Patient‐reported functional outcomes 30 days after hospitalization for COVID‐19

Abstract

Background Many coronavirus disease 2019 (COVID‐19) survivors experience persistent symptoms, such as fatigue, dyspnea, and musculoskeletal pain. However, less is known about the impact of COVID‐19 on longer term functional outcomes. Objective To evaluate patient‐reported activity of daily living (ADL) function and fatigue symptoms 30 days after hospitalization for COVID‐19. Design Cross‐sectional study. Setting Tertiary care university hospital. Participants Adults 18 years or older hospitalized for COVID‐19 and survived to 30 days after discharge. Methods A standardized telephone questionnaire was administered 30 days after hospital discharge. Main Outcome Measures Ability to perform basic and instrumental ADLs and fatigue symptoms severity (Patient‐Reported Outcome Measurement Information System [PROMIS] Fatigue Short Form 7a) were assessed by self‐report. Results Participants (n = 55) were 22‐95 years old. Compared to pre‐COVID hospitalization, 52% developed new difficulty and 6% new dependence with performing basic ADLs (bADLs), 48% developed new difficulty and 11% new dependence with instrumental ADLs (iADLs), and 69% experienced a clinically significant worsening in their fatigue symptom severity. The average fatigue symptom severity T‐score before hospitalization was 44.2 ± 7.4 and after hospitalization was 54.5 ± 9.8. In exploratory multivariate analyses, each additional COVID symptom at presentation was associated with a predicted increase of 1.43 units (95% confidence interval [CI], 0.45–2.42) in the 30‐day fatigue symptom severity T‐score, each additional day of hospitalization was associated with an 1.2 times increased odds of worsening fatigue (95% CI, 0.98–1.5; p = .08), and each unit increase in baseline body mass index was associated with 0.8 times decreased odds of new bADL or iADL dependence at 30 days (95% CI, 0.65–0.99). Conclusions New functional impairments are common at 30 days after discharge among survivors of hospitalization for COVID‐19. Early rehabilitation, advance care planning, and referrals to appropriate therapies should be considered in postacute COVID‐19 care to maximize patients' functional outcomes. However, ongoing research is still needed regarding management of these patients.

What Do We Need to Know About Musculoskeletal Manifestations of COVID-19?

“…Although there is no consensus across reviews and original research articles on the definition of post-COVID-19 syndrome, guidelines from the National Institute for Health and Care Excellence (NICE) define it as a group of signs and symptoms that are present for >12 weeks, developed during or after infection with SARS-CoV-2, and cannot be attributed to alternative diagnoses 101 . Musculoskeletal symptoms in this syndrome include fatigue, arthralgia, myalgia, new-onset back pain, muscle weakness, and poor physical performance 10,14,16,25,33,35,36,39,40,43-45,49,55-57,61,64 . Since COVID-19 is a relatively new disease, the literature lacks follow-up data to determine the natural history of post-COVID-19 syndrome and its management.…”

Rationale, Design, and Characteristics of the VALIANT (COVID‐19 in Older Adults: ALongitudinal Assessment) Cohort

“…Prior research has used administrative data to examine the post‐acute sequelae of disease 37 and to describe functional impairment among COVID‐19 survivors who receive home health care services. 38 There have been studies assessing persistent symptoms following hospitalization, 39 , 40 the development of new disability, 41 , 42 and cognitive impairment, 43 with investigators in the Post‐Hospitalization COVID‐19 Study using cluster analysis to identify recovery phenotypes among a large of cohort of patients discharged from a hospital in the United Kingdom. 44 VALIANT adds to this work in several important ways.…”

“…Second, existing cohorts of COVID‐19 survivors have nearly all collected data during a single interview. 41 , 43 , 44 One exception involves patients in Wuhan, China, who were hospitalized early in the COVID‐19 pandemic and then evaluated at 6 and 12 months after infection. 45 This cohort was considerably younger than ours, however, and participants did not undergo assessment at the time of hospitalization or provide information about function or cognition.…”

Rationale, Design, and Baseline Characteristics of the VALIANT (COVID-19 in Older Adults: A Longitudinal Assessment) Cohort

“…Prior research has used administrative data to examine the post-acute sequelae of disease 37 and to describe functional impairment among COVID-19 survivors who receive home health care services. 38 There have been studies assessing persistent symptoms following hospitalization, 39, 40 the development of new disability, 41, 42 and cognitive impairment, 43 with investigators in the Post-Hospitalization COVID-19 Study recently using cluster analysis to identify four distinct recovery phenotypes among a large of cohort of patients discharged from a hospital in the United Kingdom. 44 VALIANT adds to this work in several important ways.…”

“…Second, existing cohorts of COVID-19 survivors have nearly all collected data during a single interview. 41, 43, 44 One exception involves patients in Wuhan, China, who were hospitalized early in the COVID-19 pandemic and then evaluated at 6 and 12 months after infection. 47 This cohort was considerably younger than ours, however, and participants did not undergo assessment at the time of hospitalization or provide information about function or cognition.…”