Long-Term Health Effects of COVID-19 Disability and Function Following SARS-CoV-2 Infection (2024) / Chapter Skim
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4 Global Functioning in Long COVID
Pages 149-182

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From page 149...
... The chapter addresses global functioning, meaning an individual's overall ability to function, in people with Long COVID. The committee reviewed prospective cohort studies that followed Long COVID patients and assessed their functioning for 6 months or more.
From page 150...
... LONG-TERM FUNCTIONAL OUTCOMES IN PATIENTS NOT HOSPITALIZED FOR COVID-19 Although severe initial infection with SARS-CoV-2 is one of the strongest predictors of poor long-term functional outcomes, individuals with mild initial illness make up the great majority of the population with long-term functional impairments, simply because of their greater numbers relative to those with severe infection (Ahmad et al., 2023; Banic et al., 2022; Hodgson et al., 2021)
From page 151...
... . Risk Factors Risk factors for long-term symptoms in the nonhospitalized population are similar to those for the hospitalized population.
From page 152...
... . Recovery Trajectories Many nonhospitalized people with persistent symptoms following acute SARS-CoV-2 infection improve over time.
From page 153...
... . LONG-TERM FUNCTIONAL OUTCOMES IN PATIENTS HOSPITALIZED FOR COVID-19 Functional disability is highly prevalent in individuals surviving hospitalization for COVID-19.
From page 154...
... . Risk Factors COVID-19 severity is among the greatest risk factors for poor functional outcomes following recovery from acute infection (Ahmad et al., 2023; Banic et al., 2022; Hodgson et al., 2021)
From page 155...
... , the likelihood of long-term functional recovery may be limited in a subset of individuals. Studies of PICS and acute respiratory distress syndrome have found that many affected individuals experience persistent functional disability up to 5 years later (Herridge et al., 2011; Hodgson et al., 2021)
From page 156...
... . In a French cohort of 41 adult COVID-19 ICU survivors who underwent a neurological consultation 4 months following ICU discharge, ICU-acquired weakness was present in 16 percent, depression or anxiety in 26 percent, and posttraumatic stress symptoms in 7 percent (Jaquet et al., 2022)
From page 157...
... . Risk factors for persistent postintubation dysphagia at hospital discharge include older age, greater severity of illness upon ICU admission, presence of neurological comorbidities, type 2 diabetes mellitus, and severe swallowing impairment shortly after extubation (Sassi et al., 2022)
From page 158...
... . Risk factors for the development of Long COVID include acute-phase hospitalization, preexisting comorbidity, re-infection, and infection with pre-Omicron variants (Morello et al., 2023; Osmanov et al., 2022; Pazukhina et al., 2022; Pinto Pereira et al., 2023)
From page 159...
... LONG-TERM FUNCTIONAL OUTCOMES IN OTHER SELECTED POPULATIONS WITH COVID-19 Functional impacts from Long COVID vary among individuals, and there is no standardized approach for evaluation and treatment. Some populations that may disproportionally experience greater severity and prevalence of COVID-19 and of long-term symptoms after infection include but are not limited to racial and ethnic minorities, women (pregnant and nonpregnant)
From page 160...
... , home health aides, and/or medical equipment. Additionally, one study among farmworkers in California showed that a significant proportion experienced Long COVID and associated persistent symptoms, limiting their ability to continue working (Mora et al., 2023)
From page 161...
... In the rehabilitation literature, measuring function involves a variety of components, including cardiovascular and pulmonary fitness, muscle strength, coordination, cognitive function, and quality of life. The specific benefits of rehabilitation in individuals with Long COVID may vary depending on the individual's symptoms and severity of disease, but small studies consistently show improvements in physical function, fatigue, dyspnea, and quality of life (Calvo-Paniagua et al., 2022; de la Plaza San Frutos et al., 2023; Gloeckl et al., 2021; Nopp et al., 2022; Ostrowska et al., 2023; Parker et al., 2023; Spielmanns et al., 2023)
From page 162...
... . Regardless of disease severity, individuals with COVID-19 can present with persistent symptoms and functional decline.
From page 163...
... ASSESSING GLOBAL FUNCTIONING Table 4-2 provides an overview of selected assessments that can be used to quantify the functional impacts of Long COVID. The assessments in the table can contribute to an overall picture of individuals' functioning, but given the heterogeneity of Long COVID, there are no gold standard tests specific for this population.
From page 164...
... • Romberg (Shirley Ryan AbilityLab, 2013d) Self-reported measures: • Composite Autonomic Symptom Score-31 (COMPASS-31)
From page 165...
... • Multidimensional Fatigue Symptom Inventory • Multidimensional Fatigue Symptom Inventory Short Form • Profile of Mood States-Brief • PedsQL Multidimensional Fatigue Scale [pediatric and young adult population] • Multi-Dimensional Fatigue Scale • Profile of Fatigue • Functional Assessment Chronic Illness • Therapy Checklist Individual Strength • Patient-Reported Outcomes Measurement Information System – Fatigue • Pittsburgh Sleep Quality Assessment (Buysse et al., 1989)
From page 166...
... • Digit Vigilance Test • Paced Auditory Serial Addition Test (PASAT) Processing Speed • Trail Making Test-Part A • Symbol Digit Modalities Test • WAIS-IV Coding Executive Functioning • Trail Making Test-Part B • Wisconsin Card Sorting Test-64 (WCST-64)
From page 167...
... Other risk factors for poor functional outcomes include female sex, lack of vaccination against SARS-CoV-2, baseline disability or comorbidities, and smoking. Data on recovery trajectories are rapidly evolving, and recovery is heterogenous.
From page 168...
... 2022. Risk factors and severity of functional impairment in long COVID: A single-center experience in Croatia.
From page 169...
... 2023. Risk factors for impaired respiratory function post COVID-19: A prospective cohort study of nonhospitalized and hospitalized patients.
From page 170...
... 2006. Functional assessment of pediatric pain patients: Psycho metric properties of the Functional Disability Inventory.
From page 171...
... 2021. Persistent symptoms and decreased health-related quality of life after symptomatic pediatric COVID-19: A prospective study in a Latin American tertiary hospital.
From page 172...
... : Performance in activities of daily living and neurobehavioral impairments of persons with left and right hemisphere damage. American Journal of Occupational Therapy 56(5)
From page 173...
... 2011. Functional disability 5 years after acute respiratory distress syndrome.
From page 174...
... 2021. The impact of COVID-19 critical illness on new disability, functional outcomes and return to work at 6 months: A prospective cohort study.
From page 175...
... 1983. Assessing self-maintenance: Activities of daily living, mobility, and instrumental activities of daily living.
From page 176...
... 2023. Prevalence of physical frailty, including risk factors, up to 1 year after hospitalisation for COVID-19 in the UK: A multicentre, longitudinal cohort study.
From page 177...
... 2022. Intensive care unit-acquired weakness and hospital functional mobility outcomes follow ing invasive mechanical ventilation in patients with COVID-19: A single-centre prospec tive cohort study.
From page 178...
... 2022. Risk factors for post-COVID-19 condition in previously hospitalised children using the ISARIC Global follow-up protocol: A prospective cohort study.
From page 179...
... https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/ conditionsanddiseases/bulletins/prevalenceofongoingsymptomsfollowingcoronavirus covid19infectionintheuk/30march2023 (accessed February 20, 2024)
From page 180...
... 2022. Persistent symptoms in adult patients 1 year after coronavirus disease 2019 (COVID-19)
From page 181...
... 1991. The Functional Disability Inventory: Measuring a ne glected dimension of child health status.
From page 182...
... 2023. Identifying environmental risk factors for post-acute sequelae of SARS-CoV-2 infection: An EHR-based cohort study from the RECOVER program.


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