Rehabilitation needs following COVID-19: Five-month post-discharge clinical follow-up of individuals with concerning self-reported symptoms

Abstract

Background This report describes and objectivizes reported problems among a cohort of previously hospitalized COVID-19 patients by clinical examination and determination of the required level of rehabilitation sevices. Methods This report forms part of the Linköping COVID-19 Study (LinCoS) that included 745 individuals from one of 21 Swedish healthcare regions, Region Östergötland (RÖ), admitted to hospital for COVID-19 during March 1st–May 31st, 2020. In this descriptive ambidirectional cohort study, all 185 individuals who had reported concerning persisting symptoms were invited to a multi-professional clinical assessment of somatic, functional, affective, neuropsychological status and rehabilitation needs. Rehabilitation needs were assessed using three sub-scales of the Rehabilitation Complexity Scale-Extended. Findings Among the 158 (85·4%) cases consenting and included in the analysis, we found a broad array of symptoms and signs attributable to COVID-19 involving respiratory, visual, auditory, motor, sensory and cognitive functions that could be confirmed clinically at five months post-discharge. This translated into 16% [95% CI 13–20] of survivors (70/433) of the total regional cohort of hospitalised patients requiring further rehabilitative interventions at follow-up. Weakness in extremities was reported in 28·5% [21·6, 36·2] (45/158). On examination, clinically overt muscle weakness could be corroborated in 15 individuals (10·5%) [6·1, 16·4]. 48% [40, 56] (76/158) reported cognitive symptoms, while the physician noted overt cognitive impairments in only 3% [1·1, 7·5]. In neuropsychological testing, 37% [28–46] (45/122) performed 1.5 SD below the norm, indicating neurocognitive deficits. Fifty-five individuals (34·8%) [27·4, 42·8] reported new or aggravated pain. In three fourths of them, it exerted a ‘moderate’ or worse detrimental effect on their ability to work. Interpretation Our study underscores the importance of providing extensive examination of cases with persisting problems after COVID-19, especially since symptoms such as fatigue and breathlessness are highly nonspecific, but may represent significant underlying functional impairments. Robust neurocognitive testing should be performed, as cognitive problems may easily be overlooked during routine medical consultation. In the Swedish context, most rehabilitative interventions could be provided in a primary care setting. A substantial minority of patients should be triaged to specialized rehabilitation services.

Impact of post-COVID conditions on mental health: a cross-sectional study in Japan and Sweden

“…The results of this study suggest that many COVID-19 survivors have a long-term psychical impairment. A cohort study in Sweden reported that one out of five inpatients required rehabilitation intervention even five months after discharge [ 54 ]. These findings indicate that the next direction should be building a system that provides rehabilitation interventions to an unprecedented number of people suffering physical impairments, such as post-COVID conditions.…”

Clinical Characteristics and Mechanisms of Musculoskeletal Pain in Long COVID

“… 26 One study showed that nociceptive-type pain was considerably more common than neuropathic-type pain. 29 Another study reported that the most common regional areas for arthralgia are knee joint, ankle joint and shoulder joint, while the most common areas for myalgia are lower leg, arm, and shoulder girdle. 30 …”

Rehabilitation bei Coronavirus-Erkrankung mit SARS-CoV-2 (COVID-19)

“…Bei entsprechender Schwere und häufiger auch sehr langer Persistenz über die akute Krankenhausbehandlung hinaus [18] bedürfen sie einer spezifischen neurorehabilitativen Behandlung mit neurologischer Frührehabilitation und/oder Anschlussrehabilitation, ggf. auch erneut im weiteren Verlauf [19].…”

“…Da Schädigungen des peripheren und zentralen Nervensystems eine gute Chance auf funktionelle Erholung bei adäquater Neurorehabilitationsbehandlung haben, dafür aber häufiger eine längere Behandlung erforderlich ist, ist der Rehabilitationsbedarf bei Long-COVID/Post-COVID mit neurologischer Manifestation teilweise über eine längere Zeit erforderlich bzw. wiederholt zu prüfen, um dem individuellen Bedarf gerecht zu werden [19].…”