What’s going on following acute COVID-19? Clinical characteristics of patients in an out-patient rehabilitation program

Abstract

BACKGROUND: Coronavirus disease 2019 (COVID-19) patients present long-lasting physical and neuropsychological impairment, which may require rehabilitation. OBJECTIVES: The current cross-sectional study characterizes post COVID-19 sequelae and persistent symptoms in patients in an outpatient rehabilitation program. METHODS: Thirty patients [16 post-ICU and 14 non-ICU; median age = 54(43.8–62) years; 19 men] presenting sequelae and/or persistent symptoms (>3 months after acute COVID-19) were selected of 41 patients referred for neurorehabilitation. Patients underwent physical, neuropsychological and respiratory evaluation and assessment of impact of fatigue and quality of life. RESULTS: The main reasons for referral to rehabilitation were: fatigue (86.6%), dyspnea (66.7%), subjective cognitive impairment (46.7%) and neurological sequelae (33.3%). Post-ICU patient presented sequelae of critical illness myopathy and polyneuropathy, stroke and encephalopathy and lower forced vital capacity compared to non-ICU patients. Cognitive impairment was found in 63.3% of patients, with a similar profile in both sub-groups. Increased physical fatigue, anxiety and depression and low quality of life were prevalent irrespective of acute COVID-19 severity. CONCLUSIONS: The variability of post COVID-19 physical and neuropsychological impairment requires a complex screening process both in ICU and non-ICU patients. The high impact of persistent symptoms on daily life activities and quality of life, regardless of acute infection severity, indicate need for rehabilitation.

Psychiatric and neuropsychiatric sequelae of COVID-19 – A systematic review

“…Fatigue following recovery from acute COVID-19 was reported in 32 studies ( Al-Aly et al, 2021 , Albu et al, 2021 , Augustin et al, 2021 , Boari et al, 2021 , Chevinsky et al, 2021 , D'Cruz et al, 2021 , Daher et al, 2020 , Darley et al, 2021 , Daugherty et al, 2021 , Frontera et al, 2021 , Gautam et al, 2021 , Graham et al, 2021 , Halpin et al, 2021 , Huang et al, 2021a , Huang et al, 2021b , Iqbal et al, 2021 , Liang et al, 2020 , Morin et al, 2021 , Noviello et al, 2021 , Petersen et al, 2020 , Qu et al, 2021 , Romero-Duarte et al, 2021 , Sami et al, 2020 , Shang et al, 2021 , Sudre et al, 2021 , Sun et al, 2021 , Sykes et al, 2021 , Tenforde et al, 2020 , Townsend et al, 2020 , Townsend et al, 2021 , van den Borst et al, 2020 , Xiong et al, 2021 ). The results ranged from no fatigue at 1 month follow-up ( Huang et al, 2021b ) to 87% suffering from fatigue with 12 studies reporting >45% of their populations to be affected ( Albu et al, 2021 , Boari et al, 2021 , D'Cruz et al, 2021 , Daher et al, 2020 , Gautam et al, 2021 , Graham et al, 2021 , Halpin et al, 2021 , Huang et al, 2021a , Iqbal et al, 2021 , Liang et al, 2020 , Townsend et al, 2020 , van den Borst et al, 2020 ).…”

“…Different aspects of cognitive decline were examined in 27 studies ( Al-Aly et al, 2021 , Albu et al, 2021 , Alemanno et al, 2021 , Darley et al, 2021 , Daugherty et al, 2021 , de Graaf et al, 2021 , De Lorenzo et al, 2020 , Gautam et al, 2021 , Gennaro et al, 2021 , Halpin et al, 2021 , Lu et al, 2020 , Mattioli et al, 2021 , Mazza et al, 2021 , Mcloughlin et al, 2020 , Méndez et al, 2021 , Miskowiak et al, 2021 , Monti et al, 2021 , Morin et al, 2021 , Negrini et al, 2021 , Ortelli et al, 2021 , Shang et al, 2021 , Sykes et al, 2021 , Taquet et al, 2021b , van den Borst et al, 2020 , Venturelli et al, 2021 , Whiteside et al, 2021 , Zhou et al, 2020 ). The results range from no cognitive impairments at a 4 months follow-up ( Mattioli et al, 2021 ) to a report of 78% of the patients experiencing impaired performance on at least one cognitive domain 3 months after clinical recovery ( Mazza et al, 2021 ).…”

“…This could suggest that fatigue is not as severe as in the cases of SARS and MERS. It should though be noted that Albu et al (2021) found that fatigue was the most debilitating long-COVID symptom, and the main reason patients contacted a COVID rehabilitation program.…”

“…Further, patients exhibited an excess burden of malaise and fatigue (HR 12.6). Severity of sequelae correlated with severity of the acute COVID-19 Albu et al, 2021 (Spain) To characterize post COVID-19 sequelae in patients in an outpatient rehabilitation program Cohort study MFIS, PSQI, WHOQOL-BREF 30 (16 post-ICU, 14 non-ICU) 19 (63%) 54 >3 months PCR confirmed adult COVID-19 patients suffering from sequelae previous neurological, psychiatric or severe medical condition The main reason for referral to rehabilitation was fatigue (87%), dyspnea (67%) and cognitive impairment (47%) Alemanno et al, 2021 (Italy) To examine the impact of COVID-19 on cognitive functions of the disease Cohort study MMSE, MoCA, HAM-D, FIM 56 N/A N/A 1 month after discharge and 2 neg PCR tests COVID-19 patients discharged from COVID-19 rehabilitation unit Cognitive dysfunction, psychotropic drug use, COVID-19 encephalitis >55% of the patients had cognitive deficits at follow up. This correlated with disease severity but had improved compared to results from admission.…”

Health-related quality of life in older patients surviving ICU treatment for COVID-19: results from an international observational study of patients older than 70 years

“…Additionally, a significant number of patients developed what is now named ‘long-covid’, which has a strong influence on the physical and mental aspects of life and well-being. Such unwanted side effects of ICU-treatment may profoundly impact the quality of life of surviving patients [ 3 , 4 ]. However, which adverse outcomes have the largest impact on self-perceived, health-related quality of life is currently unclear.…”