| Author | doi | Year | Country | Experimental Dates | Aim of the study | Study Design | Type of rehabilitation service | Research Question | LFRI | Covid Phases | Population | N° of participants | Clinical presentation | Intervention | Comparator | Outcomes | Adverse events | Diagnostic test | Sensitivity | Specificity | Types of validity | Attributes of reliability | Main findings |
| Abdallah et Al. | 10.1513/AnnalsATS.202012-1489RL | 2021 | Canada | June - October, 2020 | To investigate impaired pulmonary function and diminished functional capacity in hospitalized and non-hospitalized COVID-19 survivors | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Respiratory structures (s430) and related functions (Respiration b440-455) | Post-Covid | COVID-19 | 63 | N/A | N/A | Symptom severtiy scale 3 months after COVID-19 diagnosis | Transthoracic echocardiography, pulmonary function testing, symptom- limited incremental (15 watts per minute) cycle cardiopulmonary exercise test | This study reports about 63 COVID-19 survivors: 25 were hospitalized (mean age 59.1±13.5) and 38 were not hospitalized (mean age 42.4±12.9). The patients had to be at least 18 years old, with RT-PCR COVID-19 diagnosis at least 3 months before the enrollment. They were assessed by a symptom severity scale, transthoracic echocardiography, pulmonary function testing, symptom-limited incremental cycle cardiopulmonary exercise test. The main finding is represented by the persistence of respiratory symptoms and impaired respiratory function in both groups, but they were more severe in the hospitalized patients. Forced vital capacity, total lung capacity (TLC), and the diffusing lung capacity for carbon monoxide (DLCO) were lower in hospitalized patients (88.6±14.5 vs 100.7±14.3, 84.7±14.5 vs 95.7±12.1, and 69.1±14.9 vs 81.5±15.1, respectively, all P<0.01). Left ventricular ejection fraction was similar between groups (63.6±2.5 vs 62.7±3.7). Peak oxygen consumption (VO2) % predicted was lower in hospitalized patients (64.3±19.2% vs 83.5±17.9%, P<0.001). | Hosp: 59.1±13.5 Non hosp: 42.4±12.9 | Hosp: 64%, Non hosp: 52,6% | 0 | 2 | This study reports about 63 COVID-19 survivors: 25 were hospitalized (mean age 59.1±13.5) and 38 were not hospitalized (mean age 42.4±12.9). The patients had to be at least 18 years old, with RT-PCR COVID-19 diagnosis at least 3 months before the enrollment. They were assessed by a symptom severity scale, transthoracic echocardiography, pulmonary function testing, symptom-limited incremental cycle cardiopulmonary exercise test. The main finding is represented by the persistence of respiratory symptoms and impaired respiratory function in both groups, but they were more severe in the hospitalized patients. Forced vital capacity, total lung capacity (TLC), and the diffusing lung capacity for carbon monoxide (DLCO) were lower in hospitalized patients (88.6±14.5 vs 100.7±14.3, 84.7±14.5 vs 95.7±12.1, and 69.1±14.9 vs 81.5±15.1, respectively, all P<0.01). Left ventricular ejection fraction was similar between groups (63.6±2.5 vs 62.7±3.7). Peak oxygen consumption (VO2) % predicted was lower in hospitalized patients (64.3±19.2% vs 83.5±17.9%, P<0.001). | |
| Bagnato | 10.3390/brainsci11121611 | 2021 | Italy | To evaluate neuromuscular involvement in patients who underwent post-acute intensive rehabilitation after COVID-19. | Inception Cohort study | Specialized postacute rehabilitation | Epidemiology - Natural history | Any other body structure and function-generic (s/b) | Post-Covid | COVID-19 | 21 | N/A | personalized physiotherapy program for 180 min a day, 5 days a week. | N/A | Clinical and neurophysiological evaluations, including nerve conduction studies and electromyography, FIM, 6MWT | This study reports about 21 hospitalized COVID-19 patients ( mean age 62.9 ± 13.4 years, 71.4% male) admitted to the rehabilitation unit after clearing SARS-CoV-2 infection (mean duration of hospitalization before admission to rehabilitation was 59.5 ± 25.2 days). The mean duration of rehabilitative hospitalization was 57.1 ± 52.9 days. The main findings are represented by: - All patients showed functional improvement during this hospitalization, as reflected by higher FIM scores and 6MWT distances at the time of discharge. -Clinical signs suggesting muscle or nerve involvement (weakness, reduced deep tendon reflexes, impaired sensitivity, abnormal gait) were found in 90.5% of patients. Neurophysiological examinations confirmed neuromuscular involvement in 81% of patients. These findings reflect a large spectrum of clinical and neurophysiological conditions, ranging from isolated mononeuropathies with limited functional impairment to polyneuropathies and myopathies with severe weakness and relevant functional impairment. So, Neuromuscular involvement is a very common finding among patients admitted for rehabilitation after COVID-19, and proper investigation should be conducted when muscle or nerve injury is suspected for adequate rehabilitative strategy planning. | |||||||
| Bai F | 10.1016/j.cmi.2021.11.002 | 2021 | Italy | From 15 April 2020 to 15 December 2020. | The primary aim of the study was to assess the incidence of long COVID syndrome in females. The secondary aim was to identify predictors of long COVID by multivariable logistic regression analysis. | Inception Cohort study | N/A | Epidemiology - Natural history | Any other body structure and function-generic (s/b) | Post-Covid | COVID-19 | 377 | N/A | N/A | N/A | symptoms questionnaire, HADS, IES-R | This study reports about 377 patients(median age 57 (49-68), male 63.7%) who had been hospitalized for COVID-19 (median length of stay was 11 days). The follow-up examination was done at a median of 102 (IQR 86-126) days from acute symptom onset. The main findings are represented by: - A diagnosis of long COVID syndrome was made in 69% patients. The most common reported symptoms were fatigue 39.5%, exertional dyspnoea 28.9%, musculoskeletal pain 21.2%, and “brain fog” 20.2%. Anxiety symptoms were ascertained in 18.8% individuals, whereas 10.6% patients presented symptoms of depression. Post-traumatic stress disorder was diagnosed in one-third of patients. -Factors that were found to be associated with a higher risk of developing “long COVID” syndrome were female gender, older age and active smoking, but not severity of the acute disease. | ||||||
| Baranauskas MN | 10.1113/EP089965 | 2021 | USA | N/A | To characterize heart rate responses to and recovery from a 6MWT in women ≥ 4 weeks after mild-to-moderate SARS-CoV-2 infection in comparison to control women (i.e., no infection) matched for age and body mass index. | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Any other body structure and function-generic (s/b) | Post-Covid | COVID-19 | 29 | N/A | N/A | 16 non-infected control women | pulmonary function testing and a 6MWT | This study reports about 29 women who were affected by mild-to-moderate COVID-19 (mean age = 54 ± 10; BMI = 25.6 ± 5.4) assessed about 3 months after infection (median time from positive diagnosis to enrolment was 94 ± 43 days) and compared with 16 non-infected control subjects (mean age 58 ± 11; BMI= 26.7 ± 4.8). The main finding is represented by the marked differences in chronotropic responses to and recovery from a 6MWT in COVID-19 women. Compared with control subjects, the increase in heart rate was attenuated and recovery delayed after a 6-minute walk test in COVID-19 participants. Women reporting specific symptoms at time of testing (59% were symptomatic for cough, shortness of breath, fatigue, loss of taste/smell, joint/muscle aches and/or dermatitis/hair loss) had greater impairments compared with control subjects and COVID-19 participants not actively experiencing these symptoms. Such alterations have potential to constrain not only exercise tolerance but also participation in free-living physical activity in women during post-acute recovery from COVID- 19. | ||||||
| Betschart et al. | 10.4414/SMW.2021.w30072 | 2021 | Swizerland | From March 2020 to June 2020 | To assess the longer-term recovery in terms of physical performance and HRQoL in COVID-19 survivors. | Inception Cohort study | General postacute rehabilitation | Epidemiology - Natural history | Any other body structure and function-generic (s/b) | Post-Covid | COVID 19 | 43 | N/A | Cardio-respiratory rehabilitation | n/a | Physical performance (6mWT), HRQoL (EQ-5D-5L), COVID-19 related limitations in functionality (PCFS), hospital-related anxiety and depression (HADS-A/-D), lung function (FEV1, FVC) and dyspnea during activity (mMRC). | This study reports about 43 post COVID-19 patients (mean age 60±14; 70% male). They were assessed at 3 and 6 months after discharge from the hospital. The main findings are: 6mWT, lung function (FEV1, FVC) and dyspnea during activity (mMRC) did not significantly change after the follow up. Changes in HRQoL were not significant. At 12 months, 12/41 of participants still perceived COVID-19 consequences in terms of PCFS scale, and 13/41 reported slight-to-severe symptoms of anxiety and depression. | 60±14 | 0,7 | 0 | 1 | This study reports about 43 post COVID-19 patients (mean age 60±14; 70% male). They were assessed at 3 and 6 months after discharge from the hospital. The main findings are: 6mWT, lung function (FEV1, FVC) and dyspnea during activity (mMRC) did not significantly change after the follow up. Changes in HRQoL were not significant. At 12 months, 12/41 of participants still perceived COVID-19 consequences in terms of PCFS scale, and 13/41 reported slight-to-severe symptoms of anxiety and depression. | |
| Binda | 10.1016/j.iccn.2021.103160 | 2021 | Italy | From February to March, 2020 | To evaluate the levels of muscle strength of patients discharged from ICU, and to report any adverse event related to the swimmer prone position adopted during the ICU stay. | Cohort study | N/A | Micro - Interventions (efficacy/harms) | Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) | Acute | COVID-19 | 87 | N/A | Prone positioning (34 subjects) | Supine positioning (53 subjects) | Clinical data, upper limbs strength (Manual Muscle Testing), Manchester Mobility Score. | This study reports about 87 COVID-19 patients surviving ICU stay (mean age 58, range 50-74 years, 73.6% males). Thirty-four of them needed prone positioning. The main finding is represented by the lack of influence of prone positioning on the odds of showing particular level of muscle strength, in any of the evaluated districts, namely shoulder, elbow, and wrist. The study shows that swimmer position adopted during prone ventilation is not associated with worse upper limb strength or poor mobility level in COVID-19 survivors after hospital discharge. | ||||||
| Cafiero | 10.1186/s13052-021-01166-6 | 2021 | Italy | From October 2020 to February 2021 | To evaluate the adequacy of Italian cardiopulmonary protocols for return to competitive sport after COVID-19, in order to exclude cardiorespiratory complications due to COVID-19 in children and adolescents. | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Any other body structure and function-generic (s/b) | Post-Covid | COVID-19 | 45 | N/A | N/A | N/A | return to play protocol after COVID infection includes lung function tests, cardiopulmonary exercise test, echocardiographic evaluation, blood chemistry tests. | This study reports about 45 children and adolescents (mean age 13.97 ±1.9 years; 57,8% male, 55.5% of the subjects reported an asymptomatic infection; 44.5% reported a mild symptomatic infection) with previous SARS-CoV-2 infection. The mean negative time for nasal swabs was 18 + 2.7 day. They were assessed at 70 ± 45 days after negative swab according to the protocols in force for adult. The main finding is represented by the fact that in the case of mild coronavirus infection, the pediatric population is not at risk of developing cardio-respiratory complications even under high physical stress conditions. So, Return to play seems safe, but it will be necessary to modulate and optimize the protocols, especially in the pediatric field. | ||||||
| Chen et Al. | 10.1111/irv.12943 | 2021 | China | October - November, 2021 | To investigate the characteristics, prevalence, and risk factors for mid-term (>6 months) clinical sequelae in a cohort of COVID-19 survivors. | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Any other body structure and function-generic (s/b) | Post-Covid | COVID-19 | 715 | N/A | N/A | N/A | Questionnaire | This study reports about 715 COVID patients (median age 69, range 67-73 years old, 51,3% males. The patients were assessed with a telephonic formal questionnaire about clinical sequelae at least 6 months after discharge (median time 225 days). The main finding is that COVID-19 survivors are prone to suffer from clinical sequelae as it follows: - 159 (22.2%) had general symptoms such as fatigue and others - 162 (22.7%) had respiratory symptoms such as cough, sputum, exertional or resting dyspnea, chest tightness - 36 (5.0%) had cardiovascular symptoms such as palpitations, orthopnea, lower limb edema | Median 69 (67-73) | 0,513 | 0 | 2: 48 (6.7%) | This study reports about 715 COVID patients (median age 69, range 67-73 years old, 51,3% males. The patients were assessed with a telephonic formal questionnaire about clinical sequelae at least 6 months after discharge (median time 225 days). The main finding is that COVID-19 survivors are prone to suffer from clinical sequelae as it follows: - 159 (22.2%) had general symptoms such as fatigue and others - 162 (22.7%) had respiratory symptoms such as cough, sputum, exertional or resting dyspnea, chest tightness - 36 (5.0%) had cardiovascular symptoms such as palpitations, orthopnea, lower limb edema | |
| Colombini A | 10.3390/jcm11010168 | 2021 | Italy | From April 2020 to November 2020 | To evaluate whether COVID-19 influenced biochemical parameter, recovery and mortality of surgically treated patients suffering from lower extremity fractures. | Cohort study | General postacute rehabilitation | Epidemiology - Natural history | Any other body structure and function-generic (s/b) | Post-Covid | COVID-19 | 13 | N/A | 17 Patients affected by a fracture of the lower limb without COVID-19 | Clinical Features, Biochemical Parameters, mortality, recovery | This study reports about 30 patients, all affected by a fracture of the lower limb (mean age 80.6 ± 9.3 years, male 20%), 13 were COVID-19 + ( mean age 79.5 ± 8.6 years) and 17 were COVID-19- (mean age 81.4 ± 9.9).All patients were treated surgically within 48 h from clinical presentation. Rehabilitation began, where possible, the day after surgery in order to allow for an early verticalization. They were assessed also at follow up (mean time since hospital admission was 11.7 ± 2.4 months: 9.9 ± 2.8 months and 13.0 ± 0.4 months for COVID-19 + and COVID-19 − patients, respectively). The main findings are represented by: -10% of the patients were hospitalized in ICU after surgery and they were COVID-19 + (1 died from post-operative cardiological complications). None of the COVID-19 − patients required ICU hospitalization. - The hospitalization length and the rehabilitation program were not significantly modified between the two groups of patients. -At follow-up, 36.7% of COVID-19- and 10% of COVID-19+ patients regained a level of independence comparable to that prior to the fracture. Return to sociability as before the pathological event was reported in 61.5% of COVID-19 + patients compared to 64.7% of COVID-19 − patients. Compared to COVID-19-, the COVID-19 + patients presented significantly more long-term sequelae, such as mental fog (76.9% vs 17.6%) and fatigue (76.9% vs. 23.5%). 46.2% of COVID-19 + patients developed lung problems versus 5.9% of COVID-19 −. 6.9% of COVID-19 + patients developed dyspnea on moderate exertion, whereas none of the COVID-19 − subjects developed it. After surgery and rehabilitation, 61.5% of COVID-19 + and 35.3% of COVID-19 − patients complained of arthomyalgia. Muscle damage markers, especially CPK and AST, display higher values in COVID-19 + patients, suggesting direct muscle damage caused by SARS-CoV-2. | |||||||
| Cuerda C | 10.1016/j.clnu.2021.11.017 | 2021 | Italy | From March 1 to June 30, 2020 | To describe the nutritional and functional status and the quality of life of patients admitted in ICU due to confirmed COVID-19 during the first outbreak of the pandemic, and for one year after hospital discharge. | Inception Cohort study | N/A | Epidemiology - Natural history | Nervous system structures (s1) and related functions (Neuromusculoskeletal and movement related functions b7) | Post-Covid | COVID-19 | 176 | N/A | N/A | N/A | Clinical data at discharge, HRQoL, BI, MUST, SARC-F | This study reports about 176 COVID-19 hospitalized patients (mean age 60.3≥10.5 years, 71.6% males, BMI 31.5). During the hospital stay, up to 88% of patients required invasive mechanical ventilation and up to 53.7% needed a tracheostomy (out of 175 patients). The main findings is represented by the high nutritional and functional impairment of COVID-19 survivors at hospital discharge. In fact, 83.5% and 86.9% of the patients were at risk of malnutrition and sarcopenia, and 70% of patients had significant impairment of their mobility and limitations in conducting their usual activities. Patients at high risk of malnutrition at discharge showed longer length of hospital and ICU stay and required more tracheostomy (57.5% vs. 40.4%), and invasive mechanical ventilation (89.0% vs. 5.5%).than patients at low risk | ||||||
| Dai S | 10.2147/IJGM.S337604 | 2021 | China | From January 29 to October 13, 2020 | To characterize 6-month outcomes of recovery patients with COVID-19, including symptoms, immunocytes, SARS-CoV-2 antibodies, cardiopulmonary damage, and psychological status. | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Any other body structure and function-generic (s/b) | Post-Covid | COVID-19 | 50 | N/A | N/A | N/A | DASS-21 questionnaire, medical history, laboratory examination, thoracic CT, and echocardiography. | This study reports about 50 COVID-19 patients (mean age, 48 ± 14 years, 50% male patients, 22% diagnosed with severe or critical severe diseases) who were assessed at 6-month after discharge: The main findings were: -22% of patients still showed symptoms related to COVID-19; -the inflammatory index decreased and the immune function was enhanced. - 91% of patients still showed radiological lung abnormalities - 52% of patients still showed echocardiography abnormalities -Depression was observed in 12.5% of participants, stress in 7.5%, anxiety in 15%, and among them, 2.5% showed extremely severe anxiety. -Age, comorbidities, NK cell, and antiviral therapy might be associated with the prognosis of COVID-19: age might be a risk factor, comorbidities were significantly positively correlated with persisting pulmonary damage. NK cell was a good prognostic factor for pulmonary recovery, antiviral therapy was associated with a lower anxiety score. | ||||||
| Donaghi | N/A | 2021 | Northern Ireland | From April to May 2020 | To describe the history and follow up of COVID-19 patients admitted to Belfast Nightingale unit | Inception Cohort study | N/A | Epidemiology - Natural history | Any other body structure and function-generic (s/b) | Ongoing | COVID-19 | 113 | N/A | N/A | N/A | telephone call: questionnaire symptoms; face-to-face consultation:FIS, DASI, EQ5D, Post-COVID-19 Functional Status (PCFS) | This study reports about 113 COVID-19 patients (median age of 66 years, 61.1%male) hospitalized (median length of hospital stay was 10 days). Out of them, 29 met the eligibility criteria for follow-up under the respiratory team (The median time from hospital discharge to initial telephone conversation was 42 days and median time to initial face-to-face consultation 56 days). The main findings are represented by: -28 patients were telephonically contacted: 32% reported persisting breathlessness, 14% had an ongoing cough, and 11% had chest pains. 43% were off their baseline mobility with reduced exercise tolerance. 25% reported low mood, 18% reported anxiety or panic attacks and 18% reported a disrupted sleep pattern or nightmares. 7.1% of patients had a new cognitive decline. -The majority of patients did not require face-to-face review and were recovering well. Of the 10 patients seen in the respiratory led clinic, all were functionally independent with no physical limitations to strength or balance. The main issues reported were fatigue, moderate impairment of functional status, and psychological issues. However, respiratory symptoms significantly improved in 9 out of the 10 patients seen. All patients have been introduced to the psychology services. | ||||||
| Fischer D | 10.1212/WNL.0000000000013067 | 2021 | USA | From July 2020 to March 2021 | To describe the natural history of COVID-19 patients with disorders of consciousness (COVID-DoC) and investigate its associated brain connectivity profile. | Inception Cohort study | N/A | Epidemiology - Natural history | Nervous system structures (s1) and related functions (Mental functions b1) | Post-Covid | COVID-19 | 12 | N/A | N/A | N/A | resting-state functional MRI and diffusion MRI, Glasgow Outcome Scale Extended, Disability Rating Scale | This study reports about 12 COVID-19 subjects with disorders of consciousness in the acute phase (The median age was 63.5 years [IQ 55-76.3], 42% male). They were assessed at discharge, and after 3 and 6 months. The main findings are represented by: -Excluding one who died shortly after enrollment, all of the remaining eleven patients recovered consciousness, after 0-25 days (median 7 [5-14.5]) following the cessation of continuous intravenous sedation. -At discharge, all surviving patients remained dependent. However ultimately, except for two patients with severe polyneuropathy, over the months all returned home with normal cognition and minimal disability. -Ten patients with COVID-19 and disorders of consciousness underwent advanced neuroimaging: their functional and structural brain connectivity was diminished compared to healthy controls, and structural connectivity was comparable to patients with severe TBI. | ||||||
| Garjani et al. | 10.1212/NXI.0000000000001118 | 2022 | UK | From March 17, 2020, to March 19, 2021 | Understand the course of recovery from coronavirus disease 2019 (COVID-19) among patients with multiple sclerosis (MS) and to determine its predictors, including patients’ pre–COVID-19 physical and mental health status. | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Nervous system structures (s1) and related functions (Mental functions b1) | Acute, post-acute, late-onset, or permanent on a pre-existing health condition | COVID 19 | 599 | N/A | N/A | N/A | Online questionnaries about symptoms, Expanded Disability Status Scale (web-EDSS) and Hospital Anxiety and Depression Scale (HADS) | This study reports about 599 multiple sclerosis patients after COVID-19 (participants with long-standing COVID-19 symptoms for <4 weeks mean age 49 ± 11, 25.1% male; participants with long-standing COVID-19 symptoms for ≥4 weeks: mean age 50 ± 11, 17.6% male; participants with long-standing COVID-19 symptoms for ≥12 weeks: mean age: 51 ± 11), 14.5% male. The main findings are: at least 165 participants (29.7%) had long-standing COVID-19 symptoms for ≥4 weeks and 69 (12.4%) for ≥12 weeks. Participants with pre–COVID-19 web-EDSS scores ≥7, participants with probable anxiety and/or depression (HADS scores ≥11) before COVID-19 onset, and women were less likely to report recovery from COVID-19. | <4wk 49 (SD 11), ≥4wk 50 (SD 11), ≥12wk 51 (SD 11) | <4wk 25.1%, ≥4wk 17.6%, ≥12wk 14.5% | 0 | 0 | This study reports about 599 multiple sclerosis patients followed up after developing a COVID-19 infection. Three different groups were profiled: participants with long-standing COVID-19 symptoms for <4 weeks: mean age 49 ± 11, 25.1% male; participants with long-standing COVID-19 symptoms for ≥4 weeks: mean age 50 ± 11, 17.6% male; participants with long-standing COVID-19 symptoms for ≥12 weeks: mean age: 51 ± 11), 14.5% male. The main findings are: at least 165 participants (29.7%) had long-standing COVID-19 symptoms for ≥4 weeks and 69 (12.4%) for ≥12 weeks. Participants with pre–COVID-19 web-EDSS scores ≥7, participants with probable anxiety and/or depression (HADS scores ≥11) before COVID-19 onset, and women were less likely to report recovery from COVID-19. | |
| Heightman et al. | http://dx.doi. org/10.1136/bmjresp-2021- 001041 | 2021 | United Kingdom | From 20 April, 2020 to 25 April, 2021 | Describe the 12-month experience of the first UK dedicated post- COVID-19 clinical service to include hospitalised and non- hospitalised patients. | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Respiratory structures (s430) and related functions (Respiration b440-455) | Ongoing | COVID 19 | 1325 | N/A | N/A | N/a | Clinical data | This study reports about 1325 COVID-19 patients (PH: 547, 41.3%; PED: 212, 16%; NH: 566, 42.7%) (mean age PH: 58.3 (47.0–67.7), PED: 48.5 (39.4–55.7), and NH: 44.6 (35.6–52.8); PH: 57%, PED: 40.1%, and NH: 31.8% male). The main findings are: NH patients were seen later after symptom onset with respect to PH and PED (median (IQR): 194 (118–298) days vs 69 (51–111) days vs 76 (55–128) days respectively; all p<0.0001). All had similar rates of specialist referral (NH 18.7%, PH 16.1% and PED 18.9%, p=0.452) and were likely to require support for breathlessness (23.7%, 5.5% and 15.1%, p<0.001) and fatigue (17.8%, 4.8% and 8.0%, p<0.001). PH had higher rates of pulmonary emboli, persistent lung interstitial abnormalities and other organ impairment. 54.0% reported <75% optimal health (median 70%, IQR 55%–85%). Less than half of employed individuals could return to work full time at first assessment. | PH: 58.3 (47.0–67.7), PED: 48.5 (39.4–55.7), NH: 44.6 (35.6–52.8) | PH: 57%, PED: 40.1%, NH: 31.8% | 1 | 1 | This study reports about 1325 COVID-19 patients (post-hopitalized-PH: 547, 41.3%; post emergency department-PED: 212, 16%; non hospitalized-NH: 566, 42.7%) (mean age PH: 58.3 (47.0–67.7), PED: 48.5 (39.4–55.7), and NH: 44.6 (35.6–52.8); PH: 57%, PED: 40.1%, and NH: 31.8% male) who were referred for assessment at a post-COVID-19 clinic The main findings are: NH patients were seen later after symptom onset with respect to PH and PED (median (IQR): 194 (118–298) days vs 69 (51–111) days vs 76 (55–128) days respectively; all p<0.0001). All had similar rates of specialist referral (NH 18.7%, PH 16.1% and PED 18.9%, p=0.452) and were likely to require support for breathlessness (23.7%, 5.5% and 15.1%, p<0.001) and fatigue (17.8%, 4.8% and 8.0%, p<0.001). PH had higher rates of pulmonary emboli, persistent lung interstitial abnormalities and other organ impairment. 54.0% reported <75% optimal health (median 70%, IQR 55%–85%). Less than half of employed individuals could return to work full time at first assessment. | |
| Hodgson et Al. | 10.1186/s13054-021-03794-0 | 2021 | Australia | March 06, 2020 to October 04, 2020 | To assess the impact of COVID-19 critical illness on new disability, functional outcomes and return to work at 6 month | Inception Cohort study | N/A | Epidemiology - Natural history | Any Activity limitation and participation restriction (d) | Post-Covid | COVID-19 | 212 | ICU patients after discharge | Patients who survived acute phase and acconsented to be interviewed and patients who died within 6 months after discharge from ICU | N/A | Telephonic interviews | This study reports about 212 Australian adult patients with a positive laboratory PCR for SARS-CoV-2 admitted to an Australian ICU for >24h. One-hundred sixty patients were followed up and agreed to answer a telephonic interview, 43 patients died within 6 months from ICU discharge. The main finding of this study is that, WHODAS percentage score worsened (10.40% [95% CI 7.06–13.77]; p<0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. There was a decrease in the EQ-5D-5LTM utility score (−0.19 [−0.28 to −0.10]; p<0.001). At 6 months, 82 out of 115 (71.3%) patients reported persistent symptoms. The independent predictors of death or new disability were higher severity of illness and increased frailty | 61 (51–70) | 58.5% | 0 | 1 | This study reports about 212 Australian adult patients with a positive laboratory PCR for SARS-CoV-2 admitted to an Australian ICU for >24h. One-hundred sixty patients were followed up; out of them, 43 patients died within 6 months from ICU discharge and 117 agreed to answer a telephonic interview. The main finding of this study is that: at 6 months, 38.9% responding survivors reported new disability, and 71.3% patients reported persistent symptoms. Compared to pre-illness, the WHODAS percentage score worsened (mean difference (MD), 10.40% [95% CI 7.06–13.77]; p < 0.001). Thirteen (11.4%) survivors had not returned to work due to poor health. The independent predictors of death or new disability were higher severity of illness and increased frailty. | |
| Hossain MA | 10.1136/bmjgh-2021-006838 | 2021 | Bangladesh | From June to November, 2020 | To identify the prevalence of long COVID symptoms in people affected by COVID-19 and explore any potential associations between reported symptoms and the independent variables measured. | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Any other body structure and function-generic (s/b) | Post-Covid | COVID-19 | 2198 | N/A | N/A | N/A | Clinical data, duration of symptoms, telephonic interview, PCFS | This study reports about 2198 COVID-19 patients (mean age 38.7 ± 11.4 years, 72.4% males, 75.9% had mild COVID, 23.6% moderate COVID and 0.4% severe COVID). Patients underwent a telephone interview. The main findings is represented by the the prevalence of long COVID symptoms that was 16.1%. The predictive risk factors identified for long COVID symptoms were: female gender; COVID-19 severity; one or more comorbidities; an occupation as either a frontline healthcare professional, police worker, housewife or private sector job holder; rhesus positive blood group factor and prior functional limitations. | This study reports about 2198 COVID-19 patients (mean age 38.7 ± 11.4 years, 72.4% males, 75.9% had mild COVID, 23.6% moderate COVID and 0.4% severe COVID). Patients underwent a telephone interview at more than 12 weeks of COVID_19 symptom onset. The main findings is represented by the the prevalence of long COVID symptoms that was 16.1%. The predictive risk factors identified for long COVID symptoms were: female gender; COVID-19 severity; one or more comorbidities; an occupation as either a frontline healthcare professional, police worker, housewife or private sector job holder; rhesus positive blood group factor and prior functional limitations. | |||||
| Jahn K | 10.1101/2021.01.08.21249379 | 2021 | Switzerland | From 26 February to 3 May, 2020, | To report data of cardio-pulmonary exercise testing 3 months after severe COVID-19 pneumonitis | Cohort study | N/A | Epidemiology - Natural history | Any other body structure and function-generic (s/b) | Post-Covid | COVID-19 | 35 | N/A | N/A | N/A | Cardiopulmonary exercise testing, Pulmonary function tests, Health related quality of life (St George’s Respiratory Questionnaire and the King’s Brief Interstitial Lung Disease), CT chest | This study reports about 35 COVID-19 patients (mean age 58±13, 82.9% male) followed-up to 3 months after severe COVID-19 pneumonitis. All patients were hospitalized (median length of stay 14 days) and received physiotherapy during their hospitalisation; after discharge, 23% patients were transferred for further inpatient pulmonary rehabilitation, and 9% patients underwent outpatient pulmonary rehabilitation. In all these patients, pulmonary rehabilitation programmes were completed at the time of assessment. The main findings are represented by: -On chest CT scan, 43% exhibited residuals only, and 17% had additional fibrotic changes. -Pulmonary function values were normal in 66%. -A normal VO2max during CPET was observed in 46% patients; 54% proved to have impaired VO2max. In those patients, the majority 47% was limited by deconditioning, in fact MIP and MEP were normal, making it unlikely that neuromuscular impairment caused the limitation. SO, The results demonstrated that physical deconditioning is the most common cause of impaired VO2max in patients after severe COVID-19 pneumonitis. Whether these findings are specific to SARS-CoV-2 infection or conversely depict the common sequelae after ARDS caused by any insult has to be further explored. | ||||||
| Khodeir MM | 10.1371/ journal.pone.0260259 | 2021 | Saudi Arabia | From September to October 2020. | To identify long-term symptoms, their severity, and their duration as a first step in building a system to classify post-recovery long-term symptoms of COVID-19 | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Any other body structure and function-generic (s/b) | Ongoing | COVID-19 | 929 | N/A | N/A | N/A | Questionnaire is structured into 6 sections as follows: (I) General symptoms; (II) Skin and musculoskeletal symptoms; (III) Psychological and neurologic symptoms; (IV) Special sense symptoms; (V) Respiratory system symptoms; and (VI) Gastrointestinal symptoms. Each section consisted of a group of related symptoms. For each symptom, participants were asked to score the severity of each on a three-point scale and to report the duration of persistence of this symptom(s) after recovery in days. | This study reports about 979 patients recovered from COVID-19 (mean age 37.69 ±10.77, 53% male) who underwent a cross-sectional survey about the severity of post-recovery symptoms and their duration (no more details about the duration time between infection and assessment) The main findings are represented by: -The most common long-term (i.e., persistent) symptoms were of general symptoms group, fatigue and weakness (73% each), which persisted for a mean of 7 and 8.11 days respectively. Muscle aches were the dominant symptom (66%) among the skin and musculoskeletal groups, with a mean persistence of 7.8 days. Among psychological and neurological symptoms, the headache was the most common (64%), with a mean persistence of 6.5 days. Cough was the dominant symptom (47%) in the respiratory system group, and lack of appetite (46%) was the dominant symptom in the gastrointestinal group, with a mean persistence of 11 days and 9.4 days, respectively. -There was a significant correlation of post-recovery COVID-19 symptoms with age, the persistence of symptoms, and degree of severity. | ||||||
| Larsson et al. | https://doi.org/10.3390/ ijerph182111600 | 2021 | Sweden | From July, 2020 to February, 2021 | Evaluate physical function, cognitive function, and daily activities in patients hospitalized due to COVID-19, and to investigate differences depending on age and admission to the intensive care unit (ICU) | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Any other body structure and function-generic (s/b) | Ongoing | COVID-19 | 211 | N/A | N/A | N/A | Patient’s ability to perform daily activities | This study reports about 211 post COVID-19 patients (mean age 65.1±13.4, 67.8% male). They were assessed at 1-2 days before hospital discharge (mean length of hospital stay: 33.8 ± 35.6). The patients were divided into older group > 65 years (46%) and younger group <65 years (54%), or ICU Admitted (49.3%) and non-ICU (50.7%). Patients hospitalized due to COVID-19 are physically impaired, have mild cognitive impairments, and have difficulties performing daily activities at discharge. Impairments are more severe in patients admitted to ICU (p<0.005) and patients over 65 years of age (p<0.005). The findings underlined the need for out-patient follow-up and rehabilitation for patients hospitalized due to COVID-19, especially for older patients and patients treated in the ICU. | 65.1±13.4 | 0,673 | 1 | 0 | This study reports about 211 post COVID-19 patients (mean age 65.1±13.4, 67.8% male). They were assessed at 1-2 days before hospital discharge (mean length of hospital stay: 33.8 ± 35.6). The patients were divided into older group > 65 years (46%) and younger group <65 years (54%), or ICU Admitted (49.3%) and non-ICU (50.7%). Patients hospitalized due to COVID-19 are physically impaired, have mild cognitive impairments, and have difficulties performing daily activities at discharge. Impairments are more severe in patients admitted to ICU (p<0.005) and patients over 65 years of age (p<0.005). The findings underlined the need for out-patient follow-up and rehabilitation for patients hospitalized due to COVID-19, especially for older patients and patients treated in the ICU. | |
| Li J | 10.1136/thoraxjnl-2021-217382 | 2021 | China | From 26 April and 9 December 2020 | To investigate superiority of a telerehabilitation programme for COVID-19 (TERECO) over no rehabilitation with regard to exercise capacity, lower limb muscle strength (LMS), pulmonary function, health-related quality of life (HRQOL) and dyspnoea. | Randomised controlled trial | Rehabilitation services at home | Micro - Interventions (efficacy/harms) | Any other body structure and function-generic (s/b) | Post-Covid | COVID-19 | 120 | N/A | 59 patients who underwent unsupervised home-based 6-week exercise programme comprising breathing control and thoracic expansion, aerobic exercise and LMS exercise, delivered via smartphone, and remotely monitored with heart rate telemetry. | 61 patient who received short educational instructions at baseline. | 6MWT, squat time, pulmonary function assessed by spirometry; SF-12 and mMRC-dyspnoea, at 6 weeks (post-treatment) and 28 weeks (follow-up). | This study reports about 120 COVID-19 patients (mean age was 50.61 ±10.98 years, 44.5% males, 61.3% had at least one comorbidity, Length of hospital stay for acute treatment was 26.2 ± 15.3 days; time from hospital discharge to baseline assessment was 70 ±16.9 days) who were randomly assigned to telerehabilitation programme (TERECO) or no rehabilitation. The main findings are represented by: -The TERECO programme was superior to no rehabilitation with regard to functional exercise capacity, limb muscle strength and physical HRQOL. All these effects could be sustained over a 7-month period. Pronounced differences in exercise capacity and limb muscle strength remained between the intervention and control groups. For physical HRQOL, the difference between TERECO and the control group decreased at follow-up due to improvements in controls. -A short-term effect of TERECO was found on MVV and mMRC-dyspnoea. Both effects, however, decreased at follow-up with differences no longer being statistically significant. -Adherence to the intervention programme was satisfactory and no serious adverse events occurred. | ||||||
| Liu ST | 10.1016/j.imr.2021.100796 | 2021 | China | From February 19 to March 31, 2020 | To evaluate the efficacy and advantages of the qigong exercise and acupressure rehabilitation program (QARP) for treating patients with severe COVID-19. | Randomised controlled trial | Rehabilitation in acute care | Micro - Interventions (efficacy/harms) | Respiratory structures (s430) and related functions (Respiration b440-455) | Acute | COVID-19 | 128 | N/A | QARP: Qigong exercise, Acupressure Rehabilitation Program plus standard therapies (N=64 subjects) | standard therapies (N=64 subjects) | primary: mMRC dyspnea scale. Secondary: Borg dyspnea scale, fatigue Scale-14, PHQ-9, length of hospital stay | This study reports about 128 hospitalized patients with severe COVID-19 who were randomly assigned to receive qigong exercise and acupressure rehabilitation program (QARP) plus standard therapies (N=64, mean age 50.0, 39,1%male) or standard therapies alone (N=64, mean age 53.6, 46.9%%male). The baseline demographics of each group were similar. No details about latency time between treatment and COVID-19 infection onset. The therapy was continued during the patient’s stay until the day of discharge and the outcomes were evaluated pretreatment and at discharge. The main finding is represented by the more significant improvement observed in mMRC dyspnea scale and modified Borg dyspnea scale in COVID19 patients exposed to QARP as compared to the control treatment group. Moreover, QARP group showed a significant reduction of cough duration and length of hospital stay compared with the standard therapies group. | ||||||
| Mahendru K | 10.25259/IJPC_40_21 | 2021 | India | From June 2020 to July 2020. | To assess the effect of meditation and breathing exercises in the form of pranayama on depression, anxiety, stress levels, and quality of sleep in asymptomatic or mildly symptomatic COVID-19 infected patients kept under strict institutional isolation. | Randomised controlled trial | Rehabilitation services at home | Micro - Interventions (efficacy/harms) | Any other body structure and function-generic (s/b) | Acute | COVID-19 | 84 | N/A | Video-guided meditation and pranayama for 7 days | standard care | DASS21, Likert scale for quality of sleep assessed at the end of 7 days of intervention. | This study reports about 84 SARS-CoV-2 infected patients, asymptomatic, or mildly symptomatic under institutional isolation who were randomly and equally divided into a control group and an interventional group (67.9% male; mean age was 34.52 ±9.46 years in the intervention group and 36.48 ±10.47 years in the control group; Number of days since isolation: 12.4 ± 2.53 for intervention group, 15.9 ± 5.74 for control one). The main finding is represented by the significant effect on depression level, stress level, and quality of sleep in the patients exposed to 7 days of meditation and breathing exercises as compared to standard care. | ||||||
| Mattioli et al. | https://doi.org/10.1007/s00415-021-10579-6 | 2021 | Italy | 2020 | Investigate if objective neurological or cognitive impairment is detectable four months post SARS-CoV-2 infection, with mild–moderate COVID-19 disease. | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Nervous system structures (s1) and related functions (Mental functions b1) | Post-Covid | COVID-19 | 150 | N/A | N/A | Non covid group | Neurological deficits, cognitive impairment (MMSE) or emotional disorders (DASS). | TThis study reports about 120 post COVID-19 patients and 30 non-covid control group (mean age COVID-19: 47.86 (26–65) years, non-COVID-19: 45.73 (23–62) years; COVID-19: 25% male, non-COVID-19: 26.7% male). They were assessed 4 months after the diagnosis. The main findings are: 118/120 COVID-19 cases had normal neurological examination. MMSE was negative in both group. In COVID-19 cases the number of impaired neuropsychological tests was not significantly different from non COVID-19 cases (mean 1.69 and 1 respectively, p = n.s.). Anxiety, stress and depression scores (DASS) resulted to be significantly higher in COVID-19 than in non COVID-19 cases (p<0.05).< /td> | COVID-19: 47.86 (26–65), non-COVID-19: 45.73 (23–62) | COVID-19: 25%, non-COVID-19: 26.7% | 0 | 0 | This study reports about 120 post COVID-19 health care workers previously affected by COVID-19, assessed 4 months after the diagnosis and compared to a group of 30 health care workers who did not have COVID-19 and were similar for age and co morbidities (mean age COVID-19: 47.86 (26–65) years, non-COVID-19: 45.73 (23–62) years; COVID-19: 25% male, non-COVID-19: 26.7% male). The main findings are: 118/120 COVID-19 cases had normal neurological examination. MMSE was negative in both groups. In COVID-19 cases the number of impaired neuropsychological tests was not significantly different from non COVID-19 cases (mean 1.69 and 1 respectively, p = n.s.). Anxiety, stress and depression scores (DASS) resulted to be significantly higher in COVID-19 than in non COVID-19 cases (p<0.05).< /td> | |
| McPeake J | 10.1136/bmjresp-2021-001080 | 2021 | UK | From July to December, 2020 | To understand the long-term psychosocial and physical consequences, including impact on employment, of severeCOVID-19 infection and to explore if critically ill COVID-19 survivors have unique long-term outcomes, in relation to patients admitted to critical care without COVID-19. | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Any Activity limitation and participation restriction (d) | Post-Covid | COVID-19 | 93 | N/A | N/A | 206 non-COVID-19 critical care survivors | EQ-5D-5L, HADS, BPI | This study reports about 93 survivors of severe COVID-19 infection (median age 59 years, 65.6% males; 67.7% received invasive ventilation and 19.4% received renal replacement therapy). Their long-term outcome (at 135 (IQR: 85–181) days following hospital discharge) was compared to that of 206 non-COVID-19 critical care survivors. The main finding is represented by the high rate of emotional dysfunction: 46.2% of patients had symptoms of anxiety and 34.4% symptoms of depression. Furthermore, only 53.7% of patients previously employed had returned to employment. These outcomes did not differentiate COVID-19 patients from matched controls . | ||||||
| Milne A | 10.1101/2021.11.17.21266392 | 2021 | UK | From April to August, 2020 | To assess the symptom burden and quality of life of patients 8 months post initial hospitalisation with COVID-19, comparing individuals pre-and post the initiation of dexamethasone as routine treatment. | Cohort study | N/A | Micro - Interventions (efficacy/harms) | Any other body structure and function-generic (s/b) | Post-Covid | COVID-19 | 87 | N/A | 39 subjects receiving dexamethasone in the acute phase | 48 subjects not receiving dexamethasone in the acute phase | Symptoms, SF-36 | This study reports about 87 COVID-19 hospitalized patients that needed ICU, that were divided in two groups: a group that was treated with dexamethasone (N= 39, median age 60 years, 56% males) and a group that not received dexamethasone (N=48, median age 60 years, 69% males). The main finding is represented by the fact that COVID-19 patients who received oral dexamethasone during acute hospital stay were less likely to experience persistent symptoms at 8-month follow-up | ||||||
| Misra A | 10.9734/JPRI/2021/v33i50B33435 | 2021 | India | N/A | To assess the capacity of the prone positioning to enhance oxygenation in COVID-19 patients as a lung recruitment measure. | Quasi-experimental study | Rehabilitation in acute care | Micro - Interventions (efficacy/harms) | Respiratory structures (s430) and related functions (Respiration b440-455) | Acute | COVID-19 | 400 | N/A | Prone positioning and respiratory physiotherapy. | N/A | SpO2 | This study reports about 400 COVID-19 hospitalized patients that needed ICU (age range 20-80, no data about sex). Patient underwent prone positioning and respiratory physiotherapy and SpO2 levels before and after were measured. The main finding is represented by the increase of SpO2 during prone positioning in COVID-19 patients. | ||||||
| Mollerup A | 10.1136/bmj-2021-066952. | 2021 | Denmark | From 6 October 2020 to 26 February 2021 | To determine whether PEP by PEP flute self-care is effective in reducing respiratory symptoms among community dwelling adults with SARS-CoV-2 infection and early stage COVID-19. | Randomised controlled trial | Rehabilitation services at home | Micro - Interventions (efficacy/harms) | Respiratory structures (s430) and related functions (Respiration b440-455) | Acute | COVID-19 | 378 | N/A | 190 PEP self care ( PEP flute three times per day during the 30 day intervention) and usual care | 188 usual care | CAT | This study reports about 378 community dwelling COVID-19 patients (27,5% male) who were randomized to use PEP flute self-care in addition to usual care (N=190, mean age 46,7 ±13 years) or have usual care only (188, mean age 47 ±13.3 years) in the acute phase (median illness duration at inclusion=4 days ; interquartile range 3-7). They showed 11±3.4 symtoms related to COVID-19 within the past week. Cough was the predominant respiratory symptom. The main finding is: PEP flute self-care showed a significant effect on self-reported severity of respiratory symptoms, compared to usual care. However, the estimated treatment difference in the CAT score was smaller than the two points minimal clinically important difference used in people with COPD and does not represent a robust demonstration of effectiveness. No serious adverse events were reported. | ||||||
| Moretta et Al. | 10.1111/eci.1372 | 2021 | Italy | N/A | To investigate the cognitive impairment and endothelial dysfunction in convalescent COVID-19 patients undergoing rehabilitation | Cross-sectional study | Specialized postacute rehabilitation | Epidemiology - Prevalence/Incidence | Nervous system structures (s1) and related functions (Mental functions b1) | Post-Covid | COVID-19 | 55 | RCE | N/A | Non RCE | Cognitive domains standardized tests, functional independence and quality of life perceived tests, FMD | This study reports about 55 COVID convalescent patients undergoing rehabilitation within two months from the swab test negativization; patients were enrolled on the basis of formal education, no past or current psichiatric or neurological disease, not clinically relevant premoribilities; the mean age was 60.1±11.2, 16,4% women. The patients underwent a battery of standardized tests to assess each cognitive domain, the functional independence and their perceived quality of life; also, FMD upon admission was measured. The main finding is that RCE patients showed a worse pulmonary function than non-RCE and had lower tests values and lower FMD values (2.25%±1.94 vs 3.90%±2.40 p = 0.006)"" | 60.1±11.2 | 0,836 | 1 | N/A | This study reports about 55 COVID convalescent patients undergoing rehabilitation within two months from the swab test negativization; patients were enrolled on the basis of formal education, no past or current psichiatric or neurological disease, not clinically relevant premoribilities; the mean age was 60.1±11.2, 16,4% women. The patients underwent a battery of standardized tests to assess each cognitive domain, the functional independence and their perceived quality of life; also, flow-mediated dilation of the brachial artery (FMD) upon admission was measured. The main finding is that patients with Reduced Cognitive Efficieancy (RCE) showed a worse pulmonary function than non-RCE and had lower test values and lower FMD values (2.25%±1.94 vs 3.90%±2.40 p = 0.006) | |
| Öner Cengiz H | 10.1111/jocn.16171 | 2021 | Turkey | From January to April 2021 | To evaluate the effect of deep breathing exercise applied with Triflo on dyspnoea, anxiety and quality of life in patients who are hospitalized for COVID-19 and have dyspnoea. | Randomised controlled trial | Rehabilitation in acute care | Micro - Interventions (efficacy/harms) | Any other body structure and function-generic (s/b) | Acute | COVID-19 | 44 | N/A | deep breathing with the Triflo 5–10 times an hour by watching a training video | routine treatment and care for COVID-19 at the hospital | Primary: SpO2, respiratory rate. Secondary: Dyspnoea-12 Questionnaire, BAI, and WHOQOL- Bref. Timing: first day of hospitalization, and the day of discharge | This study reports about 44 COVID-19 patients (mean age of 51.64 ± 14.16 years, 47.7% male, the median hospital stay was 3 days) with dyspnoea who were randomly assigned to the deep breathing group (n = 22) and the usual care group (n = 22). They were assessed at hospital admission and at discharge. The main finding is represented by a shorter hospitalization time (3.04 ± 0.65 vs 3.63±0.90), higher SpO2 level (97.05 ± 1.46 vs 95.23 ± 1.11), and higher quality of life (77.82 ± 6.77 vs 65.95 ± 14.54) observed in COVID19 patients exposed to deep breathing exercise with Triflo as compared to the patients in the usual care group. | ||||||
| Pauley et al. | 10.1177/17511437211052226 | 2021 | United Kingdom | 1/12/10-31/1/13 and 17/1/21- 5/10/21 | Compare the prevalence and severity of fatigue in survivors of Covid-19 versus non-Covid-19 critical illness, and to explore potential associations between baseline characteristics and worse recovery. | Cohort study | N/A | Epidemiology - Natural history | Respiratory structures (s430) and related functions (Respiration b440-455) | Post-Covid | COVID-19 | 332 | N/A | Invasive mechanical ventilation | Pre covid population | Self-reported fatigue severity, prevalence of severe fatigue (severity >7/10) | This study reports about 92 Covid-19 and 240 pre-pandemic patients who received IMV (mean age Covid-19: 59.7 years, (51.1-64.5), pre-pandemic: 62.0 years (52.0-70.0); Covid-19: 70.7%, pre-pandemic: 57.1% male). The main findings are: the median fatigue severity reported at 3-months was similar between Covid-19 and pre-pandemic (p=0.809). At 6-months, pre-pandemic reported significantly greater fatigue than Covid-19 (2/10 (1.0-5.0) vs. 5.7/10 (3.5-7.3), p<0.001). At 3-months posthospital discharge, the prevalence of severe fatigue was similar in Covid-19 (38.9%) and pre-pandemic (27.1%,), and at 6-months significantly less Covid-19 experienced severe fatigue (10.3% vs. 32.5%, p=0.015). Covid-19 was significantly associated with less severe fatigue (severity <7/10) after adjusting for age, sex and prior comorbidity (adjusted OR 0.35 (95%CI 0.15–0.76, p=0.01) | Covid-19: 59.7 years, (51.1-64.5), pre-pandemic: 62.0 years (52.0-70.0) | Covid-19: 70.7%, pre-pandemic: 57.1% | 0 | 1 | This study reports about 92 Covid-19 and 240 pre-pandemic patients who received invasdive mechanical ventilation (IMV) (mean age Covid-19: 59.7 years, (51.1-64.5), pre-pandemic: 62.0 years (52.0-70.0); Covid-19: 70.7%, pre-pandemic: 57.1% male). The main findings are: at 3-months posthospital discharge, the prevalence of severe fatigue was similar in Covid-19 (38.9%) and pre-pandemic (27.1%,), and at 6-months significantly less Covid-19 experienced severe fatigue (10.3% vs. 32.5%, p = 0.015). Covid-19 was significantly associated with less severe fatigue (severity <7 /10) after adjusting for age, sex and prior comorbidity (adjusted OR 0.35 (95%CI 0.15–0.76, p=0.01) | |
| Roge | 10.3389/fped.2021.752385 | 2021 | Latvia | From July 1, 2020, to April 30, 2021 | To identify the long-term consequences of SARS-CoV-2 infection in children, and to compare the persistent symptom spectrum between COVID-19 and community-acquired infections of other etiologies. | Cohort study | N/A | Epidemiology - Natural history | Any other body structure and function-generic (s/b) | Post-Covid | COVID-19 | 236 | N/A | N/A | 142 children with community-acquired infections of other etiologies | Questionnaires | This study reports about 236 pediatric COVID-19 patients (median age 10.0 (14.0–5.0), 55.5 % male). Additionally, 142 comparison group patients with community-acquired infections of other etiologies were also enrolled (median age 2.0 (6.0–1.0), 53.5% male). Median follow-up time from acute symptom onset was 73.5 days (IQR; 43–110 days) in the COVID-19 patient group and 69 days (IQR, 58–84 days) in the comparison group. The main findings are represented by: 1) Most pediatric COVID-19 survivors (70%) reported at least one persistent symptom, but more than half of the patients (53%) noted two or more long-lasting symptoms. The most commonly reported complaints among COVID-19 patients included persistent fatigue (25.2%), cognitive sequelae, such as irritability (24.3%), and mood changes (23.3%), as well as headaches (16.9%), rhinorrhea (16.1%), coughing (14.4%), and anosmia/dysgeusia (12.3%). 2) Taking into consideration the timeframe of patient enrollment in the study, 105 pediatric COVID-19 patients were diagnosed with the post-COVID-19 syndrome (>=12 weeks). The most frequently reported symptoms were irritability (27.6%), mood changes (26.7%), and fatigue (19.2%). No statistical differences were seen among most reported persisting symptoms before and after the 12-week cut-off point (with exception of heart rhythm disturbances, where statistically significant fall from 7.6% to 1.9%) 3) The symptom persistence is more apparent with COVID-19 than any other non-SARS-CoV-2 infection. | ||||||
| Rubeshkumar P | 10.1016/j.jinf.2021.12.019 | 2021 | India | From February 25, 2021, to March 09, 2021 | To assess the burden of persistent post COVID-19 symptoms and functional status after 12-14 weeks among those recovered from COVID-19 in Chennai, Tamil Nadu, India. | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Respiratory structures (s430) and related functions (Respiration b440-455) | Post-Covid | COVID-19 | 1001 | N/A | N/A | N/A | PCFS, mMRC dyspnoea scale | This study reports about 1001 COVID-19 patients (mean age 49.1 ± 16.1 years, 40% males, 48% were previously hospitalized, among them 28% required oxygen support). Symptoms were assessed 12-14 weeks after recovery. The main finding is represented by the fact that: weight loss (40%), hair loss (29%), Fatigue/Tiredness (26%), myalgia (10%), and sleeplessness (9%) were the most common reported symptoms; based on PCFS scale, 868 (87%) participants did not report any functional limitations in the activities of daily living; hospitalization for severe infection was independently associated with severe limitation of activities of daily living and persistent symptoms post COVID-19 recovery. | ||||||
| Sahanic et al. | 10.1093/cid/ciab978. | Between September 2020 and July 2021 | Italy, Austria | 30/9/2020 - 5/7/2021 | To assess phenotypic diversity of acute and post-acute COVID-19 manifestations in home-isolated patients which needs to be considered for predicting protracted convalescence and allocation of medical resources. | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Respiratory structures (s430) and related functions (Respiration b440-455) | Post-Covid | COVID-19 | 2050 | N/A | N/A | N/A | PASC Symptoms | This study reports about 1157 TY and 893 STY post COVID-19 patients (mean age TY: 43 yrs (IQR: 31 –53), STY: 45 yrs(IQR: 35 –55), TY: 34.9%, STY: 31.7% male). They were assessed from 28 days of symptom onset. The main finding is represented by the persistence of symptoms beyond 28 days (TY: 47.6%, STY: 49.3%). Two acute phenotypes were identified: the non-specific infection phenotype and the multi-organ phenotype (MOP - with neurological, cardiopulmonary, gastrointestinal and dermatological complaints, linked to elevated risk of protracted recovery). The major subset of long COVID individuals (TY: 49.3%, STY: 55.6%) displayed no persistent hyposmia or hypogeusia but high counts of post-acute MOP symptoms and poor self-reported physical recovery. | TY: 43 yrs (IQR: 31 –53), STY: 45 yrs(IQR: 35 –55) | TY: 34,9 STY: 31,7 | 0 | 1 | This study reports about two cohorts of 1157 Tyrol (TY) and 893 SudTyrol (STY) post COVID-19 patients (mean age TY: 43 yrs (IQR: 31 –53), STY: 45 yrs(IQR: 35 –55), TY: 34.9%, STY: 31.7% male). They were interviewed at around 90 days of symptom onset. The main finding is represented by the persistence of symptoms beyond 28 days (TY: 47.6%, STY: 49.3%). Two acute phenotypes were identified: the non-specific infection phenotype and the multi-organ phenotype (MOP - with neurological, cardiopulmonary, gastrointestinal and dermatological complaints, linked to elevated risk of protracted recovery). The major subset of long COVID individuals (TY: 49.3%, STY: 55.6%) displayed no persistent hyposmia or hypogeusia but high counts of post-acute MOP symptoms and poor self-reported physical recovery. | |
| Sivan M | 10.1002/jmv.27456 | 2021 | UK | From February 2 to May 3, 2021 | To explore the presence of symptoms severity phenotypes in a community Post‐COVID‐19 Syndrome cohort, including a large proportion of nonhospitalized participants, and understand the relationship between severity of symptoms, functional disability, and overall health | Cross-sectional study | Specialized outpatient rehabilitation | Epidemiology - Prevalence/Incidence | Any other body structure and function-generic (s/b) | Post-Covid | COVID-19 | 370 | N/A | N/A | N/A | The Covid‐19 Yorkshire Rehabilitation Scale | This study reports about 370 post-COVID-19 patients (mean age was 47 years, 36% males, 17.8% were been hospitalized) who were assessed using the COVID‐19 Yorkshire Rehabilitation Scale, at a median distance of 211 days (interquartile range 143–353) from symptom onset. 39% of patients were infected during UK Wave 1 (March 2020–August 2020), 32% during UK Wave 2a (September 2020–November 2020), 24% during UK Wave 2b (December 2020–May 2021), 5% during UK Wave 3 (June 2021 onwards). The main findings are represented by: -Symptoms and functional difficulties increased substantially when compared to the health status before infection. -By symptom severity three phenotypes were identified: mild, moderate, and severe. The severity of symptoms within each category was homogeneous with a strong correlation between symptom severity and functional difficulty and a moderate correlation between symptom severity and overall health status. -The range of individual symptoms was related to the underlying severity of the condition, regardless of hospitalization during the acute phase of illness | ||||||
| Soleymani Babadi A et al | 10.18502/acta.v59i11.7780 | 2021 | Iran | 2020 | To evaluate the pulmonary function of patients with severe COVID-19, six weeks to 3 months after discharge. | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Respiratory structures (s430) and related functions (Respiration b440-455) | Ongoing | COVID-19 | 64 | N/A | N/A | N/A | spirometry, DLCO | This study reports about 64 hospitalized patients with severe COVID-19 (mean age 59.38 years; 81.3%male) assessed within a period of 6 weeks to 3 months after discharge from the hospital (No further details about latency time between assessment and COVID-19 infection onset). The main finding is represented by: - a large percentage of patients with COVID-19 (40.63%) have a restricted pattern a few weeks after recovery. - the study of DLCO index revealed that 13.3%, 25%, and 53% of cases had mild, moderate, and severe disorders of gas exchange, respectively. - PI max and PE max were less than 50% in 62.5% and 71.88% of the subjects, respectively. In general, this study suggests that pulmonary function test and follow-up of patients' condition are not only recommended but seems to be essential after recovery. | ||||||
| Spielmanns et al. | 10.3390/microorganisms9122452 | 2021 | Switzerland | March 2020 to may 2021 | To identify the impact of different factors on PR outcomes in post-COVID-19 patients. | Cohort study | Specialized postacute rehabilitation | Epidemiology - Natural history | Respiratory structures (s430) and related functions (Respiration b440-455) | Post-Covid | COVID-19 | 184 | N/A | N/A | N/A | 6MWD, questionnaires | This study reports about 184 patients assessed after acute phase of COVID-19. Mean age 68.99 ± 10.21, 60% females. The patients underwent a 6MWT by the time of the admission and discharge; they were divided in responders vs non responders according to the 6MWD value. The patients were assessed with questionnaires which aimed to identify potential predictors of response. The main result was that 51% patients reached their reference 6MWD; FVC (0.95 (0.93–0.97)), 6MWD at admission (0.99 (0.99–1.00)), and FIM motoric (0.96 (0.93–0.99)) correlated with the risk not reaching the reference distance. | 68.99 (SD 10.21) | 0,4 | N/A | 1 | This study reports about 184 patients admitted to a rehabilitation center for pulmonary rehabilitation after the acute phase of COVID-19. Mean age 68.99 ± 10.21, 60% females. Rehabilitation outcome was assessed by the 6MWT administered at admission and discharge. Patients were divided in responders vs non responders according to the 6MWD value. The main result was that 51% patients reached their reference 6MWD. FVC, 6MWD at admission and FIM motoric correlated with the risk of not reaching the reference distance. | |
| Tleyjeh IM | 10.1016/j.jiph.2021.11.016 | 2021 | Saudi Arabia | From May to July, 2020 | To determine predictors of different functional outcomes after hospital discharge using an ambidirectional cohort study design of patients with COVID-19. | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Respiratory structures (s430) and related functions (Respiration b440-455) | Post-Covid | COVID-19 | 222 | N/A | N/A | N/A | Structured interview, mMRC dyspnoea scale | This study reports about 222 COVID-19 hospitalized patients (8.7% between 18 and 34 years of age, 30.6% between 35 and 49 years of age, 44.7% between 50 and 66 years of age, 15% older than 67 years of age, 76.9% males). Patient were interviewed a median of 122 days after hospital discharge. The main finding is represented by the fact that female gender, pre-existing lung disease, headache at presentation, ICU admission, critical COVID-19 and post-discharge ER visit were predictors of higher MRC scores at follow-up; female gender, older age >67 years, arterial hypertension and emergency room ER visit were associated with lower MET exercise tolerance scores; female gender, pre-existing lung disease, and ER visit were associated with higher risk of Covid fatigability syndrome; age, dyslipidemia, hypertension, pre-existing lung disease and duration of symptoms were negatively associated with World Health Organization-five well-being index score. | ||||||
| Vyas | 10.1080/00207411.2021.1988402 | 2021 | India | April - August, 2020 | To evaluate and compare nonspecific brain fog symptoms in COVID-19 survivors, with separate analysis on gender. | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Nervous system structures (s1) and related functions (Mental functions b1) | Post-Covid | COVID-19 | 300 | N/A | N/A | N/A | 9-item questionnaire based on Wood’s mental fatigue inventory. | This study reports about 300 COVID-19 patients (age range 15-70 years, 52% males, 73% were hospitalized). Participants were analyzed between 25 and 30 days after recovery, and answered telephonically to a 9-item questionnaire based on Wood’s mental fatigue inventory. The main findings is represented by the overall cumulative prevalence of any components of brain fog of 34%, with a mean score of 6.11 ± 1.7 in those who experienced it. | ||||||
| Wahlgren C | 10.1016/j.eclinm.2021.101219 | 2021 | Sweden | From March 1 to May 31, 2020 | To describe reported COVID-19-related impairments and activity/participation limitations persisting at five months post-discharge; to objectivize and clarify these problems through clinical examination by appropriate rehabilitation professionals, including functional testing and auxiliary investigations; and to determine adequate rehabilitation interventions in terms of intensity and complexity. | Inception Cohort study | N/A | Epidemiology - Natural history | Any Activity limitation and participation restriction (d) | Post-Covid | COVID-19 | 158 | N/A | N/A | N/A | Clinical assessment of rehabilitation, Rehabilitation Complexity Scale-Extended | This study reports about 158 COVID-19 hospitalized patients (mean age 57.4 ± 13.8 years, 61.4% males, 64.6% had a moderate disease, 10.1% had a severe disease that did not require mechanical ventilation, 25.3% had severe disease that required mechanical ventilation). Patient underwent a telephone interview 4 months after discharge and a clinical follow-up 5 months post-discharge. The main finding is represented by the persistence of both patient reported symptoms at follow-up (28.5% of patients reported weakness in extremities, 48% reported cognitive symptoms) and clinically observed symptoms (clinically overt muscle weakness was found in 10.5% of patients, neurocognitive deficit was found using neuropsychological testing in 37% of patients). | ||||||
| Zhou et Al. | 10.3389/fmed.2021.717194 | 2021 | China | January 29, 2020 to April 1, 2020 | To assess COVID-19 sequelae in patients one year after diagnosis | Cross-sectional study | N/A | Epidemiology - Prevalence/Incidence | Any other body structure and function-generic (s/b) | Post-Covid | COVID-19 | 120 | N/A | N/A | N/A | Questionnaires | This study reports about 120 severe or non-severe COVID-19 patients, mean age 51.6±10.8 years old, 49 male vs 71 female. The patients were classified as severe (13.3%) or non-severe basing on the guidelines of the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia. The patients were assessed 1 year after COVID-19 diagnosis with questionnaires about their residual symptoms, quality of life and psychological evaluation. Laboratory tests, pulmonary function test and CT were performed. The main finding is that 18.3% patients showed negative IgG tests at the follow-up, which correlated with the severity of infection (R = 0.203 p = 0.026). Pulmonary diffusion impairment was reported in 30 patients. 1.7, 8.6, 0.9, 11.2, 7.0 and 0.9% patients had respectively worse FVC, FEV1, FVC/FEV1, VC, TLC, RV. 55.7% patients showed abnormal CT findings. | 51.6±10.8 | 40.8 | N/A | N/A | This study reports about 120 severe or non-severe COVID-19 patients, mean age 51.6±10.8 years old, 49 male vs 71 female. The patients were classified as severe (13.3%) or non-severe based on the guidelines of the Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia. The patients were assessed 1 year after COVID-19 diagnosis with questionnaires about their residual symptoms, quality of life and psychological evaluation.The main finding is that 18.3% patients showed negative IgG tests at the follow-up, which correlated with the severity of infection (R = 0.203 p = 0.026). Pulmonary diffusion impairment was reported in 30 patients. 1.7, 8.6, 0.9, 11.2, 7.0 and 0.9% patients had respectively worse FVC, FEV1, FVC/FEV1, VC, TLC, RV. 55.7% patients showed abnormal CT findings. All the SF-36-domain scores correlated with the duration of hospitalization, pulmonary function, and 6MWT. |