Assessment of Musculoskeletal Pain, Fatigue and Grip Strength in Hospitalized Patients with COVID-19

Abstract

IMPORTANCE Coronavirus disease 2019 (COVID-19) is an emerging disease that was declared as a pandemic by WHO. Although there are many retrospective studies to present clinical aspects of the COVID-19, still the involvement of the musculoskeletal system has not been deeply investigated.OBJECTIVE To classify the symptoms of musculoskeletal system in COVID-19 patients, to evaluate myalgia, arthralgia and physical/mental fatigue, to assess handgrip muscle strength, and to examine the relationship of these parameters with the severity and laboratory values of the disease. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was performed at the IUC-Cerrahpaşa Pandemic Clinic. Hospitalized 150 adults with laboratory and radiological confirmation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) according to WHO interim guidance were included in the study. Data were recorded from May 15,2020, to June 30, 2020.MAIN OUTCOMES AND MEASURES Demographic data, comorbidities, musculoskeletal symptoms, laboratory findings and CT scans were recorded. To determine the disease severity 2007 idsa/ats guidelines for community acquired pneumonia was used. Myalgia severity was calculated by numerical rating scale (NRS). Visual analog scale and Chalder Fatigue Scale (CFS) were used for fatigue severity determination. Handgrip strength (HGS) was measured by Jamar hand dynamometer.RESULTS 103 patients (68.7%) were nonsevere and 47 patients (31.3%) were severe. The most common musculoskeletal symptom was fatigue (133 [85.3%]), followed by myalgia (102 [68.0%]), arthralgia (65 [43.3%]) and back pain (33 [22.0%]). Arthralgia, which was mostly notable at wrist (25 [16.7%]), ankle (24 [16.0%]) and knee (23 [15.3%]) joints, showed significant correlation with disease severity. There was severe myalgia according to NRS regardless of disease severity. The physical fatigue severity score was significantly higher in severe cases, whereas no relationship was found with mental fatigue score. Female patients with severe infection had lower grip strength with a mean value of 18.26 kg (P= .010) in dominant hand, whereas no relationship was found between disease severity and grip strength in male patients, but the mean values in both genders and in decades appears below the specified normative values. Lactate dehydrogenase (LDH) level and lymphocyte count were significantly correlated with lower grip strength. LDH, C-reactive protein (CRP) and D-dimer levels were above the normal range in patients with myalgia, arthralgia and fatigue. CONCLUSIONS AND RELEVANCE Musculoskeletal symptoms are quite common aside from other multi-systemic symptoms in patients with COVID-19. Arthralgia, which is related to the disease severity, should be considered apart from myalgia. COVID-19 patients have severe ischemic myalgia regardless of the disease activity. Although there is a muscle weakness in all patients, the loss of muscle function is related with the disease activity especially in women. Muscular involvement in coronavirus disease is a triangle of myalgia, physical fatigue, and functional impairment.

Grip strength as a predictor of disease severity in hospitalized COVID-19 patients

“…19 Another study recruiting 150 hospitalized COVID-19 patients (mean age of 53 years) compared the musculoskeletal findings (including grip strength) and revealed that female (but not male) patients with severe COVID-19 disease had lower grip strength as compared to nonsevere ones. 20 In our relatively larger study (N=312) with younger subjects (mean age of 46 years), we found that low grip strength independently increased (about three times) the risk of severe disease course in COVID-19.…”

Muscle strength is associated with COVID-19 hospitalization in adults 50 years of age or older

“…This study shows that muscle strength is independently associated with the risk of severe COVID-19 in adults 50 years of age or older. These findings further highlight muscle strength as an important factor to monitor in COVID-19 patients (19, 34, 38), thereby suggesting that hand-grip strength could improve the accuracy of composite scores used to predict COVID-19 severity (19, 39, 40).…”

Post-infectious rhombencephalitis after coronavirus-19 infection: A case report and literature review

“…For patients with neurological sequelae from COVID-19, rehabilitation (both appropriate assessments and programs) will also be critical in their recovery, especially in patients who were admitted to the intensive care unit. ( Curci et al, 2021 ; de Sire et al, 2021 ; Tuzun et al, 2021 ) Many COVID-19 patients experience fatigue( de Sire et al, 2021 ; Carfì et al, 2020 ) including in the post-acute/chronic phase, and intensive rehabilitation has been shown to improve outcomes. ( Curci et al, 2021 ; Ferraro et al, 2021 )…”