Patients Surviving Critical COVID-19 have Impairments in Dual-task Performance Related to Post-intensive Care Syndrome

Abstract

Objective The purpose was to examine Dual Task (DT) performance in patients surviving severe and critical COVID-19 compared to patients with chronic lung disease (CLD). Secondarily, we aimed to determine the psychometric properties of the Timed Up and Go (TUG) test in patients surviving COVID-19. Design Prospective, cross-sectional, observational study. Setting Academic medical center within United States. Patients Ninety-two patients including 36 survivors of critical COVID-19 that required mechanical ventilation (critical-COVID), 20 patients recovering from COVID-19 that required supplemental oxygen with hospitalization (severe-COVID), and 36 patients with CLD serving as a control group. Measurements and Main Results Patients completed the TUG, DT-TUG, Short Physical Performance Battery (SPPB), and Six Minute Walk Test (6MWT) 1-month after hospital discharge. A subset of patients returned at 3-months and repeated testing to determine the minimal detectable change (MDC). Critical-COVID group (16.8 ± 7.3) performed the DT-TUG in significantly slower than CLD group (13.9 ± 4.8 s; P = .024) and Severe-COVID group (13.1 ± 5.1 s; P = .025). Within-subject difference between TUG and DT-TUG was also significantly worse in critical-COVID group (−21%) compared to CLD (−10%; P = .012), even despite CLD patients having a higher comorbid burden ( P < .003) and older age ( P < .001). TUG and DT-TUG demonstrated strong to excellent construct validity to the chair rise test, gait speed, and 6MWT for both COVID-19 groups (r = −0.84to 0.73, P < .05). One- and 3-months after hospital discharge there was a floor effect of 14% (n = 5/36) and 5.2% (n = 1/19), respectively for patients in the critical-COVID group. Ceiling effects were noted in four (11%) critical-COVID, six (30%) severe-COVID patients for the TUG and DT-TUG at 1-month. Conclusion The ability to maintain mobility performance in the presence of a cognitive DT is grossly impaired in patients surviving critical COVID-19. DT performance may subserve the understanding of impairments related to Post-intensive care syndrome (PICS) for survivors of critical illness.

Physical functioning and health-related quality of life after COVID-19: a long-term perspective case series

“…Our long-term findings are quite like those reported from others, showing slight or no dependency in basic activities of daily living [29], and good mobility performances [30][31][32]. Our sample also showed TUG performances better than those detected in participants recovering from severe or critical COVID-19 [33].…”

The Coronavirus Footprint on Dual-Task Performance in Post-Acute Patients after Severe COVID-19: A Future Challenge for Rehabilitation

“…Until now, there has been no study that focused on the comparison of dual-task performance of PwCOVID with that of HS. Therefore, in order to calculate our sample size, we relied on the single study that investigated the dual-task performance of PwCOVID, even if it compared PwCOVID with those with chronic lung disease [ 31 ]. Nevertheless, we are aware that this choice has led to a small overestimation of the sample, since the expected difference between HS and PwCOVID should be greater than that between chronic lung disease and PWCOVID [ 45 ].…”

“…Specifically, Morelli et al [ 31 ], in their assessment of DT performance during the TUG test in PwCOVID, found a difference of 3.8 ± 5.2 s between individuals with COVID-19 vs. those with chronic lung disease. This corresponds to a Cohen’s d effect size of about 0.7.…”

“…To date, the dual-task performance of people with COVID-19 in the post-acute stage of disease has been examined only in one study [ 31 ]. Specifically, Morelli et al [ 31 ] investigated if patients recovering from severe and critical COVID-19 presented dual-task mobility deficits comparable to those of individuals with chronic lung disease.…”

“…To date, the dual-task performance of people with COVID-19 in the post-acute stage of disease has been examined only in one study [ 31 ]. Specifically, Morelli et al [ 31 ] investigated if patients recovering from severe and critical COVID-19 presented dual-task mobility deficits comparable to those of individuals with chronic lung disease. The authors found that the mobility performance during a cognitive dual-task was linked to illness severity; in fact, patients with an history of critical illness showed worse performance with respect to those who had only a severe form of COVID-19.…”