One year follow-up of physical performance and quality of life in patients surviving COVID-19: a prospective cohort study

Abstract

INTRODUCTION: The coronavirus disease (COVID-19) continues to affect many countries globally, with the long-term impact of the disease now being recognized. According to the latest research, some of the affected individuals continue to experience functional limitations, reduced physical performance and impaired health-related quality of life (HRQoL) even after eight months. This prospective cohort study aimed to describe the longer-term recovery of physical performance and HRQoL in COVID-19 survivors over one year. METHOD: A cohort (n = 43; 32-84 years old) hospitalized with COVID-19 between March and June 2020 was followed over one year and assessed at three time points: hospital discharge, 3 months and 12 months post-admission. Participants experienced mild (10/43) to critical (6/43) pneumonia and stayed in the hospital for a median of 10 days (IQR 9). Participants were assessed for physical performance (six-minute walk test), 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). All assessments were conducted by physiotherapists trained in cardio-respiratory rehabilitation. RESULTS: After discharge, 8/34 showed reduced physical performance, 9/42 had lower HRQoL and 14/32 had COVID-19 induced limitations in functionality on the PCFS scale. Physical performance did not change significantly between discharge and 12-month follow-up, but 15/34 participants showed clinically relevant improvements in walking distance (>30 m). However, 16/34 had a decreased walking distance >30 m when comparing 3-month to 12-month follow-up. At 12 months, 12/41 of participants still perceived COVID-19 related limitations in daily life on the PCFS scale. For HRQoL, 12/41 participants still perceived moderate-to-severe symptoms of pain and discomfort and 13/41 slight-to-severe symptoms of anxiety and depression. CONCLUSION: This cohort of adult patients hospitalized for mild to severe COVID-19 in Switzerland was generally mildly affected but still reported some limitations after one year. These results offer preliminary indications for ongoing support after hospitalization and point towards the need for specific, individualized follow-up to support their recovery. ClinicalTrials.gov (NCT04375709)

Physical recovery across care pathways up to 12 months after hospitalization for COVID-19: A multicenter prospective cohort study (CO-FLOW)

“…Also, it is unclear if patients received rehabilitative care after hospital discharge and, if so, in what context. Other studies found no improvement in 6MWD over 12 months follow-up, which could be due to small sample sizes, 10 , 11 or between 6 and 12 months. 2 Recovery in HGS was assessed only in a cohort of patients admitted to ICU for COVID-19, indicating improved HGS over 12 months follow-up.…”

“…However, these normative values have also been used in other COVID-19 studies. 2 , 3 , 10 The 650 participants in the CO-FLOW study were recruited from all patients who survived hospitalization and who visited the outpatient clinic for regular COVID-19 follow-up by pulmonary physicians in the participating hospitals. These numbers depended on the local logistics in each hospital, transfers to other regions, and temporary COVID-19 lock-down regulations, in which clinical follow-up was postponed or only performed by phone.…”

“…Prior studies mostly focused on cardiorespiratory fitness, reporting 80-110% of predicted levels at 12 months after hospitalization. 2 , 10 , 11 , 12 However, other components of physical function such as muscle strength and mobility are also important constructs in the evaluation of physical recovery. For example, among non-COVID-19 patients, after admission for acute respiratory distress syndrome, patients still experienced muscle wasting and weakness 12 months after discharge from ICU.…”

Quality of Life and Mental Health Status in Recovered COVID-19 Subjects at Two Years after Infection in Taizhou, China: A Longitudinal Cohort Study

“…A previous study found that the incidences of anxiety and depression in the urban Chinese population were 6.0% and 5.3%, respectively [ 21 , 22 ], and the age-normalized incidences of depression and anxiety in rural Chinese adults were 5.41% and 4.94%, respectively [ 23 ]. Previous 1-year follow-up studies in recovered COVID-19 subjects found that the incidence of psychological problems (only anxiety) was as low as 10.4% [ 10 , 12 , 24 , 25 , 26 ].…”

Long-Term Symptoms of COVID-19: One-Year Follow-Up Study

“…These include weakness, myalgias, sleep disturbances, shortness of breath, loss of taste and smell, headaches, physical and psychological disturbances, and cognitive impairment [4,5]. Moreover, health-related quality of life (HRQoL) has been reported to decrease in 51-62% of COVID-19 survivors after three to six months [6]. Raised titers of antibodies against SARS, Middle East respiratory syndrome coronavirus (MERS-CoV), and avian influenza A virus (H7N9) have been observed to be present for 12 months [7].…”