies and electronic health records in the UK. MedRxiv. 2021;2021–06. https://doi.org/10.1101/2021.06.24.21259277.
Chippa V, Aleem A, Anjum F. Post-Acute Coronavirus (COVID-19) Syndrome. 2023 Feb 3. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan. PMID: 34033370. PMID: 34033370.
Pierce JD, Shen Q, Cintron SA, Hiebert JB. Post-COVID-19 Syndrome. Nurs Res. 2022;71(2):164–74. https://doi.org/10.1097/NNR.0000000000000565.
Castro C, Deus F, Cardoso R, Xavier D, Lima V. Qualidade de vida relacionada à saúde na síndrome Pós-Covid-19. ASSOBRAFIR Ciênc. 2023;14:e47349. https://doi.org/10.47066/2177-9333.AC.2022.0060.
Jacobson KB, Rao M, Bonilla H, Subramanian A, Hack I, Madrigal M, Singh U, Jagannathan P, Grant P. Patients with uncomplicated coronavirus disease 2019 (COVID-19) have long-term persistent symptoms and functional impairment similar to patients with severe COVID-19: a cautionary tale during a global pandemic. Clin Infect Dis. 2021;73(3):e826–9. https://doi.org/10.1093/cid/ciab103.
Fonseca A, Lima R, Ladeira I, Guimarães M. Evaluation of pulmonary function in post-COVID-19 patients-when and how should we do it? J Bras Pneumol. 2021;47(3):e20210065. https://doi.org/10.36416/1806-3756/e20210065.
Taquet M, Dercon Q, Harrison PJ. Six-month sequelae of post-vaccination SARS-CoV-2 infection: A retrospective cohort study of 10,024 breakthrough infections. Brain Behav Immun. julho de 2022;103:154–62. https://doi.org/10.1016/j.bbi.2022.04.013.
Caruso P, Albuquerque AL, Santana PV, Cardenas LZ, Ferreira JG, Prina E, Trevizan PF, Pereira MC, Iamonti V, Pletsch R, Macchione MC, Carvalho CR. Métodos diagnósticos para avaliação da força muscular inspiratória e expiratória. J Bras Pneumol. 2015;41(2):110–23. https://doi.org/10.1590/S1806-37132015000004474.
Facio CA, Guimarães FS, da Cruz AGT, Bomfim RF, Miranda SRAP, Viana DR, Dos Santos Couto Paz CC, Sato TO, Lorenzo VAPD. Post-COVID-19 functional status scale: Cross-cultural adaptation and measurement properties of the Brazilian Portuguese version. Braz J Phys Ther. 2023;27(3):100503. https://doi.org/10.1016/j.bjpt.2023.100503.
Santos M, Monteiro AL, Santos B. EQ-5D Brazilian population norms. Health Qual Life Outcomes. 2021;19(1):162. https://doi.org/10.1186/s12955-021-01671-6.
Bagattini ÂM, Camey SA, Miguel SR, Andrade MV, de Souza Noronha KVM, de C Teixeira MA, Lima AF, Santos M, Polanczyk CA, Cruz LN. Electronic Version of the EQ-5D Quality-of-Life Questionnaire: Adaptation to a Brazilian Population Sample. Value Health Reg Issues. 2018;17:88–93. https://doi.org/10.1016/j.vhri.2017.11.002.
Nogueira I, Fontoura F, Carvalho C. Recomendações para avaliação e reabilitação pós-COVID-19. Assobrafir São Paulo. 2021.
Cavalcanti TM, de Melo RLP, de Medeiros ED, Santos LCDO, Gouveia VV. Escala de Avaliação da Fadiga: funcionamento diferencial dos itens em regiões brasileiras. J Psychol Assess. 2016;15(1):105–13. https://doi.org/10.15689/ap.2016.1501.11.
Michielsen HJ, De Vries J, Van Heck GL, Van de Vijver FJ, Sijtsma K. Examination of the dimensionality of fatigue. Eur J Psychol Assess. 2004;20(1):39–48. https://doi.org/10.1027/1015-5759.20.1.39.
Oliveira GF, Gouveia VV, Peixoto GP, Soares MAL. Análise fatorial da escala de avaliação da fadiga em uma amostra de universitários de instituição pública. ID Line Rev Psicol. 2010;4(11):51–60. https://doi.org/10.14295/idonline.v4i11.82.
Heyward VH, Wagner DR. Applied body composition assessment. Human Kinetics; 2004.
Pagotto V, Santos KF dos, Malaquias SG, Bachion MM, Silveira EA. Calf circumference: clinical validation for evaluation of muscle mass in the elderly. Rev Bras Enferm. 2018;71:322–8. https://doi.org/10.1590/0034-7167-2017-0121.
Visconti NRGDR, Cailleaux-Cezar M, Capone D, Dos Santos MIV, Graça NP, Loivos LPP, Pinto Cardoso A, de Queiroz Mello FC. Long-term respiratory outcomes after COVID-19: a Brazilian cohort study. Rev Panam Salud Pública. 2023;46:e187. https://doi.org/10.26633/RPSP.2022.187.
Nakayama LF, Urias MG, Gonçalves AS, Ribeiro RA, Macruz TA, Pardo RB. Post-discharge follow-up of patients with COVID-19: A Brazilian experience. SAGE Open Med. 2022;10. https://doi.org/10.1177/20503121221096602.
Ota LS, Nakamatsu AP, Alves ÉO, Fré GGP, Trevisan IB. POST-COVID-19: Persistent symptoms and relationship to the level of fatigue. Res Soc Dev. 2023;12(2):e27312240235–e27312240235. https://doi.org/10.33448/rsd-v12i2.40235.
Moreira NGR, Licurci M das GB, Nogueira DV, Fagundes AA, Costa MS. Comparison of respiratory mechanics and muscle performance between individuals cured from SARS-CoV-2 with home and hospital treatment. Res Soc Dev. 2022;11(5):e58011527816–e58011527816. https://doi.org/10.33448/rsd-v11i5.27816.
Ricotta ACG, Nunes GB, Almeida AF de, Gonzaga FMG, Licurci MGB, Nogueira DV. Post-Covid effects on respiratory mechanics, pulmonary function, response to physical exercise and quality of life. Res Soc Dev. 2022;11(15):e324111537053–e324111537053. https://doi.org/10.33448/rsd-v11i15.37053
Neder JA, Andreoni S, Lerario MC, Nery LE. Reference values for lung function tests: II. Maximal respiratory pressures and voluntary ventilation. Braz J Med Biol Res. 1999;32:719–27. https://doi.org/10.1590/S0100-879X1999000600007.
Schmidt D, Margarites AG, Alvarenga LPKB, Paesi PM, Friedman G, Sbruzzi G. Post–COVID-19 Intensive Care Unit-Acquired Weakness Compromises Long-Term Functional Status. Phys Ther. 2023;103(12):pzad117. https://doi.org/10.1177/11795476221106759.
Kingery JR, Safford MM, Martin P, Lau JD, Rajan M, Wehmeyer GT, Li HA, Alshak MN, Jabri A, Kofman A, Babu CS, Benitez EK, Palacardo F, Das IG, Kaylor K, Woo KM, Roberts NL, Rahiel S, Gali V, Han L, Lee J, Roszkowska N, Kim YE, Bakshi S, Hogan C, McNairy M, Pinheiro LC, Goyal P. Health status, persistent symptoms, and effort intolerance one year after acute COVID-19 infection. J Gen Intern Med. 2022;37(5):1218–25. https://doi.org/10.1007/s11606-021-07379-z.
Nielsen TB, Leth S, Pedersen M, Harbo HD, Nielsen CV, Laursen CH, Schiøttz-Christensen B, Oestergaard LG. Mental fatigue, activities of daily living, sick leave and functional status among patients with long COVID: a cross-sectional study. Int J Environ Res Public Health. 2022;19(22):14739. https://doi.org/10.3390/ijerph192214739.
Almeida KO, Nogueira Alves IG, de Queiroz RS, de Castro MR, Gomes VA, Santos Fontoura FC, Brites C, Neto MG. A systematic review on physical function, activities of daily living and health-related quality of life in COVID-19 survivors. Chronic Illn. 2023;19(2):279–303. https://doi.org/10.1177/17423953221089309.
Qorolli M, Beqaj S, Ibrahimi-Kaçuri D, Murtezani A, Krasniqi V, Mačak Hadžiomerović A. Functional status and quality of life in post-COVID-19 patients two to three weeks after hospitalization: A cross-sectional study. Health Sci Rep. 2023;6(8):e1510. https://doi.org/10.1002/hsr2.1510
Tarazona V, Kirouchena D, Clerc P, Pinsard-Laventure F, Bourrion B. Quality of Life in COVID-19 Outpatients: A Long-Term Follow-Up Study. J Clin Med. 2022;11(21):6478. https://doi.org/10.3390/jcm11216478.
Walker S, Goodfellow H, Pookarnjanamorakot P, Murray E, Bindman J, Blandford A, Bradbury K, Cooper B, Hamilton FL, Hurst JR, Hylton H, Linke S, Pfeffer P, Ricketts W, Robson C, Stevenson FA, Sunkersing D, Wang J, Gomes M, Henley W, Collaboration LWCR. Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndrome: a cross-sectional observational study. BMJ Open. 2023;13(6):e069217. https://doi.org/10.1136/bmjopen-2022-069217
Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, Kang L, Guo L, Liu M, Zhou X, Luo J, Huang Z, Tu S, Zhao Y, Chen L, Xu D, Li Y, Li C, Peng L, Li Y, Xie W, Cui D, Shang L, Fan G, Xu J, Wang G, Wang Y, Zhong J, Wang C, Wang J, Zhang D, Cao B. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. The Lancet. 2023;401(10393):e21–33. https://doi.org/10.1016/S0140-6736(23)00810-3
Al-Aly Z, Bowe B, Xie Y. Long COVID after breakthrough SARS-CoV-2 infection. Nat Med. 2022;28(7):1461–7. https://doi.org/10.1038/s41591-022-01840-0

No competing interests reported.

Clinical aspects, persistent symptoms, physical functionality, and quality of life 24 months after COVID-19

Status:

Version 1

Abstract

Figures

1 Introduction

2 Methods

2.1 Study design and population

2.2 Instruments and procedures

2.3 Statistical analysis

3 Results

4 Discussion

5 Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1