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5 Long-Term Impairments and Functional Limitations Related to Long COVID
Pages 53-72

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From page 53...
... The final presentation in the session introduced workshop participants to a tool that can be used to assess functioning in COVID-19 patients. PHYSICAL FUNCTION, COGNITIVE FUNCTION, AND HEALTH-RELATED QUALITY OF LIFE Laura Tabacof, research instructor at the Department of Rehabilitation and Human Performance at Icahn School of Medicine at Mount Sinai, began by giving a working definition of Long COVID, stating that it refers to a range of new, returning, or ongoing health problems experienced by people 4 or more weeks after initial coronavirus infection.
From page 54...
... The most common symptoms reported were fatigue, brain fog, headache, insomnia, dizziness, dyspnea, memory loss, and palpitations. Physical exertion triggered symptom exacerbation for 86 percent of patients, stress did so for 69 percent, and dehydration for 49 percent.
From page 55...
... 52, in Laura Tabacof presentation, March 22, 2022.
From page 56...
... or in the general population. On the Neuro QOL Cognitive Function scale, 70 percent of respondents indicated some level of dysfunction, with 51 percent reporting moderate to severe dysfunction (Figure 5-2)
From page 57...
... • Investment in local support systems of Long COVID is crucial: rehabilitation, care delivery workforce, and infrastructure. LIMITATIONS AND IMPAIRMENTS AFTER A STAY IN THE INTENSIVE CARE UNIT Postintensive care syndrome (PICS)
From page 58...
... 58 FIGURE 5-3  Health-related quality of life on the EuroQol-5D-5L scale among patients with postacute COVID-19 infection. SOURCE: Laura Tabacof presentation, March 22, 2022; unpublished data from the speaker.
From page 59...
... FIGURE 5-4  Employment status among patients with postacute COVID-19 infection. 59 SOURCE: Laura Tabacof presentation, March 22, 2022; unpublished data from the speaker.
From page 60...
... PICS affects patients in three main areas: mental health, including anxiety, PTSD, and depression; cognitive impairments, including executive function, memory, attention, visuospatial ability, and mental processing speed; and physical impairments, including pulmonary, neuromuscular, and physical function. The family of the survivor may deal with issues of anxiety, PTSD, depression, and complicated grief.
From page 61...
... tions of patients reporting psychiatric distress, functional decline, anxiety, and depression. Azola summarized her main points: • A hospital stay in the intensive care unit is associated with physical, cognitive, and mental health impairments that may lead to long-term disability.
From page 62...
... . Treatments depend on the needs and interests of the patients, noted Kurylo, and can include individual therapy, cognitive behavioral therapy, mindfulness training, group therapy, Long COVID support groups, peer support, phone and computer apps, and alternative approaches such as biofeedback and meditation.
From page 63...
... , although Johnston noted that these children may be less able to communicate their symptoms well. Like in adults, a variety of symptoms have been reported in children that have been attributed to Long COVID, including fatigue, postexertional fatigue, exercise intolerance, dyspnea, cough, dizziness, brain fog, insomnia, muscle weakness, pain, nausea, and anosmia.
From page 64...
... Our understanding of other conditions may also be useful in understanding the trajectory of Long COVID, said Johnston. For example, a study on ME/CFS in adolescents found that half reported severe fatigue and physical impairment at 2 years postdiagnosis, and that school and work attendance in the population was low (van Geelan et al., 2010)
From page 65...
... Functioning information can be reported independent of the data collection tool or the data source, and data can be easily compared. FIGURE 5-6  International Classification of Functioning, Disability, and Health model of functioning and disability.
From page 66...
... In closing, Stucki reiterated three main points: • An ICF-based approach can support clinical measurement and standardized reporting of functioning information. • COVID-19 affects a broad spectrum of functioning domains ranging from body functions to activities and participation.
From page 67...
... : Unpleasant √ √ √ sensation indicating potential or actual damage of some body structure b440 Respiratory functions: ICF book: √ √ √ Functions of inhaling air into the lungs, the exchange of gases between air and blood, and exhaling b445 Respiratory muscle functions: ICF √ √ √ book: Functions of the muscles involved in breathing air b455 Exercise tolerance functions: √ √ √ Capacity of enduring physical exertion related to respiratory and cardiovascular functions b710 Mobility of joint functions: Range √ √ √ and ease of movement of a joint b730 Muscle power functions: Capacity √ √ √ to generate force through the contraction of a muscle or muscle groups continued
From page 68...
... : √ √ √ Plan, manage and complete routine daily life activities d240 Handling stress and other √ √ √ psychological demands: Manage and control the psychological demands to carry out tasks demanding responsibilities involving stress and/or distractions and/or critical issues d450 Walking (G) : Moving in an √ √ √ upright position, step by step, always maintaining a support on the ground d455 Moving around (G)
From page 69...
... She said depressed patients tend to perceive more impairment in cognition than the objective test reveals, but that there is "definitely a component of cognitive dysfunction that is separate from their depression and anxiety and posttraumatic stress." Tabacof noted that while there are limitations of patient-reported outcomes, including subjectivity and risk of recall bias, there are also limitations of biomarker or clinical testing. There is no universal test or set of tests to diagnose or quantify the effect of Long COVID, and it is unknown if existing tests correlate objectively with levels of impairment.
From page 70...
... While it is important to recognize that there can be a relationship between the two, the critical thing is to address the symptoms in a well-rounded and effective way. Pre-COVID-19 research indicates that the best and longestlasting mental health treatments are typically a combination of psychotherapy and medication, said Kurylo, and there is reason to hope that this would be the same for Long COVID patients who are experiencing mental health symptoms.
From page 71...
... LONG-TERM IMPAIRMENTS AND FUNCTIONAL LIMITATIONS 71 the challenges. Even with the tests, however, assessment still requires gathering information about changes over time and a degree of speculation about which symptoms are related to Long COVID.


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