Comparison of the 1-minute sit-to-stand test with the 6- minutes walk test for the evaluation of the functional status of post-COVID-19 patients

The assessment of functional capacity in severe post-COVID-19 patients, after hospitalization, is essential for estimating functional consequences, disability and exertional desaturation. To date, the 6-minutes walk test (6WMT) and the 1-minute sit-to-stand test (1STST) have been the most commonly used tests. The aim of this study is to investigate the relationship and discuss the utility of the 1STST compared to the 6MWT for follow-up evaluation of the functional status of severe post-COVID-19 patients. A cross-sectional study was performed in a post-COVID-19 public care clinic. A total of 55 patients (mean age: 57.85, SD 12.65) were evaluated. Functional performance was evaluated by 1STST and 6MWT. Both tests were performed 6 months after hospital discharge, on the same day, 1 hour apart. During the tests, the severity of dyspnea (by Modified Borg Scale), heart rate and pulse oxygen saturation (by pulse oximeter) were measured. A significant positive correlation was observed between 1STST and 6MWT (r = 0.30, p =. 026, 95% CI = [0.04, 0.53]). The correlation coefficient between the two tests was 0.30, indicating a moderate effect size. Also, the differences on the severity of dyspnea, heart rate and pulsed oxygen saturation between the two tests were not statistically significant (p =. 061;p =. 169;p =. 965). The 6MWT requires technical execution conditions that are not always easy to meet. Considering the statistically significant relationship between the 1STST and 6MWT, the 1STST may be used for a quick and alternative measurement of the functional assessment in post-COVID-19 patients.

Anxiety symptoms in critically ill COVID-19 survivors and its association with post-discharge health concerns

Introduction: Evidence suggest that critically ill COVID-19 patients are at higher risk of developing anxiety symptoms, which may be related to or exacerbated by patients concerns regarding their health status and recovery. Objective(s): To assess anxiety symptoms in critically ill COVID-19 survivors, 1-2 months after hospital discharge and to analyze its association with concerns reported by patients regarding their own health status and recovery. Method(s): In the framework of MAPA prospective research, this preliminary study included COVID-19 patients admitted in the Intensive Care Medicine Department (ICMD) of a University Hospital. Patients were excluded if they had an ICMD length of stay (LoS) <=24h, terminal illness, major auditory impairment or inability to communicate at the evaluation time. Participants were assessed at a scheduled telephone follow-up appointment, with Generalized Anxiety Disorder Scale (GAD-7). Additional questions were asked to assess the survivors' post-discharge concerns regarding discrimination against for COVID-19, infection of a family member, re-infection or sequelae related to COVID-19. Result(s): Eighty-three patients were included (median age=63 years;63% male) and 24% had anxiety symptoms. Anxiety scores were higher in survivors who reported being afraid of being discriminated against for COVID-19 (30% vs 10%;p=0.034), being re-infected (100% vs 79%;p=0.032) and having sequelae (94% vs 44%;p<0.001). Conclusion(s): These findings revealed that anxiety is common in COVID-19 survivors and is associated with post-discharge patients concerns that may limit patient daily living. This study emphasizes the importance of psychological assessment and follow-up of the COVID-19 survivors, in order to support these patients recovery.

Depression and health-related quality of life in critical COVID-19 survivors

Introduction: Long-term neuropsychiatric consequences of critical illness are well known. Therefore, it is expected that critical COVID-19 patients might also present several psychiatric symptoms such as depression, with inevitable negative effect on healthrelated quality of life (HRQoL), commonly used as an indicator of illness and treatment impact. Objective(s): To identify depressive symptoms in critical COVID-19 survivors and to examine its association with HRQoL domains. Method(s): This preliminary study involved critical COVID-19 patients admitted into the Intensive Care Medicine Department (ICMD) of a University Hospital, between October and December of 2020. Patients with an ICMD length of stay (LoS)<=24h, terminal illness, major auditory loss, or inability to communicate at the follow-up time were excluded. From 1-2 months after discharge, all participants were evaluated by telephone at follow-up appointment, with Patient Health Questionnaire (PHQ-9) (depression) and EuroQol 5-dimension 5-level EQ-5D-5L (HRQoL). This study is part of the longitudinal MAPA project. Result(s): Eighty-three patients were included with a median age of 63 years (range: 31-86) and the majority were male (63%). The most reported problems on EQ-5D-5L domains were usual activities (82%) and mobility (76%). About 27% presented depressive symptoms, and with more problems of self-care (68%vs41%;p=0.029), pain/discomfort (86%vs49%;p=0.002), and anxiety/depression (96%vs54%;p<0.001). Conclusion(s): These preliminary results are in line in previous studies in critical COVID-19 survivors, with depression being associated with worse HRQoL. Bearing this in mind, follow-up approaches with an early screening and treatment of these psychiatric symptoms will be fundamental to optimize the recovery of these patients.

Delirium and health-related quality of life in severe COVID-19 survivors

Introduction: Severe COVID-19 survivors experience long-term neuropsychiatric morbidity, particularly those who developed delirium, with a negative impact on health-related quality of life (HRQoL). Objective(s): To identify the cases of delirium in severe COVID-19 patients and to describe its association with post-hospital discharge HRQoL. Method(s): In the context of the longitudinal MAPA project, we included adult patients (>= 18 years old) admitted with COVID-19 to the Intensive Care Medicine Department (ICMD) of a Portuguese University Hospital (October 2020-April 2021). Exclusion criteria were: ICMD length of stay <=24h, terminal illness, major auditory loss, or inability to communicate at the time of assessment. Delirium during ICMD stay was ascertained based on patients' clinical records. HRQoL was evaluated using the 5-Level EQ-5D questionnaire (EQ-5D-5L), at a scheduled telephone follow-up appointment on average 1-2 months after hospital discharge. Result(s): Overall, 124 patients were included with a median age of 62 (range: 24-86) years, being mostly male (65%). About 19% had delirium, 42% were deeply sedated and 43% required invasive mechanical ventilation. Most survivors reported problems on the EQ-5D-5L domains: usual activities (85%), mobility (73%) and anxiety/depression (65%). Patients with delirium reported more pain/discomfort (75%vs46%;p=0.011) and considerably anxiety/ depression (83%vs60%;p=0.032). Conclusion(s): These findings pointed that COVID-19 patients who experienced delirium reported worse HRQoL, regarding pain/discomfort and anxiety/depression. This study highlights the importance of not only prevention but also early screening of delirium during hospital stay, as well as the crucial role of the timely interventions at discharge, in order to minimize delirium longterm impacts.

Depressive symptoms and health-related quality of life in critical COVID-19 survivors: Preliminary results of 1-year follow-up

Introduction: A higher risk of mental health consequences in critical COVID-19 patients is expected due to several reasons, including prolonged mechanical ventilation with exposure to high sedation. In this context, post-discharge depression has been reported in previous COVID-19 studies, with a profound impact on patients' health-related quality of life (HRQoL). Objective(s): To identify depressive symptoms in COVID-19 survivors 1-year after hospital discharge and to analyse its association with HRQoL. Method(s): As part of the longitudinal MAPA project, this study enrolled critical COVID-19 patients admitted in the Intensive Care Medicine Department of a University Hospital (March-May 2020). Participants were assessed through telephone by an intensive care nurse and a psychologist, with the Patient Health Questionnaire (PHQ-9) (depressive symptoms), EuroQol five-dimension fivelevel questionnaire (EQ-5D-5L) and EQ-Visual Analogue Scale (EQ-VAS) (global health status patient record). Result(s): A sample of 55 survivors (median age=66 years;69% males) were included, with 20% showing depressive symptoms. Pain/discomfort (67%) and anxiety/depression (67%) were the most EQ-5D-5L domains reported. Survivors scoring for depression had more problems in all HRQoL areas (mobility:91%vs.48%, p=0.015;self-care:64%vs.27%, p=0.035;usual activities:91%vs.50%, p=0.017;pain/discomfort:100%vs.59%, p=0.010;anxiety/depression:100% vs.59%, p=0.010). Moreover, they had a lower EQ-VAS median, corresponding a worse self-perception of health status (50vs.80, p=0.010). Conclusion(s): Even after 1-year, a significant proportion of survivors presented depressive symptoms with repercussions in all HRQoL dimensions and association with worse self-perception of global quality of life. Taking this in mind, early screening and treatment of depression in COVID-19 survivors will be crucial, minimizing its impact on quality of life.