ABSTRACT
Research Objectives To identify distinct post-acute COVID-19 phenotypes among adults hospitalized for severe SARS-CoV-2 infection and describe multidimensional outcomes and trajectories at 6 and 12 months post-hospitalization. Design Prospective, longitudinal data collection in functional, physical, cognitive, and psychological domains at 3, 6, and 12 months post-hospitalization. Retrospective data collection from the acute care and post-acute care settings. Setting Acute care and post-acute telephone follow-up. Participants English- and Spanish- speaking adults, with decision-making capacity, admitted for inpatient rehabilitation following inpatient rehabilitation for acute COVID-19 related illness (N = 61). Interventions N/A. Main Outcome Measures Physical, cognitive, and psychological symptoms;self-reported employment status and assistance with ADLs. Results Median age 60.8 years;59% male;72.1% white;72.1% non-Hispanic;26.2% preferred assessment in Spanish. 83% required mechanical ventilation in acute care. Comorbidities were common. We found a high prevalence of persistent symptoms at 6- and 12- months across physical, cognitive, and emotional health outcome domains. Three post-acute phenotypes were identified at 6 months;a "minimally symptomatic" subgroup with minimal symptom endorsement across all domains relative to other subjects (22.95%, n = 14), a “predominantly physical symptoms” subgroup (47.54%, n = 29), and a “globally symptomatic” subgroup (29.51%, n = 18). A similar pattern for phenotypes emerges at 12-months, with 67.21% of subjects falling into the same phenotype at both time points. In the Predominantly Physical Symptom phenotype, 31.0% declined into the Globally Symptomatic Phenotype and 10.3% improved. In the Globally Symptomatic phenotype, 11.1% of participants transitioned to the Minimally Symptomatic phenotype and 16.7% to the Predominantly Physical Symptom phenotype. Compared to premorbid level of employment (50.8%), 24.6% of participants were employed at 12-months. Phenotype at 6-months was a significant predictor of employment at 12-months (B = 2.26, p = .05, OR = 9.6). Conclusions Persons with severe COVID-19 illness experience persistent functional limitations and reduced employment up to 12 months post-hospitalization. Distinct recovery subgroups were found suggesting the need for comprehensive assessment and tailored treatment for recovery. Author(s) Disclosures The authors declare no relevant conflicts of interest.
ABSTRACT
Post-COVID-19 condition is characterized by a myriad of persistent symptoms experienced up to 60 days after the acute infection, not only in those hospitalized, but also in patients with mild to moderate acute symptoms. The overwhelming evidence on multisystem involvement in post-COVID-19 condition brings to attention the need for integrated delivery models to address health care needs of this population. The World Health Organization recently highlighted critical gaps in adequately providing the level of integrative care required to address the multisystem needs of this population in current health care delivery models and recommended development of new innovative models of delivery. This article presents a novel approach to addressing these gaps from a rehabilitation perspective.
ABSTRACT
To identify distinct post-acute COVID-19 phenotypes among adults hospitalized for severe SARS-CoV-2 infection and describe multidimensional outcomes at 6 months post-hospitalization. Prospective, longitudinal data collection in functional, physical, cognitive, and psychological domains at 3, 6, and 12 months post-hospitalization. Retrospective data collection from the acute care and post-acute care settings. Acute care and post-acute telephone follow-up. Spanish- and English-speaking adults, with decision-making capacity, admitted for inpatient rehabilitation following inpatient hospitalization for acute COVID-19 related illness (N = 52). N/A. Physical, cognitive, and psychological symptoms;Self-reported employment status and assistance with ADLs. Median age was 60.96 (IQR = 20.89), with race/ethnicity representative of the US adult population (71% White;13% Black;27% Hispanic). Compared to premorbid status, 33% of individuals were no longer employed full-time and 23% were no longer independent in basic ADLs. Latent profile analysis identified distinct subgroups within physical, cognitive, and emotional domains of functioning. Approximately 31% were in either the moderately or most symptomatic groups for both cognitive and emotional functioning, with 88% of these also falling into the most symptomatic group for physical functioning. There were 29% in the least symptomatic group across all domains. Persons with severe COVID-19 illness experience persistent functional limitations that interfere with employment and ADLs up to 6 months post-hospitalization. Although symptom variability is high at 6 months, we identified distinct subgroups, including those with co-occurring emotional and cognitive symptoms, that suggest the need for comprehensive assessment and tailored treatment for physical, emotional, and cognitive symptoms. The author's declare no relevant conflict of interests.