Psychometric Properties of the Functional Impairment Checklist (FIC) as a Disease-Specific Patient-Reported Outcome Measure (PROM) in Previously Hospitalized COVID-19 Survivors with Long-COVID.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is associated with a plethora of long-lasting symptoms (long-COVID). The presence of long-COVID symptoms causes decreased functionality. This study described the psychometric properties of the Functional Impairment Checklist (FIC), a disease-specific patient-reported outcome measure (PROM) used for evaluating the functional consequences of SARS in previously hospitalized COVID-19 survivors with long-COVID symptoms. The LONG-COVID-EXP-CM is a multicenter cohort study including patients hospitalized with COVID-19 during the first wave of the pandemic in five hospitals in Madrid. A total of 1969 (age: 61 ± 16 years, 46.4% women) COVID-19 survivors with long-COVID completed the FIC at a long-term follow-up after hospitalization (mean: 8.4 ± 1.5 months). Internal consistency (Cronbach alpha value), reliability (item-internal consistency, item-discriminant validity), construct validity (exploratory factor analysis), floor effect and ceiling effect were calculated. The mean time for fulfilling the FIC was 62 ± 11 s. The Cronbach's alpha values reflecting the internal consistency reliability were 0.864 for FIC-symptoms and 0.845 for FIC-disability. The correlation coefficient between the FIC-symptoms and FIC-disability scale was good (r: 0.676). The ceiling effect ranged from 2.29% to 9.02%, whereas the floor effect ranged from 38.56% to 80.19%. The exploratory factor analysis showed factor loadings from 0.514 to 0.866, supporting good construct validity. Women exhibited greater limitations in all physical symptoms and disability-related domains of the FIC compared with men (all, p < 0.001). Further, younger patients (those aged <45 years) self-reported lower physical symptoms and disability-related domains than older patients. In conclusion, this study indicates that the FIC has good psychometric properties to be used as a specific-disease PROM to measure function and disability in COVID-19 survivors with long-COVID.

Psychometric Properties of the Hospital Anxiety and Depression Scale (HADS) in Previously Hospitalized COVID-19 Patients.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is associated with psychological/emotional disturbances. This study aimed to assess internal consistency, reliability, and construct validity of the Hospital Anxiety and Depressive Scale (HADS), as a patient-reported outcome measure (PROM) for evaluating emotional consequences of SARS-CoV-2 in hospitalized COVID-19 survivors with long COVID. The LONG-COVID-EXP-CM is a multicenter cohort study including patients hospitalized by COVID-19 during the first wave of the pandemic in five hospitals in Madrid. A total of 1969 (age: 61 ± 16 years, 46.5% women) COVID-19 survivors experiencing post-COVID symptoms a mean of 8.4 ± 1.5 months after hospital discharge completed HADS. Internal consistency (Cronbach α), reliability (item-internal consistency, item-discriminant validity), construct validity (confirmatory factor analysis), and floor effect and ceiling effect were calculated. The mean time for fulfilling HADS was 65 ± 12 s. A ceiling effect ranging from 1.99% to 13.74% and a floor effect ranging from 43.05% to 77.77% was observed. Based on the item-scale correlation coefficients, the Cronbach's alpha values reflecting the internal consistency reliability were 0.890 for the anxiety scale (HADS-A) and 0.856 for the depressive scale (HADS-D) The correlation coefficient between HADS-A and HADS-D scores was excellent (r: 0.878). The confirmatory factor analysis revealed that five out of the seven fitness indexes were excellent: CFI = 0.969, NNFI = 0.963; TLI = 0.963; AGFI = 0.951; GFI = 0.972), supporting good construct validity. In conclusion, this study indicates that both anxiety and depressive symptoms scales of HADS had overall good psychometric properties to be used for assessing psychological and emotional stress in COVID-19 survivors with long COVID.

Serological biomarkers of COVID-19 severity at hospital admission are not related to long-term post-COVID pain symptoms in hospitalized COVID-19 survivors.

ABSTRACT: This study investigated the association between serological biomarkers at hospital admission with the development of long-term post-COVID pain symptoms in previously hospitalized coronavirus disease, 2019 (COVID-19) survivors. A cohort study including patients hospitalised because of COVID-19 in 1 urban hospital of Madrid (Spain) during the first wave of the outbreak was conducted. Hospitalisation data, clinical data, and 11 serological biomarkers were collected at hospital admission. Participants were scheduled for an individual telephone interview after hospital discharge for collecting data about post-COVID pain symptoms. A total of 412 patients (mean age: 62, SD: 15 years; 46.1% women) were assessed twice, at a mean of 6.8 and 13.2 months after discharge. The prevalence of post-COVID pain symptoms was 42.7% (n = 176) and 36.2% (n = 149) at 6.8 and 13.2 months after hospital discharge. Patients reporting post-COVID pain exhibited a greater number of COVID-19-associated symptoms at hospital admission, more medical comorbidities, higher lymphocyte count, and lower glucose and creatine kinase levels (all, P < 0.01) than those not reporting post-COVID pain. The multivariate analysis revealed that lower creatine kinase and glucose levels were significantly associated, but just explaining 6.9% of the variance of experiencing post-COVID pain. In conclusion, the association between serological biomarkers associated with COVID-19 severity at hospital admission and the development of post-COVID pain is small. Other factors, eg, higher number of COVID-19 onset symptoms (higher symptom load) could be more relevant for the development of post-COVID pain. Because inflammatory biomarkers were not directly analyzed, they may have stronger predictive strengths for the development of post-COVID pain symptoms.

Prevalence and risk factors of musculoskeletal pain symptoms as long-term post-COVID sequelae in hospitalized COVID-19 survivors: a multicenter study.

ABSTRACT: This study investigated the prevalence of long-term musculoskeletal post-COVID pain and their risk factors in a large cohort of COVID-19 survivors. A multicenter cohort study including patients hospitalised because of COVID-19 in 5 hospitals of Madrid (Spain) during the first wave of the pandemic was conducted. Hospitalisation and clinical data were collected from medical records. Patients were scheduled for a telephone interview after hospital discharge for collecting data about the musculoskeletal post-COVID pain. Anxiety/depressive levels and sleep quality were likewise assessed. From 2000 patients recruited, a total of 1969 individuals (46.4% women, age: 61 years, SD: 16 years) were assessed on average at 8.4 (SD: 1.5) months after discharge. At the time of the study, 887 (45% women) reported musculoskeletal post-COVID pain. According to the presence of previous pain symptoms, the prevalence of "de novo" (new-onset) musculoskeletal post-COVID pain was 74.9%, whereas 25.1% experienced an increase in previous symptoms (exacerbated COVID-related pain). Female sex (odds ratio [OR]: 1.349, 95% confidence interval [CI]: 1.059-1.720), history of musculoskeletal pain (OR 1.553, 95% CI 1.271-1.898), presence of myalgia (OR 1.546, 95% CI 1.155-2.070) and headache (1.866, 95% CI 1.349-2.580) as COVID-19-associated onset symptoms, and days at hospital (OR 1.013, 95% CI 1.004-1.022) were risk factors associated with musculoskeletal post-COVID pain. In conclusion, musculoskeletal post-COVID pain is present in 45.1% of COVID-19 survivors at 8 months after hospital discharge with most patients developing de novo post-COVID pain. Female sex, history of musculoskeletal pain, presence of myalgia and headache as COVID-19 symptoms at the acute phase, and days at hospital were risk factors associated with musculoskeletal post-COVID pain.

Fatigue and Dyspnoea as Main Persistent Post-COVID-19 Symptoms in Previously Hospitalized Patients: Related Functional Limitations and Disability.

BACKGROUND: Multicentre studies focussing on specific long-term post-COVID-19 symptoms are scarce. OBJECTIVE: The aim of this study was to determine the levels of fatigue and dyspnoea, repercussions on daily life activities, and risk factors associated with fatigue or dyspnoea in COVID-19 survivors at long term after hospital discharge. METHODS: Age, gender, height, weight, symptoms at hospitalization, pre-existing medical comorbidity, intensive care unit admission, and the presence of cardio-respiratory symptoms developed after severe acute respiratory syndrome coronavirus 2 infection were collected from patients who recovered from COVID-19 at 4 hospitals in Madrid (Spain) from March 1 to May 31, 2020 (first COVID-19 wave). The Functional Impairment Checklist was used for evaluating fatigue/dyspnoea levels and functional limitations. RESULTS: A total of 1,142 patients (48% women, age: 61, standard deviation [SD]: 17 years) were assessed 7.0 months (SD 0.6) after hospitalization. Fatigue was present in 61% patients, dyspnoea with activity in 55%, and dyspnoea at rest in 23.5%. Only 355 (31.1%) patients did not exhibit fatigue and/or dyspnoea 7 months after hospitalization. Forty-five per cent reported functional limitations with daily living activities. Risk factors associated with fatigue and dyspnoea included female gender, number of pre-existing comorbidities, and number of symptoms at hospitalization. The number of days at hospital was a risk factor just for dyspnoea. CONCLUSIONS: Fatigue and/or dyspnoea were present in 70% of hospitalized COVID-19 survivors 7 months after discharge. In addition, 45% patients exhibited limitations on daily living activities. Being female, higher number of pre-existing medical comorbidities and number of symptoms at hospitalization were risk factors associated to fatigue/dyspnoea in COVID-19 survivors 7 months after hospitalization.

Future Challenges for Physical Therapy during and after the COVID-19 Pandemic: A Qualitative Study on the Experience of Physical Therapists in Spain.

This qualitative exploratory study addressed the perspectives of Spanish physical therapists (PTs) regarding (a) the organization of their work during the first wave of the pandemic; (b) their role within the intensive care units (ICUs); (c) management of COVID-19 survivors; (d) potential future challenges identified for the physical therapy profession. Thirty PTs who had worked at a National Public Hospital in Madrid during the first COVID-19 outbreak were recruited by purposeful sampling and snowball techniques. In-depth interviews and researcher field notes were used to collect data. Interviews were transcribed verbatim. An inductive thematic analysis was used to identify emerging themes. After identifying 1110 codes, four themes emerged. Throughout the first wave of the pandemic, the role and work of PTs in hospitals experienced a change. These changes took place at their organizational level, affecting the distribution of PTs in the hospital, and the role of PTs in front-line COVID units such as ICUs, as well as direct management of outpatients at the onset of the pandemic, and after discharge from the ICUs. This situation has led to PTs foreseeing challenges and developing new expectations concerning their role and the physical therapy profession in the future.

Working on the Frontlines of the COVID-19 Pandemic: A Qualitative Study of Physical Therapists' Experience in Spain.

OBJECTIVE: Knowledge of the experiences of health care professionals who have actively worked on the first line of the COVID-19 pandemic could help to identify specific professional duties focused on health assistance objectives. No qualitative study has yet been published, to our knowledge, describing the experience of physical therapists during the COVID-19 pandemic. The purpose of this study was to describe and explore the experiences and perspectives of physical therapists working in public hospitals in Madrid, Spain, during the COVID-19 pandemic. METHODS: A qualitative exploratory study was conducted based on an interpretive framework. Thirty physical therapists working at 11 national public hospitals during the COVID-19 outbreak were recruited by purposeful sampling and snowball techniques. In-depth interviews and researchers' field notes were used to collect data. Interviews were transcribed verbatim. Inductive thematic analysis was used to identify emerging themes. RESULTS: After identifying 3912 codes and 13 categories, 3 themes emerged. The first theme was "call of duty"; as COVID-19 infection dramatically spread, the hospitals were contaminated and overwhelmed, and all floors were converted into COVID-19 wards. The second theme was "working in war time." Every day, therapists were given "the war report," receiving their orders, meeting protective personal equipment requirements, and confronting fear. The third theme was "when I arrive at home." Working during the pandemic had an impact on the therapists' families and the information shared with them. CONCLUSIONS: Physical therapists described the COVID-19 outbreak as an apocalyptic and unexpected war. Comprehensive support is needed for all frontline health care professionals. The COVID-19 outbreak revealed that health care systems were not prepared for a pandemic. IMPACT: To our knowledge, this is the first qualitative study to be published describing the experience of physical therapists during the COVID-19 pandemic.

Emotional Experience and Feelings during First COVID-19 Outbreak Perceived by Physical Therapists: A Qualitative Study in Madrid, Spain.

Knowing the experiences and feelings of health professionals who have actively worked on the first-line during the first COVID-19 outbreak could help for identifying specific professional duties focused on health assistance objectives. No qualitative study has been published describing the emotion/feelings of physical therapists during the first COVID-19 outbreak. This study describes and explores the emotional experiences and feelings of thirty physical therapists working at the first-line at eleven public health hospitals in Madrid (Spain) during the first COVID-19 outbreak (March-May 2020). A qualitative exploratory study was conducted based on an interpretive framework. Participants were recruited by purposeful sampling and snow-ball techniques between May and June 2020. In-depth interviews and researchers' field notes were used to collect the data. An inductive thematic analysis was conducted to identify significant emerging themes from verbatim transcription. After identifying 2135 codes and 9 categories, three themes emerged to describe their emotional experiences and feelings. First, "Critical events", with negative and positive critical events. Second theme, "Emotional Roller Coaster", with emotions, feelings, and coping strategies. Third theme: "Last words: Conclusions of the COVID-19 outbreak experience", with the meaning of the COVID-19 outbreak from a personal and professional perspective. Comprehensive support for all first-line healthcare professionals is needed.

Emotional Experience and Feelings during First COVID-19 Outbreak Perceived by Physical Therapists: A Qualitative Study in Madrid, Spain

Knowing the experiences and feelings of health professionals who have actively worked on the first-line during the first COVID-19 outbreak could help for identifying specific professional duties focused on health assistance objectives. No qualitative study has been published describing the emotion/feelings of physical therapists during the first COVID-19 outbreak. This study describes and explores the emotional experiences and feelings of thirty physical therapists working at the first-line at eleven public health hospitals in Madrid (Spain) during the first COVID-19 outbreak (March–May 2020). A qualitative exploratory study was conducted based on an interpretive framework. Participants were recruited by purposeful sampling and snow-ball techniques between May and June 2020. In-depth interviews and researchers’field notes were used to collect the data. An inductive thematic analysis was conducted to identify significant emerging themes from verbatim transcription. After identifying 2135 codes and 9 categories, three themes emerged to describe their emotional experiences and feelings. First, “Critical events”, with negative and positive critical events. Second theme, “Emotional Roller Coaster”, with emotions, feelings, and coping strategies. Third theme: “Last words: Conclusions of the COVID-19 outbreak experience”, with the meaning of the COVID-19 outbreak from a personal and professional perspective. Comprehensive support for all first-line healthcare professionals is needed.