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Objectives: The prospective, longitudinal, community-based CONTACT study aimed to improve our understanding of COVID-19 immunity, and other characteristics related to SARS-CoV-2 long-term, including the assessment of health-related quality of life (HRQoL) at baseline and over time by infection status. Method(s): Participants living or working in Lake County, IL were recruited between November 2020 and January 2021. At baseline and follow up visits (3-, 6-, and 9-Months-M-), participants self-reported their occupational exposure, COVID-19 vaccination status and provided nasal and blood serum specimens for molecular (RT-PCR) and serologic (IgG) testing to detect current or previous SARS-CoV-2 infection. HRQoL questionnaires EQ-5D-5L were completed online approximately within two weeks post-testing (at 0.5, 3.5, 6.5, and 9.5 months) after results were communicated. EQ-5D-5L information was described and stratified by COVID-19 status at baseline, 3M, 6M and 9M - software: SAS-v9.4. Result(s): Data from 1008 participants were analyzed. Participants testing positive to COVID-19 were 56/952, 48/751, 40/693, and 19/654, respectively, at baseline, 3M, 6M, and 9M. Of the five domains of EQ-5D-5L, a higher percentage of participants who tested positive for COVID-19 reported having no anxiety or depression versus those who tested negative: at baseline (55.4% [31/56] vs 50.5% [481/952]);3M (68.8% [33/48] vs. 56.3% [423/751]);6M (67.5% [27/40] vs. 56.3% [390/693]);and 9M (73.7% [14/19] vs. 60.4% [395/654]). Median Visual Analogue Scale (VAS) score was at least 2 points higher at all time- points for participants who tested positive except at last visit (baseline: 89.0 vs. 87.0;3M: 88.0 vs. 86.0;6M: 87.5 vs. 85.0;9M: 85.0 vs. 87.0) Conclusion(s): This analysis provides insight into participant HRQoL burden at enrollment and over time when a positive test to COVID-19 was communicated. At all time-points, anxiety or depression was experienced by more participants who tested negative versus those who didn't.Copyright © 2023
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Intro: Patients affected with COVID-19 have been reported to have persistent symptoms even months after the acute episode, most commonly fatigue, breathlessness, and symptoms of anxiety and depression. These residual symptoms have been shown to compromise the quality of life and lead to significant impairment in both the mental and physical health of these patients. Method(s): A prospective observational cohort study was carried out and patients were followed for a month after discharge. Residual symptoms were noted, quality of life (QoL) assessment was done using EQ-5D-5L, and anxiety/depression was evaluated using WHO-SRQ 20 scores. Appropriate statistical tests were applied to compare improvement in QoL and residual symptoms between first and the last visit. Finding(s): A total of 110 patients were included. Mean age of the patients was 53.7 (SD+/- 13) years. Most common symptoms at 1st follow up were shortness of breath (66%) and fatigue (65%) which reduced in frequency on the last visit to (43%) and (46%) respectively. Significant improvement was seen in SpO2 levels recorded at both visits (p=0.000). An overall improvement in QoL was seen (p=0.000). WHO-SRQ 20 score above 8 was noted in 20% patients and mean score was 5.91. On further categorization into mild, moderate, severe and critical disease on admission, patients showed improvement in symptoms at four weeks irrespective of categories. For QoL assessment, mean utility score showed improvement in all disease categories on the 2nd visit except for patients with mild disease on admission. Conclusion(s): Our study showed a significant improvement in residual symptoms and overall quality of life when followed over a period of time in majority of the patients. Symptoms of anxiety and depression were also not frequent. However, our findings emphasize the need of a multidisciplinary approach towards rehabilitation of COVID-19 patients for earlier improvement in their quality of life.Copyright © 2023
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Background: Whether early antiviral therapy reduces the risk of Long COVID is not known. The combination SARS-CoV-2 monoclonal antibodies amubarvimab+romlusevimab (A+R) were highly effective in reducing 28-day all-cause hospitalization/death among high-risk adults with mild-to-moderate COVID-19 in the randomized, placebo-controlled ACTIV-2/A5401 trial. We assessed the impact of A+R on late outcomes including Long COVID in ACTIV-2. Method(s): A long-term (LT) symptom diary and 2 health-related quality of life questionnaires (EQ-5D-5L and SF-36v2) were completed at week 36. The primary analysis compared the proportion of participants with the composite outcome of self-reported Long COVID (having any COVID-19 symptoms present on a global assessment question in LT diary) at week 36, or hospitalization or death by week 36 between A+R and placebo using regression models with inverse probability weighting to account for incomplete outcome data;supplemental analysis compared the proportion with Long COVID among those alive. Other analyses were restricted to observed data only. Result(s): 807 were randomized and received A+R (n=405) or placebo (n=402) from Jan-July 2021. At entry, median age was 49 years, 51% were female, >99% cis-gender, 17% Black/African American, 50% Hispanic/Latino, and 9% previously received COVID vaccination. 70 (17%) on A+R and 93 (23%) on placebo met the primary outcome;113 (14%) had incomplete data for determining the outcome (Figure 1). Accounting for incomplete data, weighted Risk Ratio [wRR]=0.74;95% CI: 0.56, 0.97;p=0.03. The difference was driven by fewer hospitalizations/deaths in the A+R arm (5%) than placebo arm (15%), particularly by day 28. Excluding 12 participants who died by week 36, frequency of Long COVID was similar in the arms, 16% for A+R and 14% for placebo (wRR=1.09;95%CI: 0.75, 1.58;p=0.64). There were no differences in the proportions reporting return to pre-COVID health (global assessment) or individual symptoms, or in number of symptoms reported or distribution of worst symptom severity. RRs favored the A+R arm on several EQ-5D-5L domains, but none met statistical significance. No differences were observed on SF-36v2 assessments. Conclusion(s): While A+R was highly effective in preventing all-cause hospitalizations and deaths in high-risk outpatients with mild-to-moderate COVID-19, there was no meaningful effect of treatment on measures of Long COVID at 36 weeks. Additional interventions are needed for Long COVID prevention. (Figure Presented).
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Aim Functional neurological disorders (FND) are one of the most common presentation in neurology clinics, causing a significant disability and economic burden. Cognitive behavioural therapy (CBT) has one of the best available evidence in managing FND, although access remains limited. Queen Square, London neuropsychiatry experts have established an excellent model for a CBT based, Guided Self Help (GSH) programme, which is preparatory to a multidisciplinary inpatient treatment. It has been shown to have good outcomes. This study was designed to ascertain the feasibility and acceptance of this QGSH model, in an Exonian cohort of FND patients, whilst piloting its stand-alone version, without the inpatient component. Additionally, the study explores the need and types of modifications required for the stand-alone adaptation of QGSH. Method Consecutive patients referred to Exeter FND Service, between February to June 2020, who had internet access, were offered the QGSH pilot. Patients with a primary mental disorder concurrent drug/alcohol misuse or risk of self-harm or suicide were excluded. Ethics approval was not required. The QGSH intervention constitutes of 11 modules focussing on specific elements crucial to FND management along with homework tasks, delivered by the author, under supervision by QGSH experts. Patients completed Pre and Post-intervention questionnaires as well as structured feedback. Results Three successive patients with varied FND symptoms were recruited to the pilot between February and June 2020. The baseline health status of these patients was worse as compared to EQ-5D-5L population norms with significant baseline psychiatric comorbidity. Outcome measures used before and after QGSH intervention included PHQ 9, GAD 7, EQ-5D-5L and a locally devised symptom severity questionnaire. Necessary modifications were made to the program based on the patients informal feedback and structured formal feedback was sought in the end. Conclusion All patients derived some benefit from QGSH and certain modifications were suggested in patient feedback to improve engagement. Despite study limitations, especially small size and the impact of Covid 19 pandemic during the intervention;QGSH model appears acceptable and feasible in an Exonian cohort, however, some modifications are recommended for the stand-alone version to succeed. The recommendations will be presented.
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The aim of the study to examine the level of psychological distress among nursing students volunteering in Covid-19 frontline prevention in Vietnam and related factors. Nursing students volunteering in frontline prevention presented emotional effects, including positive and negative effects on their psychological well-being. A cross-sectional study design was used and four hundred seventy-one students who volunteered for frontline prevention were randomly selected in the study using inclusion criteria. Data were collected from October to December 2021. A demographic questionnaire, the General Self-Efficacy Scale, the 6-item Kessler Psychological Distress Scale, the Brief Coping Orientation to Problems Experienced Inventory Questionnaire, and the Quality of life EQ-5D-5L were used to measure the variables. The data analysis was conducted by using descriptive statistics and linear regression. The research found that students presented a high risk of psychological distress. There was a significant correlation between problem-and emotional-coping strategies, quality of life, and psychological distress. Moreover, family support and psychological distress among nursing students had a strong relationship. Lecturers and high education institutions responsible for nursing students should pay more attention to developing psychological interventions in enhancing coping strategies and quality of life and various supports to reduce distress among nursing students fighting the epidemic.Copyright © 2022 Mohan R, et al.
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Early experiences of the your COVID recovery programme for individuals with long COVID Background: There is a significant prolonged symptom burden for a high proportion of patients after an initial acute infection with COVID. Objective measures in large cohorts have demonstrated that exercise capacity is disrupted in a large proportion of the Long COVID population. Recommendations for rehabilitation are emerging but clinical pathways and models of rehabilitation are lacking. Your COVID Recovery (YCR) is an online 'light touch' digital recovery programme for individuals recovering from Long COVID. Aim(s): To describe the early data from the YCR phase two site and to understand the data collected from the two outcome measures. Method(s): Participants were referred on the YCR programme. Basic demographics and questionnaire (EQ5D5L and the CAT) data were extracted from the site for the period February - November 2021. Result(s): 110 patients completed the programme (68% female, 88% White British, age: 46 +/- 11 years, height: 170 +/- 10 cm, weight: 87 +/- 21 kg). 47% of patients had comorbidities. Patients were on the programme for 9 +/- 4.3 weeks. There was an increase in EQ5D5L VAS score (pre = 49 +/- 19.5;post = 60 +/- 22.1;p<0.01) and EQ5D5L Index Value pre- to post-intervention (pre = 0.52 +/- 0.25;post = 0.57 +/- 0.27;p=0.09). CAT total score improved pre- to postintervention (pre = 19.8 +/- 7.2;post = 15.6 +/- 7.6, p<0.01). Discussion(s): This early data describes the impact of the YCR programme on the first cohort of patients to complete the programme. The outcome data is promising and should promote adoption by HCPs. Future research should focus on the comparing the YCR programme versus best usual care.
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Background: Fatigue, pain and faecal incontinence are common in people with IBD. However, little is known about co-existence of these multiple symptoms, how they inter-relate and whether people want help for these symptoms. In qualitative interviews, patients have reported that these symptoms are often ignored in clinical consultations where the focus is on inflammation, but that they are very bothered by these symptoms, even when disease is apparently in remission The aim of this study was to determine the presence and relationship between fatigue, pain and incontinence in people with inflammatory bowel disease, and desire for intervention for these symptoms Methods: A purpose-designed survey (online or postal), incorporating validated tools and demographic details, was sent to unselected UK clinic and UK IBD-BioResource adult patients. When the covid-19 pandemic halted clinic recruitment, additional self-selected UK recruits were solicited via social media. Using the validated PROMIS tools the following definitions were used for presence of symptoms: Fatigue: PROMIS fatigue T-score of 60 or more;pain: PROMIS pain intensity T-score of 60 or more;PROMIS bowel incontinence: Raw score of 50 or more. Participants also reported disease activity using the relevant PRO-2 score, IBD-Control, anxiety (GAD-7), depression (PHQ-9) and quality of life (EQ-5D-5L) which will all be reported elsewhere Results: A total of 8486 useable responses were received (7716 online 770 postal). 4176 reported Crohn's disease, 4255 had ulcerative colitis or other form of IBD. There were 3281 men and 4883 women. Median age was 51 years (range 18 - 92). 2550 (30%) reported fatigue 1766 (21%) pain and 4565 (54%) faecal incontinence according to the above definitions;925 (10.9%) reported having all three symptoms Demographics by symptom are shown in Table 1. Table 2 reports those participants indicating the presence of each symptom and each combination of symptoms. Table 3 shows a summary of self-defined severity and impact of symptoms (scoring scale 0-10 for both severity and impact of each symptom). Participants scored severity and impact a mean between 3.3 and 4.8, with a wide variation. 56% of all respondents (not just those with symptoms) "definitely" wanted help for fatigue;42% wanted help for pain;53% wanted help for incontinence. 29% reported "definitely" wanting help for all three symptoms (Table 4) Conclusion(s): This study confirms that fatigue, pain and urgency are common in IBD and for the first time reports the co-existence and unmet need for help with these symptoms.
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Introduction: One in ten people will develop symptoms of Long COVID (LC) following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite widely reported symptomology, the impact upon quality of life (QoL) and functional status (FS) is not well documented. Accordingly, we conducted a cohort observation to determine the impact of LC on QoL and FS that also captured the lived experience. Method(s): Fifty-six patients (n=41 female, mean age 51+/-10 years) with confirmed history of COVID-19 were recruited from LC clinics in the United Kingdom and completed a 16-week cohort observation (five face-to-face visits and biweekly telephone consultations). QoL was assessed via the EQ-5D-5L and FS via the post-COVID functional status scale (PCFS) and the six-minute walk test (6MWT). Symptom profile and lived experience was captured via selfreport diaries and analysed via thematic analysis. Result(s): QoL across all domains was 2.5+/-0.6 AU at baseline and unchanged at 16-weeks (2.4+/-0.9, P=0.12). PCFS was improved at 16-weeks (2.1 +/-1.1 AU) when compared to baseline (2.7+/-0.4 AU, P=0.02) but highlighted impaired FS. 6MWT was 322+/-133 M at baseline and improved at 16 weeks (430+/-150 meters, P<0.01) but was lower than normative data for healthy age matched controls. Patients recorded 2,197 references to symptoms profile (66% coverage), highlighting broad and cyclical symptoms that impacted QoL (30% coverage) and physical and mental wellbeing. Conclusion(s): LC patients exhibit severely impacted QoL and FS that demonstrates little change over 16 weeks. Research must inform treatment and support to address symptomology and restore QoL and FS.
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Introduction: The extended half-life (EHL) registry was established in 2016 to ascertain the long-term outcomes in patients with HaemophiliaA(HA) and B(HB) receiving replacement therapy. The aim was to quantify disease burden and quality of life at baseline and after switching to EHLs. Method(s): The study is a prospective, observational cohort study that enrolled patients switching EHLs or on standard replacement therapy after informed consent following local ethics approval and was registered at www.clinicaltrials.gov (NCT02938156). The study was paused during the COVID pandemic. Here the baseline results are presented for pain, activity and quality of life and their correlations. Pain evaluation was assessed through the brief pain inventory (BPI) 7-day recall, quality of life by EuroQol-5 Dimension (EQ5D5L) and physical activity through the international physical activity questionnaire (IPAQ). The BPI assess severity of pain and the interference with activities. IPAQ assess physical activity undertaken across a comprehensive set of domains. Three levels of physical activity are used to classify the populations: 'low', 'moderate', and ' high'. Result(s): A total of 231 HA and 97 HB were included in the analysis, of whom 231 had switched to EHL products and 96 were on standard replacement therapy. The levels of Physical Activity were similar between Haemophilia types, with approximately 46%, 32% and 22% of patients reporting high, moderate, and low physical activity, respectively. BPI mean (+/-SD) severity score in HA was 2.86 (+/-2.1), HB 3.24 (+/-2.0);interference score HA 3.22 (+/-2.8), HB 3.09 (+/-2.5), mean EQ5D5L visual analogue scale (VAS) for HA 72.92 (+/-15.5) and HB 71.10 (+/-18.2). Within instruments, IPAQ sub-scores and BPI average scores were highly correlated. Between instruments, the strongest linear correlations were seen between theVAS and the BPI scores (R=-0.59, p< 0.0001, n=206 for the average interference score, R=-0.57, p< 0.0001, n=208 for the average pain severity, v.s. the VAS). Correlations between the IPAQ total score and either VAS or BPI scores were weaker, even when limiting to patients with moderate or high activity and using a log scale given the skewed distribution of the IPAQ summary measure. Discussion/Conclusion: The study demonstrates for the first time a strong correlation between pain and quality of life, and weaker correlation between physical activity and quality of life.
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Introduction: After COVID-19 infection, symptoms last for weeks or months. In this study, it was aimed to examine the relationship between functional status and fatigue and the associated factors in patients with COVID-19. Method(s): Patients with COVID-19 infection who applied to 13 centers were included into the study according to the inclusion criteria. Age, gender, height, body weight, body mass index (BMI), marital status, smoking status and amount, presence, duration of chronic disease, Charlson comorbidity index, regular exercise habit, time of diagnosis with COVID-19, presence of hospitalization,length of hospital stay, intubation status, home oxygen therapy need, participation in PR program, presence of dyspnea, cough, sputum, mMRC score, post-COVID functional status scale, fatigue severity scale, EQ-5D-5L Questionnaire scores were recorded. Result(s): Of the 1095 patients, 603 (55%) were male and 492 (45%) were female. Their mean age was 50+/-14 years. The most common chronic lung disease was COPD (11%), while 266 patients (29%) had non-pulmonary systemic disease. The median time of COVID-19 diagonosis was 5 months ago with 47% hospitalization rate. The median value of post-COVID functional status scale was 1 (0:4), and fatigue severity scale score was 4.4 (1:7). There was a significant correlation between post-COVID functional status and fatigue severity scale (r=0.43, p <0.01). Conclusion(s): Functional status and fatigue were found to be related primarily to quality of life and then patients' age, BMI, presence of chronic and systemic lung disease, regular exercise habits before COVID-19, hospitalization and its duration, home oxygen therapy and symptoms.
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Introduction: The importance of movement iswidely confirmed in people with haemophilia. After the spread of SARS-CoV-2, though, and the subsequent pandemic and lockdown, several haemophilia centres started providing physiotherapy via tele medicine. The role of telerehabilitation in haemophilia patients remains unclear. We, therefore, studied the impact of a physiotherapy course with group sessions via Zoom platform (Zoom Video Communications, Inc.) on a group of severe haemophilia A patients. Method(s): We included patients with severe haemophilia A, who were undergoing prophylaxis with clotting factor concentrates or emicizumab and with at least one target joint;an exclusion criterion was a therapeutic switch during the year. A complete assessment of the patients was performed using the Hemophilia Joint Health Score (HJHS) and the quality-of-life questionnaire EQ-5D-5L before starting the physiotherapy course (T0) and at the end of the one-year-course (T1). During the course year, one exercise session per week was planned, led by a physiotherapist, and corrected by an observer physiotherapist. During the session, warm-up, global muscle strengthening, stretching, proprioception and coordination exercises were carried out. Result(s):We recruited 10 patients aged 29-54 years (mean: 42.6;standard deviation: 9.607). In this group, only two were already doing sports once a week - swim and nordic walking. Only one patient required additional treatment due to a post-fall hematoma on amountain hike. The mean HJHS was 10.8 at T0, decreased to 9.6 at T1. The HJHS-specific items relating to pain, muscle strength and muscle atrophy had all improved, while the parameters relating to joint damage were understandably unchanged. All the patients reported a feeling of well-being at the end of the course, and the mean of the global EQ-5D-5L score in T0 was 81, while at T1 was 85. Discussion/Conclusion: This experience highlights the role of telerehabilitation, an innovative tool that can give access to physical exercise to patients otherwise limited by the geographical distance or by the impossibility of reaching the treatment sites. However, further large studies are needed to fully explore its potential.
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Background: Post-COVID Syndrome (PCS) is an important sequela of COVID-19, characterised by symptom persistence >3 months, subacute symptom onset, and worsening of pre-existing comorbidities. The causes and public health impact of PCS are still unclear, not least for the lack of efficient means to assess the presence and severity of PCS. Method(s): COVIDOM is a population-based cohort study of PCR-confirmed cases of SARS-CoV-2 infection, recruited through local public health authorities in three German regions. Standardised interviews and in-depth onsite examinations were scheduled 6-12 months post infection. Based upon 12 long-term symptom complexes, we developed a comprehensive PCS severity score in a training cohort and validated the score in two independent subcohorts. Result(s): In the training sub-cohort (n=667, 56% female), 90% of participants were treated as outpatients for acute COVID-19. Neurological ailments (61.5%) and fatigue (57.1%) persisted most frequently. Across all sub-cohorts, higher PCS scores were associated with lower health-related quality of life (EQ-5D-5L-VAS/-index, all p<0.001). Similarly, participants with a higher PCS score consistently showed increased blood inflammatory markers and Ddimer as well as lower diffusing capacity in lung function (all p<0.01). Significant early predictors of the PCS score included the number and intensity of acute symptoms, resilience, and general anxiousness. Conclusion(s): PCS severity can be quantified by an easy-to-use score summarising individual disease burden and reflecting pathological processes. The PCS score promises to facilitate diagnosis of PCS, studies of its natural course, and of therapeutic interventions.
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Background Despite robust evidence and national guidance recommending cardiac rehabilitation (CR) for heart failure (HF), access remains poor, a situation magnified by COVID- 19. The Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) randomised controlled trial demonstrated the clinical and cost-effectiveness of a novel home-based CR selfmanagement programme. The SCOT:REACH-HF study was designed to provide the understanding of real-world implementation needed for NHS-wide roll-out in a Scottish context. Aim To 1) compare outcome improvements and delivery costs with those identified in the RCT;and 2) identify facilitators of and barriers to real-world implementation. Methods A mixed-method implementation study of REACHHF delivery across six NHS Scotland areas in 2021-22. Health professionals were trained to facilitate delivery of the 12-week programme. We assessed patient- and caregiverreported outcomes (including health-related quality of life, psychological wellbeing) pre-and post-REACH-HF participation. Primary Outcome: Minnesota Living with Heart Failure Questionnaire (MLHF). 136 adults with reduced ejection fraction HF (HFrEF) were recruited, and 101 completed follow-up. 54 participants nominated caregivers, 26 of whom completed follow- up. Qualitative interviews with 20 key health professionals (primarily REACH-HF facilitators) were subject to thematic analysis to explore barriers to and facilitators of implementation. Fidelity, contextual, and economic data were also collected. Results REACH-HF participation resulted in significant gains in health-related quality of life, as assessed by the MLHF, PROM-CR+, and EQ-5D-5L, and Self-Care of Heart Failure Index (SCHFI). MLHF improvements were both statistically significant and met the minimum clinically important difference in 63% of participants (see figure 1). Interviewees were largely positive about REACH-HF - considering it to have 'filled a gap' when no other CR was available - and key issues to support future roll-out were identified. Conclusion Our findings support the scaled roll-out of REACH-HF. This would offer people with HFrEF, and their families and friends, an accessible alternative to centre-based CR. (Figure Presented).
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Background and Aim: This study aimed to understand the impact of breathlessness on quality of life, productivity loss and healthcare use of Australian adults. Method(s): The National Breathlessness Survey was a nationwide cross-sectional web-based survey in Oct 2019, recruiting Australians aged >=18 years stratified by age-group, gender and state of residence. Severity of breathlessness using the modified Medical Research Council (mMRC) dyspnoea scale (0-5), quality of life (QoL) using EQ-VAS and EQ-5D-5L, and healthcare use (HCU) and productivity loss associated with having a "breathing problem" in the past 12 months were analysed. Quintile regression was conducted to analyse QoL and binary logistic regression for HCU and productivity loss outcomes. Effect sizes were adjusted for age, gender, Indigenous background, self-reported heart and lung disease, high PHQ-4 score, multimorbidity and smoking. Result(s): 10,072 adults completed the survey. The prevalence of clinically important breathlessness (mMRC>=2) was 9.54%. mMRC>=2 was associated with worse QoL, and greater healthcare use and productivity loss compared with mMRC=1 (Table). Despite COVID-19 impacts, similar prevalence (8.15%) and associations were seen in a repeat cross-sectional survey in December 2020 (n=10,024). Conclusion(s): Breathlessness carries a significant burden for patients, the healthcare system, and the economy.
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Abstract Many people report post-COVID-19 symptoms, regardless of the severity of their acute COVID-19 illness (i.e., hospitalized or not). Neurological symptoms are common among patients with post-COVID-19 symptoms, with fatigue as the most prevalent. Our previous studies have shown that people with post-COVID-19 fatigue experience increased perception of fatigue, rather than performance fatigability. In this study we compared symptom severity in people with post-COVID-19 fatigue that were <= (N = 11) or >= (N = 9) 6 months post-COVID-19 infection. Additionally, we assessed the effects four consecutive daily of sessions of 4 mA or sham tDCS over the motor cortex (M1) on perception of fatigue (via the Fatigue Severity Scale (FSS), Fatigue Assessment Scale (FAS), and the EQ-5D-5L Visual Analog Scale for Health (EQ-5D-5L VAS)). The subjects that were <= 6 months post initial infection reported higher FSS (<= 6 months: 5.37, >= 6 months: 4.01, p < 0.01), FAS (<= 6 months: 32.18, >= 6 months: 23.78, p < 0.01), and lower VAS scores (<= 6 months: 64.00, >= 6 months: 77.78, p = 0.04) than subjects >= 6 months post initial infection. Moreover, the subjects that were <= 6 months post-infection and received 4 mA tDCS reported significantly decreased FSS (pre: 5.46, post: 4.86, p = 0.01), FAS (pre: 32.14, post: 27.57, p = 0.03), and significantly increased VAS scores (pre: 64.86, post: 75.92, p = 0.03). There were no significant differences in the other groups (<= 6 months/sham, >= 6 months/sham, >= 6 months/4 mA tDCS;all p >= 0.051). Our data suggest that post-COVID-19 symptoms are most severe within 6 months post-COVID-19 infection and that 4 mA tDCS over M1 may decrease perceived fatigability in people with post-COVID-19 fatigue that are less than 6 months post-COVID-19 infection. Research Category and Technology and Methods Clinical Research: 9. Transcranial Direct Current Stimulation (tDCS) Keywords: Fatigue, Post COVID-19, Motor Cortex, SymptomsCopyright © 2023
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Background. Post-COVID-19 alterations have been recognized even after mild disease. We aimed to assess which factors are the main contributors to a decrease in quality of life(QOL) of patients with different times elapsed from the COVID-19 diagnosis. Methods. A cross-sectional study from January 2021 to April 2021 in a Referral Center in Mexico City. Patients were invited for a follow-up visit in which a structured questionnaire about symptoms, the EQ-5D-5L QOL for QOL, and an objective olfactory evaluation with The Sniffin' Sticks Screening 12 test. Results. We included 179 patients, 64% were female with a median age of 33 years. The median time since COVID-19 diagnosis until the evaluation was 219 days (IQR, 94-255). Persistent symptoms were present up to in 158/179 (88%), fatigue, pain/discomfort and cognitive alterations were present in 61%, the median EQ-5D-5L index value preCOVID-19 was 1 (IQR, 0.94-1) and post- COVID-19 was 0.87 (IQR, 0.80-0.94), P< 0.001. There were 101/179 (56%) patients with decreased QOL;In the multivariate analysis, post-COVID-19 pain (aOR, 2.5;P= 0.01), anxiety (aOR, 13;P= 0.03), and the persistence of three or more symptoms (aOR, 2.6;P= 0.05) were factors associated with decreased QOL. Conclusion. Within the post- COVID-19 alterations, psychological and physical factors such as Pain/discomfort, anxiety, and persistent symptoms explained the decreased QOL in the post-COVID-19 patient. These alterations were present as early as 30 days to more than eight months.
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Background. The objective of this study was to characterize frailty and resilience in people evaluated for Post-Acute COVID-19 Syndrome (PACS), in relation to quality of life (QoL) and Intrinsic Capacity (IC). Methods. This cross-sectional, observational, study included consecutive people previously hospitalized for severe COVID-19 pneumonia attending Modena (Italy) PACS Clinic from July 2020 to April 2021. Four frailty-resilience phenotypes were built: 'fit/resilient', 'fit/non-resilient', 'frail/resilient' and 'frail/non-resilient'. Frailty and resilience were defined according to frailty phenotype and Connor Davidson resilience scale (CD-RISC-25) respectively. Study outcomes were: QoL assessed by means of Symptoms Short form health survey (SF-36) and health-related quality of life (EQ-5D-5L) and IC by means of a dedicated questionnaire. Their predictors including frailty-resilience phenotypes were explored in logistic regressions. Results. 232 patients were evaluated, median age was 58.0 years. PACS was diagnosed in 173 (74.6%) patients. Scarce resilience was documented in 114 (49.1%) and frailty in 72 (31.0%) individuals. Table 1 shows demographic, anthropometric and clinical characteristics, comorbidities and patient-reported outcomes according to four frailty-resilience phenotypes. With regards to study outcomes, Figure 1 depicts in radar graphs, mean scores of each domain of SF-36 (1A), EQ-5D5L (1B) and IC (1C). Figures shows polygon areas for each frailty/resilience phenotypes. Progressive increase of mean scores of each domain are plotted in the vertices of polygons, from the lowest (near the center) in frail and non-resilient, to highest (towards periphery) in fit and resilient. Multivariate logistic analyses were used to identify predictors of the total scores of SF-36 (Figure 2A), EQ-5D5L (Figure 2B) and IC (Figure 2C). Conclusion. Resilience is complementary to frailty in the identification of clinical phenotypes with different impact on wellness and QoL. Frailty and resilience should be evaluated in hospitalized COVID-19 patients to identify vulnerable individuals to prioritize urgent health interventions in people with PACS. Funding. This study is supported by a Gilead Sciences Inc. unrestricted grant.
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Objectives: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), as a poorly understood, serious, complex, multisystem disorder, remains relevant and its coverage has increased due to COVID-19 pandemic. Based on the earlier studies on other infections, researchers suggested that 10% of COVID-19 survivors could develop ME/CFS. Prevalence is expanding rapidly, but effective treatments are still being sought. In these circumstances, it is worth considering an integrative approach and attracting additional efforts to improve patients' health. The aim of this research was dedicated to evaluating the coaching potential in healthcare of ME/CFS and persistent-post-COVID-19 syndrome (PPCS) patients, by using a case studies approach, at a primary healthcare institution in Latvia. Method(s): The coaching sessions for two ME/CFS and two PPCS patients were carried out from March to May 2022. The sessions were performed by a certified coach of the Erickson Coaching International. The patient's Health-related quality of life (HRQoL) was assessed using the EuroQol-5D-5L measure, as well as the overall health status - by the Visual Analogue Scale (VAS) for the time prior to the onset of illness, for the state before coaching sessions and after a one-month period of coaching. Descriptive and analytical statistical methods were used for the analysis of the obtained data. Result(s): After the coaching period, all patients demonstrated an improvement in overall health status: ME/CFS patients - by 30% each, one PPCS patient - by 20%, and another patient - by 10%. The HRQoL reported by EuroQol-5D-5L demonstrated improvement in all domains, with a stronger impact on pain/discomfort and anxiety/depression reduction;moderate enhancement in mobility and usual activities;and less improvement - in self-care ability (self-care ability was reported as less affected by illness). Conclusion(s): The case studies performed in the framework of Research project No. lzp-2019/1-0380, demonstrated the potential of an integrative approach to improving healthcare outcomes for ME/CFS and PPCS patients. Copyright © 2022
ABSTRACT
Aims: The novel Coronavirus (COVID-19) has continued to present a significant burden to global public health. Although many individuals fully recover, some continue to experience long-term complications, known as post-acute sequelae of SARS CoV-2 infection, or long COVID. The purpose of this study was to estimate the health-related quality of life, disability, and health status of individuals with selfreported long COVID at various lengths of recovery. Method(s): We conducted a cross-sectional online survey of individuals with selfreported long COVID. Participants were recruited from social media platforms (e.g., Reddit, Facebook) with dedicated groups to long COVID. Participants were asked to complete the five-item EuroQOL EQ-5D-5L and EQ visual analog scale (VAS), the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 and the 10-item Patient Reported Outcome Measurement Information System (PROMIS) Global Health v1.2 short form. We also collected demographic and clinical characteristics of respondents, including time since COVID-19 infection. Descriptive statistics characterized the instrument responses. Comparisons across demographic and clinical strata were made using Mann-Whitney U or Kruskal-Wallis tests, as appropriate. Data were analyzed in SAS v9.4 (SAS Institute, Cary, NC). The University of Utah institutional review board (IRB) reviewed and deemed this research exempt. Result(s): Eighty-two participants from 13 countries completed the EQ-5D-5L, 73 completed the WHODAS 2.0 and 80 participants completed the PROMIS. The mean EQ-5D-5L utility score was 0.51. The mean WHODAS scores were 49.0. In the previous 30 days, participants reported their symptoms affected them for a mean of 24 days, they were unable to carry out usual activities for 15 days, and they cut back or reduced activities for 26 days. The mean PROMIS physical health and mental health scores were 10.7 and 8.6, respectively, corresponding to belowaverage health. Stratified by time intervals, utility scores were highest in the first 6 months and lowest in the 13-18 month timeframe, although these differences were not statistically different. Similar trends were seen with disability scores. Conclusion(s): Long COVID presents a significant chronic health burden to adults in the US and abroad. Clinical awareness of the health impacts will help patients access the resources needed to manage their symptoms and promote recovery.
ABSTRACT
Aims: For cancer patients with oligo metastatic disease (OMD), defined as five metastases or less, a more aggressive treatment approach has been suggested. In SOFT, an international multicenter phase II trial, patients with OMD and infra-diaphragmatic soft tissue metastases were treated with online MR-guided stereotactic ablative radiotherapy (SABR). To better identify early adverse events related to SABR, longitudinal collection of electronic patient-reported outcomes (ePROs) were included. As this is a short-course treatment in an elderly population our aim was to report the feasibility of continuous ePRO for the first 100 patients. Method(s): Patients were enrolled at four sites;Herlev Hospital, Rigshospitalet, Odense University Hospital in Denmark, and Henry Ford Hospital, Detroit. They were allocated to 3-8 radiotherapy fractions depending on target site and dose to organs at risk. Early toxicity was measured with eight symptomatic AEs from the PRO-CTCAE item library and quality of life with the EUROqol EQ-5D-5L at pre-specified time points (Fig. 1). A link to the ePRO system (REDCap) was sent out electronically. In case of no computer access, a paper version was provided. The invitation was re-send after 2 days. No back-up call was provided. Result(s): The first 100 patients having reached a 24-week follow-up evaluation were included in the analysis. Five patients had a second enrollment (105 enrollments) and 19 had more than one target. The median age was 70 years. The majority were men (67%) and had oligo metastatic recurrence (54%) (Table 1).The consent rate for ePRO completion was 87% (91 electronic/13 paper/1 declined). For an elderly population with metastatic cancer, the overall adherence level to PRO completion was high (88%) and the high level remained until week 24 (retention rate 91%) (Fig. 2). Only 44% of the paper questionnaires were completed week 24. This may partly be due to in-person visits being changed to telephone consults during COVID-19. Four patients (4%) reported technical difficulties. Conclusion(s): Collecting ePROs among elderly cancer patients with OMD having short-course radiotherapy is feasible. All but one patient completed PROs with the majority doing electronic reporting. Overall, adherence was high except for patients completing paper-based PROs.