A Prospective Study of Patients with Persistent Symptoms after SARS-CoV-2 Infection Referred to Physical Medicine and Rehabilitation
Autor(a) principal: | |
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Data de Publicação: | 2023 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19382 |
Resumo: | Introduction: New evidence and extrapolated data from other coronaviruses suggest that symptoms and consequences of COVID-19 may persist beyond the cure. The aims of this study were to evaluate persistent symptoms after SARS-CoV-2 infection and its impact on physical condition, activities of daily living, and quality-of-life; establish whether symptom persistence is associated with higher disability; and document the evolution of the multiple domains after a home exercise program.Methods: Prospective study with patients referred to a Physical and Rehabilitation Medicine clinic, after SARS-CoV-2 infection. Patient evaluations, including a symptom questionnaire, the 1-Min Sit-to-stand test (1-MSTS), the EQ-5D questionnaire and the London Chest Activity Daily Living (LCA-DL) questionnaire, were performed before and after a home exercise program.Results: Seventy-four patients were included. The majority (n = 71) had been hospitalized (mean stay 19.66 ± 13.35 days), 51% required intensive care. At first evaluation, 54 days after symptom onset, a mean of 18.6 repetitions in the 1-MSTS were performed. The percentage of LCA-DL was above 28% in 23% of the patients. Impairments on EQ-5D were present in 44% for mobility and 44% for anxiety/depression. Mean EQ-5D VAS was 66.5 out of 100. Fifty-one (70%) had at least one persistent symptom (Symptomatic Group), while 22 (30%) were asymptomatic (Asymptomatic Group). The Symptomatic Group had statistically significantly worse mean results on 1-MSTS (16.8 vs 22.9; p < 0.001), % LCA-DL score, EQ-D5 (7.8 vs 5.7; p < 0.001) and EQ-D5-VAS. No patient characteristic, clinical background, comorbidity, or hospitalization characteristics was significantly different between groups. Every patient was given a home exercise program; 47 patients joined an additional rehabilitation program or were clinically discharged and were therefore excluded from the second evaluation. Twenty-seven patients participated in a second evaluation. In the matched analysis, mean 1-MSTS improved by 3.4 repetitions. Mean LCA-DL, mean EQ-5D score (7.1 to 6.6) and EQ-VAS score changed favourably and significantly.Conclusion: Two months after infection by SARS-CoV-2, persistent symptoms were frequent in patients referred to a Physical Medicine and Rehabilitation clinic. Additionally, the SARS-CoV-2 infection, as well as the persistence of symptoms, had a negative impact in the physical condition and functionality in ADL and quality-of-life. With a home exercise program in place, a statistically significant improvement was observed. Referral of patients with persistent symptoms to Physical and Rehabilitation Medicine may be warranted. |
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A Prospective Study of Patients with Persistent Symptoms after SARS-CoV-2 Infection Referred to Physical Medicine and RehabilitationUm Estudo Prospetivo de Doentes com Sintomas Persistentes após Infeção por SARS-CoV-2 Referenciados à Medicina Física e ReabilitaçãoAtividades da Vida DiáriaMedicina Física e de ReabilitaçãoPortugalQualidade de VidaSíndrome Pós COVID-19 AgudaActivities of Daily LivingPhysical and Rehabilitation MedicinePortugalPost-Acute COVID-19 SyndromeQuality of LifeIntroduction: New evidence and extrapolated data from other coronaviruses suggest that symptoms and consequences of COVID-19 may persist beyond the cure. The aims of this study were to evaluate persistent symptoms after SARS-CoV-2 infection and its impact on physical condition, activities of daily living, and quality-of-life; establish whether symptom persistence is associated with higher disability; and document the evolution of the multiple domains after a home exercise program.Methods: Prospective study with patients referred to a Physical and Rehabilitation Medicine clinic, after SARS-CoV-2 infection. Patient evaluations, including a symptom questionnaire, the 1-Min Sit-to-stand test (1-MSTS), the EQ-5D questionnaire and the London Chest Activity Daily Living (LCA-DL) questionnaire, were performed before and after a home exercise program.Results: Seventy-four patients were included. The majority (n = 71) had been hospitalized (mean stay 19.66 ± 13.35 days), 51% required intensive care. At first evaluation, 54 days after symptom onset, a mean of 18.6 repetitions in the 1-MSTS were performed. The percentage of LCA-DL was above 28% in 23% of the patients. Impairments on EQ-5D were present in 44% for mobility and 44% for anxiety/depression. Mean EQ-5D VAS was 66.5 out of 100. Fifty-one (70%) had at least one persistent symptom (Symptomatic Group), while 22 (30%) were asymptomatic (Asymptomatic Group). The Symptomatic Group had statistically significantly worse mean results on 1-MSTS (16.8 vs 22.9; p < 0.001), % LCA-DL score, EQ-D5 (7.8 vs 5.7; p < 0.001) and EQ-D5-VAS. No patient characteristic, clinical background, comorbidity, or hospitalization characteristics was significantly different between groups. Every patient was given a home exercise program; 47 patients joined an additional rehabilitation program or were clinically discharged and were therefore excluded from the second evaluation. Twenty-seven patients participated in a second evaluation. In the matched analysis, mean 1-MSTS improved by 3.4 repetitions. Mean LCA-DL, mean EQ-5D score (7.1 to 6.6) and EQ-VAS score changed favourably and significantly.Conclusion: Two months after infection by SARS-CoV-2, persistent symptoms were frequent in patients referred to a Physical Medicine and Rehabilitation clinic. Additionally, the SARS-CoV-2 infection, as well as the persistence of symptoms, had a negative impact in the physical condition and functionality in ADL and quality-of-life. With a home exercise program in place, a statistically significant improvement was observed. Referral of patients with persistent symptoms to Physical and Rehabilitation Medicine may be warranted.Introdução: Nova evidência e dados extrapolados de outros coronavírus sugerem que os sintomas e consequências da COVID-19 podem persistir para além da cura. Os objetivos deste estudo foram: avaliar a persistência de sintomas após infeção por SARS-CoV-2 e o seu impacto no condicionamento ao esforço, atividades da vida diária e qualidade-de-vida; estabelecer se a persistência de sintomas condiciona maior incapacidade; e documentar evolução dos vários domínios, após um programa de exercícios domiciliário.Métodos: Estudo prospetivo, de doentes referenciados à consulta de Medicina Física e de Reabilitação, após infeção por SARS-CoV-2. Foram realizadas avaliações clínicas com questionário de sintomas, o teste 1-Minuto Sentar-e-Levantar (1-MSTS), o questionário EQ-5D e o questionário London Chest Activity Daily Living (LCA-DL), antes e após um programa de exercício domiciliário. Resultados: Setenta e quatro pacientes foram incluídos. A maioria (n = 71) foi hospitalizada (média de 19,7 ± 13,4 dias), 51% necessitaram de cuidados intensivos. Na primeira avaliação, realizada 54 dias após instalação de sintomas, a média de repetições no 1-MSL foi de 18,6. A percentagem de LCA-DL foi superior a 28% em 23% dos pacientes. Alterações no EQ-5D estavam presentes em 44% na mobilidade e 44% para ansiedade/depressão. O EQ-5D VAS médio foi de 66,5 de 100. Cinquenta e um (70%) tinham pelo menos um sintoma persistente (Grupo Sintomático), enquanto 22 (30%) eram assintomáticos (Grupo Assintomático). O Grupo Sintomático teve piores resultados médios no 1-MSL (16,8 vs 22,9; p < 0,001), % pontuação LCA-DL, EQ-D5 (7,8 vs 5,7; p < 0,001) e EQ-D5-VAS. Nenhuma das características de paciente, antecedente clínico, característica da doença ou da hospitalização foi significativamente diferente entre os grupos. Todos os pacientes receberam um programa de exercício domiciliário; 47 pacientes integraram um programa de reabilitação adicional ou tiveram alta clínica, pelo que foram excluídos da segunda avaliação. Vinte e sete pacientes foram submetidos a uma segunda avaliação. Na análise emparelhada, o 1-MSL melhorou em 3,4 repetições. O LCA-DL médio, a pontuação média no EQ-5D (7,1 para 6,6) e o EQ-VAS evoluíram favorável e significativamente.Conclusão: Dois meses após a infeção por SARS-CoV-2, os sintomas persistentes foram frequentes em doentes referenciados para Medicina Física e de Reabilitação. Adicionalmente, a infeção por infeção por SARS-CoV-2, bem como a persistência de sintomas, tiveram impacto negativo na condição física e funcionalidade nas atividades da vida diária e qualidade de vida. Com um plano de exercícios domiciliários implementado, observou-se uma melhoria estatisticamente significativa. O seguimento em Medicina Física e de Reabilitação dos doentes com sintomatologia persistente poderá ser vantajoso.Ordem dos Médicos2023-07-18info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19382Acta Médica Portuguesa; Vol. 36 No. 10 (2023): October; 639-646Acta Médica Portuguesa; Vol. 36 N.º 10 (2023): Outubro; 639-6461646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19382https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19382/15189Direitos de Autor (c) 2023 Acta Médica Portuguesainfo:eu-repo/semantics/openAccessRomano, JoanaRibeiro, PedroAlberto, JoanaAlmeida, PaulaDantas, Duarte2023-10-08T03:00:15Zoai:ojs.www.actamedicaportuguesa.com:article/19382Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T19:54:27.939188Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
A Prospective Study of Patients with Persistent Symptoms after SARS-CoV-2 Infection Referred to Physical Medicine and Rehabilitation Um Estudo Prospetivo de Doentes com Sintomas Persistentes após Infeção por SARS-CoV-2 Referenciados à Medicina Física e Reabilitação |
title |
A Prospective Study of Patients with Persistent Symptoms after SARS-CoV-2 Infection Referred to Physical Medicine and Rehabilitation |
spellingShingle |
A Prospective Study of Patients with Persistent Symptoms after SARS-CoV-2 Infection Referred to Physical Medicine and Rehabilitation Romano, Joana Atividades da Vida Diária Medicina Física e de Reabilitação Portugal Qualidade de Vida Síndrome Pós COVID-19 Aguda Activities of Daily Living Physical and Rehabilitation Medicine Portugal Post-Acute COVID-19 Syndrome Quality of Life |
title_short |
A Prospective Study of Patients with Persistent Symptoms after SARS-CoV-2 Infection Referred to Physical Medicine and Rehabilitation |
title_full |
A Prospective Study of Patients with Persistent Symptoms after SARS-CoV-2 Infection Referred to Physical Medicine and Rehabilitation |
title_fullStr |
A Prospective Study of Patients with Persistent Symptoms after SARS-CoV-2 Infection Referred to Physical Medicine and Rehabilitation |
title_full_unstemmed |
A Prospective Study of Patients with Persistent Symptoms after SARS-CoV-2 Infection Referred to Physical Medicine and Rehabilitation |
title_sort |
A Prospective Study of Patients with Persistent Symptoms after SARS-CoV-2 Infection Referred to Physical Medicine and Rehabilitation |
author |
Romano, Joana |
author_facet |
Romano, Joana Ribeiro, Pedro Alberto, Joana Almeida, Paula Dantas, Duarte |
author_role |
author |
author2 |
Ribeiro, Pedro Alberto, Joana Almeida, Paula Dantas, Duarte |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Romano, Joana Ribeiro, Pedro Alberto, Joana Almeida, Paula Dantas, Duarte |
dc.subject.por.fl_str_mv |
Atividades da Vida Diária Medicina Física e de Reabilitação Portugal Qualidade de Vida Síndrome Pós COVID-19 Aguda Activities of Daily Living Physical and Rehabilitation Medicine Portugal Post-Acute COVID-19 Syndrome Quality of Life |
topic |
Atividades da Vida Diária Medicina Física e de Reabilitação Portugal Qualidade de Vida Síndrome Pós COVID-19 Aguda Activities of Daily Living Physical and Rehabilitation Medicine Portugal Post-Acute COVID-19 Syndrome Quality of Life |
description |
Introduction: New evidence and extrapolated data from other coronaviruses suggest that symptoms and consequences of COVID-19 may persist beyond the cure. The aims of this study were to evaluate persistent symptoms after SARS-CoV-2 infection and its impact on physical condition, activities of daily living, and quality-of-life; establish whether symptom persistence is associated with higher disability; and document the evolution of the multiple domains after a home exercise program.Methods: Prospective study with patients referred to a Physical and Rehabilitation Medicine clinic, after SARS-CoV-2 infection. Patient evaluations, including a symptom questionnaire, the 1-Min Sit-to-stand test (1-MSTS), the EQ-5D questionnaire and the London Chest Activity Daily Living (LCA-DL) questionnaire, were performed before and after a home exercise program.Results: Seventy-four patients were included. The majority (n = 71) had been hospitalized (mean stay 19.66 ± 13.35 days), 51% required intensive care. At first evaluation, 54 days after symptom onset, a mean of 18.6 repetitions in the 1-MSTS were performed. The percentage of LCA-DL was above 28% in 23% of the patients. Impairments on EQ-5D were present in 44% for mobility and 44% for anxiety/depression. Mean EQ-5D VAS was 66.5 out of 100. Fifty-one (70%) had at least one persistent symptom (Symptomatic Group), while 22 (30%) were asymptomatic (Asymptomatic Group). The Symptomatic Group had statistically significantly worse mean results on 1-MSTS (16.8 vs 22.9; p < 0.001), % LCA-DL score, EQ-D5 (7.8 vs 5.7; p < 0.001) and EQ-D5-VAS. No patient characteristic, clinical background, comorbidity, or hospitalization characteristics was significantly different between groups. Every patient was given a home exercise program; 47 patients joined an additional rehabilitation program or were clinically discharged and were therefore excluded from the second evaluation. Twenty-seven patients participated in a second evaluation. In the matched analysis, mean 1-MSTS improved by 3.4 repetitions. Mean LCA-DL, mean EQ-5D score (7.1 to 6.6) and EQ-VAS score changed favourably and significantly.Conclusion: Two months after infection by SARS-CoV-2, persistent symptoms were frequent in patients referred to a Physical Medicine and Rehabilitation clinic. Additionally, the SARS-CoV-2 infection, as well as the persistence of symptoms, had a negative impact in the physical condition and functionality in ADL and quality-of-life. With a home exercise program in place, a statistically significant improvement was observed. Referral of patients with persistent symptoms to Physical and Rehabilitation Medicine may be warranted. |
publishDate |
2023 |
dc.date.none.fl_str_mv |
2023-07-18 |
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info:eu-repo/semantics/publishedVersion |
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info:eu-repo/semantics/article |
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article |
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publishedVersion |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19382 |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19382 |
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eng |
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eng |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19382 https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19382/15189 |
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Direitos de Autor (c) 2023 Acta Médica Portuguesa info:eu-repo/semantics/openAccess |
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Direitos de Autor (c) 2023 Acta Médica Portuguesa |
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Ordem dos Médicos |
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Ordem dos Médicos |
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Acta Médica Portuguesa; Vol. 36 No. 10 (2023): October; 639-646 Acta Médica Portuguesa; Vol. 36 N.º 10 (2023): Outubro; 639-646 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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RCAAP |
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RCAAP |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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