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1.
J Int Med Res ; 50(9): 3000605221126657, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2053627

ABSTRACT

OBJECTIVE: To investigate the correlations between clinical, functional, and radiological outcomes in inpatients with coronavirus disease 2019 (COVID-19). METHODS: In this observational study, we recruited inpatients affected by moderate COVID-19 disease. The clinical evaluation comprised the Cumulative Illness Rating Scale (CIRS), numerical rating scale (NRS), modified Rankin scale (mRS), and the modified Borg dyspnea scale (mBDS). Respiratory involvement was assessed with computed tomography (CT) and graded with a CT-severity score (CT-SS). We retrospectively assessed functioning using the International Classification of Functioning, Disability and Health (ICF) codes of the Clinical Functioning Information Tool (ClinFIT) COVID-19 in the acute phase. Correlation analysis was performed 1) between clinical, instrumental, and functional parameters and 2) between ICF categories. RESULTS: The data showed statistically significant moderate correlations between CT-SS and the following categories: b152 "emotional functions" and b440 "respiratory functions". CONCLUSION: This is the first study to use the ICF framework in people with a moderate form of COVID-19 in the acute phase. Considering the correlations between some ICF categories and radiological findings, our results support the use of the ClinFIT COVID-19 for a comprehensive assessment of COVID-19 patients.


Subject(s)
COVID-19 , International Classification of Functioning, Disability and Health , Activities of Daily Living , Disability Evaluation , Humans , Inpatients , Retrospective Studies
2.
Eur Spine J ; 31(11): 2844-2850, 2022 11.
Article in English | MEDLINE | ID: covidwho-2035075

ABSTRACT

PURPOSE: Lockdown measures to combat the COVID-19 pandemic restricted social interactions and travel. This retrospective, observational study was conducted to evaluate the effect of lockdown restrictions on Oswestry Disability Index (ODI) scores in patients with spinal conditions. METHODS: Prospectively collected data from the British Spine Registry were retrospectively analysed in two groups. The study group included patients' baseline pre-operative ODI scores collected during the first national lockdown in the UK between March and May 2020. The reference group included ODI scores recorded during the same period in 2019, before the pandemic. Scores were compared between groups using the Mann-Whitney U test. We also calculated modified scores that omitted responses to questions related to travel and social life. These were compared using Wilcoxon matched-pairs signed-rank test and Bland-Altman analyses. RESULTS: The median ODI scores for the reference and lockdown groups were 49 and 45, respectively, with no significant differences in the mean ranks (p = 0.068). Comparisons of original and modified ODI scores showed different outcomes for each study group. No significant differences were observed in the lockdown group (p = 0.06). However, for the pre-COVID-19 reference group, there was a significant difference (p < 0.01). Bland-Altman analyses showed reasonable agreement between the methods for calculating ODI in both groups. CONCLUSION: We found no clinically important differences in ODI scores between the two groups. The findings suggest that the ODI is reliable during lockdown situations and can be used with confidence in the future research using both retrospective and prospective data. LEVEL OF EVIDENCE: Level 3.


Subject(s)
COVID-19 , Disability Evaluation , Humans , Cross-Sectional Studies , Retrospective Studies , COVID-19/prevention & control , Pain Measurement , Prospective Studies , Pandemics , Treatment Outcome , Communicable Disease Control , Lumbar Vertebrae/surgery
3.
Sci Rep ; 12(1): 14163, 2022 08 19.
Article in English | MEDLINE | ID: covidwho-2000931

ABSTRACT

The present study aimed to determine the magnitude of and risk factors for the effects of the COVID-19 pandemic on the international classification of functioning, disability and health (ICF) in patients with multiple system atrophy (PwMSA). The study was part of a cross-sectional, nationwide, multipurpose mail survey for Japanese PwMSA from October to December, 2020. The primary outcome was the impact of the early COVID-19 pandemic on ICF functioning, consisting of body function, activity, and participation. Age, sex, disease type, disease duration, and dwelling place were asked as participants' characteristics, and the multiple system impairment questionnaire (MSIQ), patient health questionnaire-2, modified rankin scale, barthel index, life-space assessment (LSA), and EuroQoL were examined. Multivariate logistic regression analyses were performed to identify independent risk factors for a worse function score due to the COVID-19 pandemic for each ICF functioning domain. A total of 155 patients (mean age 65.6 [SD 8.1] years; 43.9% women; mean disease duration 8.0 [SD 6.2] years; 65% MSA with cerebellar ataxia, 13% MSA with parkinsonism, 9% MSA with predominant autonomic features) were analyzed. Of the ICF functioning domains, the respondents reported that the early COVID-19 pandemic affected body function in 17.4%, activity in 17.6%, and participation in 46.0%. The adjusted multivariate model identified MSIQ and LSA as the two variables that independently contributed to all domains. The COVID-19 pandemic affected ICF functioning of PwMSA in Japan, and the severity of disease-related impairments and a large daily living space were common risk factors. These results help support the focus on patient characteristics for medical and social welfare support.


Subject(s)
COVID-19 , Multiple System Atrophy , Activities of Daily Living , Aged , COVID-19/epidemiology , Cross-Sectional Studies , Disability Evaluation , Female , Humans , International Classification of Functioning, Disability and Health , Japan/epidemiology , Male , Multiple System Atrophy/epidemiology , Pandemics
4.
Int J Environ Res Public Health ; 19(15)2022 07 27.
Article in English | MEDLINE | ID: covidwho-1994048

ABSTRACT

Elbow musculoskeletal pain (EP) is a major cause of disability. Telerehabilitation has shown great potential in mitigating musculoskeletal pain conditions, but EP is less explored. This single-arm interventional study investigates clinical outcomes and engagement levels of a completely remote multimodal digital care program (DCP) in patients with EP. The DCP consisted of exercise, education, and cognitive-behavioral therapy for 8 weeks. Primary outcome: disability change (through the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), treatment response cut-offs: 12.0-point reduction and 30% change). Secondary outcomes: pain, analgesic intake, surgery intent, mental health, fear-avoidance beliefs, work productivity, and patient engagement. Of the 132 individuals that started the DCP, 112 (84.8%) completed the intervention. Significant improvements were observed in QuickDASH with an average reduction of 48.7% (11.9, 95% CI 9.8; 14.0), with 75.3% of participants reporting ≥30% change and 47.7% reporting ≥12.0 points. Disability change was accompanied by reductions in pain (53.1%), surgery intent (57.5%), anxiety (59.8%), depression (68.9%), fear-avoidance beliefs (34.2%), and productivity impairment (72.3%). Engagement (3.5 (SD 1.4) sessions per week) and satisfaction 8.5/10 (SD 1.6) were high. The significant improvement observed in clinical outcomes, alongside high engagement, and satisfaction suggests patient acceptance of this care delivery mode.


Subject(s)
Musculoskeletal Pain , Arthralgia , Cohort Studies , Disability Evaluation , Elbow , Humans , Longitudinal Studies , Musculoskeletal Pain/psychology , Musculoskeletal Pain/therapy , Prospective Studies , Surveys and Questionnaires
5.
Disabil Health J ; 15(3): 101318, 2022 07.
Article in English | MEDLINE | ID: covidwho-1982913

ABSTRACT

BACKGROUND: This international, multi-center cross-sectional study is one of the preparatory studies in the development of the International Classification of Functioning, Disability and Health (ICF) Core Sets for adults with cerebral palsy (CP) to describe their functioning and health. OBJECTIVE: To identify the most common problems in functioning of adults with CP presenting in healthcare services, and facilitating and hindering environmental factors, using the ICF as a reference. METHODS: Participants were adults with CP who visited healthcare services in the Netherlands, Sweden, Thailand, and the United States. Structured interviews were performed using an adapted version of the generic ICF checklist 2.1a (106 categories) to rate the participant's functioning and the impact of environmental factors. Descriptive statistics were used for frequency analysis. RESULTS: In total, 101 participants were included, of whom 69 without intellectual disability (mean age ± SD of 38.4 ± 14.7 y; 85.5% with spastic type of CP; Gross Motor Function Classification System (GMFCS) levels I-V) and 32 with intellectual disability (mean age ± SD of 25.0 ± 6.4 y; 71.9% with spastic type of CP; GMFCS levels I-V). A total of 104 ICF categories in the ICF checklist were frequently present in adults with CP: 27 body functions, 4 body structures, 53 activities and participation, and 20 environmental factors. CONCLUSIONS: The most common problems of adults with CP presenting in healthcare services are diverse and highly prevalent. The study results add the clinical perspective on relevant categories of functioning to the basis for developing the ICF Core Sets for adults with CP.


Subject(s)
Cerebral Palsy , Disabled Persons , Intellectual Disability , Activities of Daily Living , Adult , Cross-Sectional Studies , Disability Evaluation , Humans , International Classification of Functioning, Disability and Health , Muscle Spasticity
6.
Spinal Cord ; 60(10): 875-881, 2022 10.
Article in English | MEDLINE | ID: covidwho-1815518

ABSTRACT

STUDY DESIGN: A cross-sectional design. OBJECTIVES: To investigate rater reliability of the Spinal Cord Independence Measure or SCIM III among rehabilitation professionals, along with the concurrent validity of the tool as compared to standard measures covering wheelchair users (WU) and ambulatory (AM) individuals with spinal cord injury (SCI). SETTING: A tertiary rehabilitation center and communities. METHODS: Eighty-two participants with SCI (39 WU and 43 AM individuals) were assessed using SCIM III items. The data of first 30 participants were video recorded for rater reliability assessments by seven rehabilitation professionals, including nurses, occupational therapists, and physical therapists (one novice and one experienced rater for each professional). All participants were also assessed using standard measures to verify concurrent validity of SCIM III by an experienced rater. RESULTS: The SCIM III showed excellent intra-rater and inter-rater reliability among rehabilitation professionals when analyzed for overall items (intraclass correlation coefficient (ICC) >0.90) and separately for each subscale (kappa values >0.80). The total SCIM III of WU and the mobility scores of AM participants showed significant correlation with standard measures for muscle strength, limit of stability, balance control, functional endurance, and walking ability (rs = 0.343-0.779; p < 0.05). CONCLUSIONS: The present findings extend clinical benefit and confirm the use of SCIM III interchangeably among rehabilitation professionals after they have been adequately trained. The findings are important for community-based rehabilitation and home healthcare services, especially during the coronavirus (COVID-19) pandemic, when hospital beds and in-patient services are limited for individuals with SCI.


Subject(s)
COVID-19 , Spinal Cord Injuries , Cross-Sectional Studies , Disability Evaluation , Humans , Reproducibility of Results , Spinal Cord Injuries/rehabilitation
7.
Int J Environ Res Public Health ; 19(5)2022 02 26.
Article in English | MEDLINE | ID: covidwho-1736904

ABSTRACT

The International Classification of Functioning, Disability, and Health (ICF) of the World Health Organization (WHO) was established as an international framework for monitoring rehabilitation outcomes and the impacts of health interventions since, as the term "functioning" implies, it emphasizes a person's "lived health" in addition to their biological health status. Equine-assisted therapy (EAT) represents a holistic intervention approach that aims to improve both biomedical functioning and the patient's lived health in relation to performing activities and participating in social situations. In this study, the psychometric properties of an ICF-based digital assessment tool for the measurement of the rehabilitation impacts of EAT were analyzed via simultaneous confirmatory factor analyses (CFA) and reliability and sensitivity tests. In total, 265 patients from equine-assisted therapy centers in Germany were included for CFA. Change sensitivity was assessed via multi-level analyses based on 876 repeated assessments by 30 therapists. Results show satisfactory model-fit statistics; McDonald's omega (ML) showed excellent scores for the total scale (ω = 0.96) and three subscales (ω = 0.95; ω = 0.95, ω = 0.93). The tool proved itself to be change sensitive and reliable (change sensitivity p ≤ 0.001), retest r = 0.745 **, p ≤ 0.001). Overall, the developed assessment tool satisfactorily fulfills psychometric requirements and can be applied in therapeutic practice.


Subject(s)
Disabled Persons , Equine-Assisted Therapy , Animals , Disability Evaluation , Disabled Persons/rehabilitation , Factor Analysis, Statistical , Horses , Humans , International Classification of Functioning, Disability and Health , Reproducibility of Results
8.
BMJ Open ; 12(3): e060826, 2022 03 07.
Article in English | MEDLINE | ID: covidwho-1731283

ABSTRACT

INTRODUCTION: As the prevalence of Long COVID increases, there is a critical need for a comprehensive assessment of disability. Our aims are to: (1) characterise disability experiences among people living with Long COVID in Canada, UK, USA and Ireland; and (2) develop a patient-reported outcome measure to assess the presence, severity and episodic nature of disability with Long COVID. METHODS AND ANALYSIS: In phase 1, we will conduct semistructured interviews with adults living with Long COVID to explore experiences of disability (dimensions, uncertainty, trajectories, influencing contextual factors) and establish an episodic disability (ED) framework in the context of Long COVID (n~10 each country). Using the conceptual framework, we will establish the Long COVID Episodic Disability Questionnaire (EDQ). In phase 2, we will examine the validity (construct, structural) and reliability (internal consistency, test-retest) of the EDQ for use in Long COVID. We will electronically administer the EDQ and four health status criterion measures with adults living with Long COVID, and readminister the EDQ 1 week later (n~170 each country). We will use Rasch analysis to refine the EDQ, and confirm structural and cross-cultural validity. We will calculate Cronbach's alphas (internal consistency reliability), and intraclass correlation coefficients (test-retest reliability), and examine correlations for hypotheses theorising relationships between EDQ and criterion measure scores (construct validity). Using phase 2 data, we will characterise the profile of disability using structural equation modelling techniques to examine relationships between dimensions of disability and the influence of intrinsic and extrinsic contextual factors. This research involves an academic-clinical-community partnership building on foundational work in ED measurement, Long COVID and rehabilitation. ETHICS AND DISSEMINATION: This study was approved by the University of Toronto Research Ethics Board. Knowledge translation will occur with community collaborators in the form of presentations and publications in open access peer-reviewed journals and presentations.


Subject(s)
COVID-19 , HIV Infections , Adult , COVID-19/complications , Concept Formation , Disability Evaluation , HIV Infections/rehabilitation , Humans , Psychometrics/methods , Reproducibility of Results , SARS-CoV-2 , Surveys and Questionnaires
9.
Rev Neurol ; 74(5): 156-162, 2022 03 01.
Article in Spanish | MEDLINE | ID: covidwho-1716464

ABSTRACT

INTRODUCTION: Patients who have suffered a chronic cerebrovascular accident or a stroke need long-term physiotherapy treatments. However, they have had to be stopped due to the COVID-19 pandemic. To be able to offer these patients an online functional assessment, a proposal was put forward to design an adaptation of the Spanish version of the Fugl Meyer assessment scale and to test its viability. PATIENTS AND METHODS: The adapted online scale, based on the Fugl Meyer assessment scale. The motor function, balance and pain domains were kept, and items requiring assistance for the patient were removed. This scale was administered to 13 patients with a chronic cerebrovascular accident from the Salamanca Acquired Brain Injury Association (Asociacion de Dano Cerebral Adquirido) via different web platforms. The procedure followed was the same as for the original scale and lasted from 30 to 45 minutes. RESULTS: All the patients completed the Fugl Meyer assessment scale, online version. The greatest difficulty was encountered in the assessment of the lower limbs. Patients and physiotherapists highlighted how easy it was to complete the items in the scale. On comparing the versions, statistically significant positive correlations were found with the original version (p < 0.001) and the correlation coefficients indicated a strong association. The difference between the equivalent sections of the scale in each instrument was no greater than 5%, except for balance. CONCLUSION: The Fugl Meyer assessment scale, online version, is a feasible, useful and easy to apply scale that allows assessment of the functional status of stroke patients and can help meet the current needs during the COVID-19 pandemic.


TITLE: Adaptación y viabilidad de la versión telemática de la escala Fugl Meyer para la evaluación de pacientes tras accidentes cerebrovasculares.Introducción. Los pacientes que han sufrido un accidente cerebrovascular crónico o un ictus necesitan tratamientos de fisioterapia a largo plazo. Sin embargo, la pandemia de COVID-19 ha obligado a detenerlos. Con el objetivo de poder ofrecer una evaluación funcional de forma telemática a estos pacientes, se propuso diseñar una adaptación de la escala de evaluación Fugl Meyer-versión española y comprobar su viabilidad. Pacientes y métodos. Escala telemática adaptada, basada en la escala de evaluación Fugl Meyer. Se mantuvieron los dominios de función motora, equilibrio y dolor, y se eliminaron ítems que requerían ayuda para el paciente. Dicha escala se administró a 14 pacientes con accidente cerebrovascular crónico de la Asociación de Daño Cerebral Adquirido de Salamanca, a través de diferentes plataformas web, siguiendo el mismo procedimiento que la escala original y con una duración de 30 a 45 minutos. Resultados. Todos los pacientes completaron la escala de evaluación Fugl Meyer-versión telemática. La mayor dificultad se encontró para la evaluación de las extremidades inferiores. Los pacientes y los fisioterapeutas destacaron la facilidad de realización de los ítems de la escala. Al comparar las versiones se encontraron correlaciones positivas estadísticamente significativas con la versión original (p menor de 0,001) y los coeficientes de correlación indicaron una fuerte asociación. La diferencia entre las secciones de la escala equivalentes en cada instrumento no fue mayor que el 5%, excepto en el equilibrio. Conclusión. La escala de evaluación Fugl Meyer-versión telemática, es una escala viable, útil y fácil de aplicar que permite la evaluación del estado funcional de los pacientes con ictus y que puede responder a las necesidades actuales durante la pandemia de COVID-19.


Subject(s)
Disability Evaluation , Stroke/diagnosis , Telemedicine , Adult , Aged , Aged, 80 and over , COVID-19 , Feasibility Studies , Female , Humans , Male , Middle Aged
10.
Int J Environ Res Public Health ; 19(3)2022 01 27.
Article in English | MEDLINE | ID: covidwho-1686735

ABSTRACT

The Back Pain and Body Posture Evaluation Instrument (BackPEI) was created in 2013 to assess back pain and its risk factors in school children. However, it does not assess neck pain or the habits of mobile device usage, which are aspects that are often part of school children's lives. Therefore, we aimed to update the BackPEI questionnaire to include new questions assessing aspects related to neck pain and the use of mobile devices and to test the content validity and reliability of the new questions. The updated questionnaire was named Back Pain and Body Posture Evaluation Instrument for Children and Adolescents (BackPEI-CA). The content was validated by eight experts using the content validity index (CVI). To assess reliability, the BackPEI-CA questionnaire was applied at two different times in 105 school children, and Cohen's kappa (k) and intraclass correlation coefficient (ICC) were calculated. All aspects assessed regarding content validity had a CVI higher than 0.8. The new questions presented moderate and good kappa values and excellent ICC values. The updated version of BackPEI-CA can be used as a clinic tool for assessing the presence, frequency, and intensity of back and neck pain and their risk factors.


Subject(s)
Back Pain , Posture , Adolescent , Child , Disability Evaluation , Humans , Psychometrics , Reproducibility of Results , Risk Factors , Surveys and Questionnaires
11.
Neurol Sci ; 43(2): 1007-1014, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1669827

ABSTRACT

OBJECTIVES: To evaluate the concordance between Google Maps® application (GM®) and clinical practice measurements of ambulatory function (e.g., Ambulation Score (AS) and respective Expanded Disability Status Scale (EDSS)) in people with multiple sclerosis (pwMS). MATERIALS AND METHODS: This is a cross-sectional multicenter study. AS and EDSS were calculated using GM® and routine clinical methods; the correspondence between the two methods was assessed. A multinomial logistic model is investigated which demographic (age, sex) and clinical features (e.g., disease subtype, fatigue, depression) might have influenced discrepancies between the two methods. RESULTS: Two hundred forty-three pwMS were included; discrepancies in AS and in EDDS assessments between GM® and routine clinical methods were found in 81/243 (33.3%) and 74/243 (30.4%) pwMS, respectively. Progressive phenotype (odds ratio [OR] = 2.8; 95% confidence interval [CI] 1.1-7.11, p = 0.03), worse fatigue (OR = 1.03; 95% CI 1.01-1.06, p = 0.01), and more severe depression (OR = 1.1; 95% CI 1.04-1.17, p = 0.002) were associated with discrepancies between GM® and routine clinical scoring. CONCLUSION: GM® could easily be used in a real-life clinical setting to calculate the AS and the related EDSS scores. GM® should be considered for validation in further clinical studies.


Subject(s)
Multiple Sclerosis , Search Engine , Cross-Sectional Studies , Disability Evaluation , Fatigue/diagnosis , Fatigue/epidemiology , Humans , Multiple Sclerosis/diagnosis
12.
Ann Med ; 54(1): 235-243, 2022 12.
Article in English | MEDLINE | ID: covidwho-1625511

ABSTRACT

PURPOSE: To address the feasibility, reliability and internal validity of natural language processing (NLP) for automated functional assessment of hospitalised COVID-19 patients in key International Classification of Functioning, Disability and Health (ICF) categories and levels from unstructured text in electronic health records (EHR) from a large teaching hospital. MATERIALS AND METHODS: Eight human annotators assigned four ICF categories to relevant sentences: Emotional functions, Exercise tolerance, Walking and Moving, Work and Employment and their ICF levels (Functional Ambulation Categories for Walking and Moving, metabolic equivalents for Exercise tolerance). A linguistic neural network-based model was trained on 80% of the annotated sentences; inter-annotator agreement (IAA, Cohen's kappa), a weighted score of precision and recall (F1) and RMSE for level detection were assessed for the remaining 20%. RESULTS: In total 4112 sentences of non-COVID-19 and 1061 of COVID-19 patients were annotated. Average IAA was 0.81; F1 scores were 0.7 for Walking and Moving and Emotional functions; RMSE for Walking and Moving (5- level scale) was 1.17 for COVID-19 patients. CONCLUSION: Using a limited amount of annotated EHR sentences, a proof-of-concept was obtained for automated functional assessment of COVID-19 patients in ICF categories and levels. This allows for instantaneous assessment of the functional consequences of new diseases like COVID-19 for large numbers of patients.Key messagesHospitalised Covid-19 survivors may persistently suffer from low physical and mental functioning and a reduction in overall quality of life requiring appropriate and personalised rehabilitation strategies.For this, assessment of functioning within multiple domains and categories of the International Classification of Function is required, which is cumbersome using structured data.We show a proof-of-concept using Natural Language Processing techniques to automatically derive the aforementioned information from free-text notes within the Electronic Health Record of a large academic teaching hospital.


Subject(s)
COVID-19 , Electronic Health Records , Disability Evaluation , Humans , Natural Language Processing , Quality of Life , Reproducibility of Results , SARS-CoV-2
13.
Neurol Sci ; 43(4): 2253-2261, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1623263

ABSTRACT

BACKGROUND: Evidence of the cost-effectiveness of telemedicine (TM) for the management of Multiple Sclerosis (MS) has been provided recently. However, some doubts persist about the accuracy of neurological examinations performed remotely. OBJECTIVES: This study investigated the reliability of neurological evaluations performed through TM in mild MS patients as compared with standard in-person visits. METHODS: In total, 76 patients with relapsing-remitting MS and Expanded Disability Status Scale (EDSS) ≤ 3.5 were consecutively recruited. Of them, 40 patients (52.6%) accepted to undergo both in-person and TM evaluations with independent examiners within 48 h. We alternatively asked patients to assure or not the presence of a caregiver during TM visits. A satisfaction questionnaire was administered to all participants. RESULTS: The inter-rater agreement attributed by two independent neurologists during TM visit was high (κ > 0.80) for EDSS and Functional Systems (FS) scores. Moderate agreement between TM and in-person evaluations emerged for pyramidal (κ = 0.57; p < 0.001), brainstem (κ = 0.57; p < 0.001), bowel and bladder (κ = 0.54; p < 0.001) and sensory (κ = 0.51; p < 0.001) FS scores, higher in patients providing the support of a caregiver. A good reliability was reported for EDSS scores computed during remote and in-person visits (ICC = 0.83; 95% CI 0.70-0.91; p < 0.001). CONCLUSIONS: Despite the complexity of neurological examination, TM could be useful in monitoring MS patients with low disability.


Subject(s)
COVID-19 , Multiple Sclerosis, Relapsing-Remitting , Multiple Sclerosis , Disability Evaluation , Humans , Multiple Sclerosis/diagnosis , Multiple Sclerosis, Relapsing-Remitting/diagnosis , Reproducibility of Results , SARS-CoV-2
14.
J Med Virol ; 94(4): 1419-1427, 2022 04.
Article in English | MEDLINE | ID: covidwho-1527442

ABSTRACT

There is currently limited information on clinical severity phenotypes of symptoms and functional disability in post-coronavirus disease 2019 (COVID) Syndrome (PCS). A purposive sample of 370 PCS patients from a dedicated community COVID-19 rehabilitation service was assessed using the COVID-19 Yorkshire Rehabilitation Scale where each symptom or functional difficulty was scored on a 0-10 Likert scale and also compared with before infection. Phenotypes based on symptom severity were extracted to identify any noticeable patterns. The correlation between symptom severity, functional disability, and overall health was explored. The mean age was 47 years, with 237 (64%) females. The median duration of symptoms was 211 days (interquartile range 143-353). Symptoms and functional difficulties increased substantially when compared to before infection. Three distinct severity phenotypes of mild (n = 90), moderate (n = 186), and severe (n = 94) were identified where the severity of individual symptoms was of similar severity within each phenotype. Symptom scores were strongly positively correlated with functional difficulty scores (0.7, 0.6-0.7) and moderately negatively correlated with overall health (-0.4, -0.3, to -0.5). This is the first study reporting on severity phenotypes in a largely nonhospitalized PCS cohort. Severity phenotypes might help stratify patients for targeted interventions and planning of care pathways.


Subject(s)
COVID-19/rehabilitation , Community Health Services/organization & administration , Critical Pathways/organization & administration , SARS-CoV-2 , Adult , Aged , Community Health Services/methods , Cross-Sectional Studies , Disability Evaluation , Female , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Phenotype , Severity of Illness Index
15.
AIDS Res Ther ; 18(1): 87, 2021 11 19.
Article in English | MEDLINE | ID: covidwho-1526645

ABSTRACT

BACKGROUND: Events associated with the COVID-19 pandemic, such as physical distancing, closure of community services, postponement of health appointments, and loss of employment can lead to social isolation, financial uncertainty, and interruption of antiretroviral adherence, resulting in additional health-related challenges (disability) experienced among adults living with chronic illness such as HIV. 'Living strategies' is a concept derived from the perspectives of people living with HIV, defined as behaviors, attitudes and beliefs adopted by people living with HIV to help deal with disability associated with HIV and multi-morbidity. Our aim was to describe disability among adults living with HIV and self-care living strategies used during the COVID-19 pandemic. METHODS: Adults living with HIV in Toronto, Ontario, Canada, including some with pre-pandemic HIV Disability Questionnaire (HDQ) data, completed a cross-sectional web-based survey between June-August 2020. The survey included the HDQ and questions about self-care living strategy use during the pandemic. We compared disability (HDQ) scores prior to versus during the pandemic using paired t-tests. We reported the proportion of participants who engaged in various living strategies at least 'a few times a week' or 'everyday' during the pandemic. RESULTS: Of the 63 respondents, 84% were men, median age 57 years, and 62% lived alone. During the pandemic the greatest disability severity was in the uncertainty [median 30; Interquartile range (IQR): 16, 43] and mental-emotional (25; IQR: 14, 41) domains. Among the 51 participants with pre-pandemic data, HDQ severity scores were significantly greater (worse) during the pandemic (vs prior) in all domains. Greatest change from prior to during the pandemic was in the mental-emotional domain for presence (17.7; p < 0.001), severity (11.4; p < 0.001), and episodic nature (9.3; p < 0.05) of disability. Most participants (> 60%) reported engaging a 'few times a week' or 'everyday' in self-care strategies associated with maintaining sense of control and adopting positive attitudes and beliefs. CONCLUSIONS: People living with HIV reported high levels of uncertainty and mental-emotional health challenges during the pandemic. Disability increased across all HDQ dimensions, with the greatest worsening in the mental-emotional health domain. Results provide an understanding of disability and self-care strategy use during the COVID-19 pandemic.


Subject(s)
COVID-19 , HIV Infections , Adult , Cross-Sectional Studies , Disability Evaluation , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Self Care , Surveys and Questionnaires
16.
Am J Phys Med Rehabil ; 100(12): 1109-1114, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1526236

ABSTRACT

OBJECTIVE: The aim of the study was to describe the characteristics and functional outcomes of patients undergoing acute inpatient rehabilitation after hospitalization for COVID-19. DESIGN: Using a retrospective chart review, patients were identified who were admitted to inpatient rehabilitation after COVID-19. Patient information collected included sociodemographic characteristics, comorbidities, length of stay, discharge disposition, self-care, mobility, and cognitive functioning. These patients were compared with patients (controls) without COVID-19 with similar impairment codes treated at the same facility before the COVID-19 pandemic. RESULTS: There were 43 patients who were admitted to the inpatient rehabilitation hospital after COVID-19 infection and 247 controls. Patients who had COVID-19 were significantly more likely to be African American and to have been admitted to a long-term acute care hospital. They also had a longer length of rehabilitation stay. The groups did not differ by age, sex, or insurance. Functionally, although presenting with significantly worse mobility, self-care, and motor scores, the patients previously infected with COVID-19 had similar functional outcomes at time of discharge to the control group. CONCLUSIONS: Although patients with a history of COVID-19 had worse function at time of admission to acute rehabilitation, inpatient rehabilitation significantly improved their function to comparable levels as patients who did not have COVID-19. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Identify how characteristics of patients with COVID-19 admitted to acute rehabilitation differ from those with similar admission codes but without COVID-19; (2) Describe changes in functional measures at admission and discharge of COVID-19 patients compared with patients without COVID-19; and (3) Recognize how inpatient rehabilitation may help reduce inequities in outcomes after severe COVID-19 infection. LEVEL: Advanced. ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


Subject(s)
COVID-19/rehabilitation , Functional Status , Hospitals, Rehabilitation/statistics & numerical data , Length of Stay/statistics & numerical data , Patient Discharge/statistics & numerical data , Aged , Case-Control Studies , Disability Evaluation , Female , Hospitalization , Humans , Male , Middle Aged , Recovery of Function , Retrospective Studies , SARS-CoV-2 , Time Factors , Treatment Outcome
17.
Eur Spine J ; 31(1): 167-175, 2022 01.
Article in English | MEDLINE | ID: covidwho-1499459

ABSTRACT

PURPOSE: The coronavirus 2019 (COVID-19) pandemic led to a compulsory lockdown of 3 months with strict restrictions. The impact of the COVID-19 pandemic has shown broad repercussions on patients with chronic pain; especially for conditions that present a significant emotional participation such as chronic low back pain (cLBP). METHODS: We performed a prospective study on 50 patients. Pre- and 1-month post-lockdown questionnaires such as: the Impact of Event Scale (IES), the Oswestry Disability Index (ODI), the Roland-Morris questionnaire (RMQ) and the visual analogue scale (VAS) for back and leg pain intensity were collected. RESULTS: The mean time of the evolution of cLBP was 33.04 months (range 5-120 months). Eighteen (36%) patients improved their cLBP (i-cLBP), whereas for 14 (28%) it was worse (w-cLBP). Cox multivariate proportional hazard model identified that MODIC 1 disc disease [OR 19.93, IC95% (2.81-102.13), p = 0.015] and at-home workouts [OR 18.854, IC95% (1.151-204.9), p = 0.040] were good prognosis factors of the improvement of cLBP while subclinical/mild Covid-19 anxiety (IES score < 26) was a poor prognosis factor in improving cLBP [OR 0.21, IC95% (0.001-0.384), p = 0.009]. Furthermore, pre-lockdown benzodiazepine medication [OR 2.554, IC95% (1.20-9.9), p = 0.002] was a prognosis factor of worse cLBP. In contrast, patients with severe Covid-19 anxiety (IES score > 26) significantly improved their cLBP [OR 0.58, IC95% (0.025-0.834), p = 0.01]. CONCLUSION: Lockdown affected the somatic component of cLBP by decreasing activities and physical measures, whereas the SARS-CoV-2 pandemic spectrum paradoxically improved the psychic and emotional component of cLBP.


Subject(s)
COVID-19 , Chronic Pain , Low Back Pain , Chronic Pain/epidemiology , Communicable Disease Control , Disability Evaluation , Humans , Low Back Pain/epidemiology , Pandemics , Prospective Studies , SARS-CoV-2 , Surveys and Questionnaires
18.
J Rehabil Med ; 53(11 (November)): jrm00239, 2021 Nov 23.
Article in English | MEDLINE | ID: covidwho-1468295

ABSTRACT

OBJECTIVES: To investigate functioning, activity and disability in people with post-COVID syndrome. DESIGN: Cross-sectional. SUBJECTS/PATIENTS: Participants were recruited online via Facebook and a stakeholders' organization for post-COVID syndrome in Sweden. METHODS: Sociodemographic data and International Classification of Functioning, Disability and Health (ICF)-based questionnaire were collected via an online platform and analysed. RESULTS: A total of 100 participants were included (mean age 44.5 years, 82% women, 61% with higher education, and 56% working full- or part-time). For the ICF component Body Functions, the most impaired functions were: fatigability and energy drive (98-99%); higher cognitive functions (74-94%); sleep functions (98%); muscle functions (93%); respiratory functions (92%); heart functions (82%); emotional functions (80%); sexual functions (77%); pain problems (56-90%); and thermoregulatory functions (68%). For the component Activity, the most frequent limitations were: handling stressful situations (98%); remunerative employment (95%); recreation and leisure (94%); climbing the stairs (94%); doing housework (84%); and informal socializing (64%). The most frequent degrees of impairment/limitations were light and moderate, except for severe-complete for fatigue, higher cognitive functions, multitasking, handling stressful situations; and recreation and leisure activities. CONCLUSION: Post-COVID syndrome following a mild COVID-19 infection can result in impaired body functions and activities. These results support the importance of a multidisciplinary rehabilitation approach for these patients.


Subject(s)
COVID-19 , Disabled Persons , Activities of Daily Living , Adult , Cross-Sectional Studies , Disability Evaluation , Female , Humans , International Classification of Functioning, Disability and Health , Male , SARS-CoV-2
19.
J Stroke Cerebrovasc Dis ; 30(12): 106121, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1415617

ABSTRACT

BACKGROUND: There is little information regarding the safety of intravenous tissue plasminogen activator (IV-tPA) in patients with stroke and COVID-19. METHODS: This multicenter study included consecutive stroke patients with and without COVID-19 treated with IV-tPA between February 18, 2019, to December 31, 2020, at 9 centers participating in the CASCADE initiative. Clinical outcomes included modified Rankin Scale (mRS) at hospital discharge, in-hospital mortality, the rate of hemorrhagic transformation. Using Bayesian multiple regression and after adjusting for variables with significant value in univariable analysis, we reported the posterior adjusted odds ratio (OR, with 95% Credible Intervals [CrI]) of the main outcomes. RESULTS: A total of 545 stroke patients, including 101 patients with COVID-19 were evaluated. Patients with COVID-19 had a more severe stroke at admission. In the study cohort, 85 (15.9%) patients had a hemorrhagic transformation, and 72 (13.1%) died in the hospital. After adjustment for confounding variables, discharge mRS score ≥2 (OR: 0.73, 95% CrI: 0.16, 3.05), in-hospital mortality (OR: 2.06, 95% CrI: 0.76, 5.53), and hemorrhagic transformation (OR: 1.514, 95% CrI: 0.66, 3.31) were similar in COVID-19 and non COVID-19 patients. High-sensitivity C reactive protein level was a predictor of hemorrhagic transformation in all cases (OR:1.01, 95%CI: 1.0026, 1.018), including those with COVID-19 (OR:1.024, 95%CI:1.002, 1.054). CONCLUSION: IV-tPA treatment in patients with acute ischemic stroke and COVID-19 was not associated with an increased risk of disability, mortality, and hemorrhagic transformation compared to those without COVID-19. IV-tPA should continue to be considered as the standard of care in patients with hyper acute stroke and COVID-19.


Subject(s)
COVID-19/complications , Fibrinolytic Agents/administration & dosage , Ischemic Stroke/drug therapy , Thrombolytic Therapy , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/mortality , Disability Evaluation , Europe , Female , Fibrinolytic Agents/adverse effects , Hospital Mortality , Humans , Infusions, Intravenous , Intracranial Hemorrhages/chemically induced , Iran , Ischemic Stroke/complications , Ischemic Stroke/diagnosis , Ischemic Stroke/mortality , Male , Middle Aged , Risk Assessment , Risk Factors , Thrombolytic Therapy/adverse effects , Thrombolytic Therapy/mortality , Time Factors , Treatment Outcome
20.
PLoS One ; 16(8): e0256433, 2021.
Article in English | MEDLINE | ID: covidwho-1372012

ABSTRACT

BACKGROUND: Endometriosis is a chronic pain condition in premenopausal women. Pain is mainly characterized by pain intensity and may induce disability in all areas of daily life. Nevertheless, pain is influenced by emotional and social factors as well. Social distancing measures or quarantine, as reaction to rapidly rising infections with the COVID-19 virus due to the SARS-CoV-2 pandemic, were implemented across Europe to prevent the spread of the virus and social distancing measures were imposed by the German government by beginning of March 2020 with initiation of the lockdown by the end of March 2020. The objective of this study was to assess, how social distancing measures during the lockdown impacted the various aspects of pain perception in a group of chronic pain patients, such as women suffering from endometriosis. METHODS: Between 6th to 27th April 2020, an online questionnaire was activated at internet platforms of endometriosis patients support groups. Participants were asked retrospectively at one time point about their visual pain intensity measured by the visual analogue scale (VAS) and pain disability via pain disability index (PDI) prior to initiation of social distancing measures in Germany (VASP, PDIP), as well as the pain intensity and pain disability since implementation of social distancing measures (VASI, PDII). Differences of VAS and PDI previous and after implementation of social distancing measures were displayed as ΔVAS and ΔPDI. Pain experience and social support were assessed by a 5-point Likert scale. RESULTS: 285 participants completed at least one question regarding pain intensity, disability, pain experience or social support. Dysmenorrhea, the symptom with the highest level of pain assessed by VAS, decreased significantly during the SARS-CoV-2 pandemic compared to the time period prior to social isolation (45.30% respondents experienced improvemenet vs 40.50% who experienced worsening; p = 0.025). The global physical impairment improved significantly (improvement of pain induced disability in 48.20% vs 40.90% with worsening of pain symptoms; p = 0.032) after the implementation of social distancing measures. Pain experience was negatively affected by social distancing measures, since frequency of pain awareness increased in 43.6% (p<0.001) of participants and 30.0% (p<0.001) more participants experienced pain as a threat. Verbalization of pain experience was reduced in 36.6% (p = 0.001) of participants and 14.6% (p = 0.91), 21.9% (p<0.001) and 31.5% (p<0.001) of participants reported less social support from their partner, family and friends. CONCLUSIONS: Physical pain and disability on one hand and emotional and social pain experience on the other were differentially affected by the emerged emotional, social and health care constraints related to the SARS-CoV-2 pandemic.


Subject(s)
COVID-19/epidemiology , Chronic Pain/etiology , Endometriosis/pathology , Social Support , Adult , COVID-19/virology , Cross-Sectional Studies , Disability Evaluation , Endometriosis/complications , Female , Germany/epidemiology , Humans , Internet , Pain Measurement , Pain Perception , Pandemics , Quarantine , Retrospective Studies , SARS-CoV-2/isolation & purification , Social Isolation , Surveys and Questionnaires
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