Postdischarge pain, fatigue severity and quality of life in COVID-19 survivors

Abstract

Objectives: Fatigue and pain symptoms were common complaints among post-COVID-19 patients, and these lead to impaired quality of life (QoL). We aimed to evaluate severity of pain and fatigue 3 months after disease onset in discharged COVID-19 patients.

Methods: Patients were contacted by phone at their third month following disease onset. Demographic data of the patients such as weight, height, body mass index (BMI), gender, smoking history, comorbidities, length of hospitalization, duration of stay in the intensive care unit, were recorded. The patients' pain and fatigue severities were evaluated by visual analog scale (VAS). QoL was questioned with the EuroQol Group Association five-domain, three-level questionnaire (EQ-5D-3L).

Results: A total of 392 participants enrolled into the study. At admission, 94.6% of the participants had fatigue and 73.7% of them had pain. A high proportion of them still reported fatigue (55.1%) and pain (41.3%) at third month. The mean value of pain-VAS score was 5.37 ± 3.85, and it was 7.58 ± 2.82 for fatigue-VAS at admission. VAS scores of pain and fatigue at third month were 1.44 ± 2.11 and 2.04 ± 2.40 respectively. While 66.6% of the patients reported moderate-severe pain at disease onset, the rate was 18.1% at the third month. And also almost half had severe pain at admission (48%), it was 2.8% at third month. At disease onset 89.6% of the patients reported moderate-severe fatigue (severe: 48%). Aproximately one third of them had moderate-severe fatigue (27.9%) at third month (severe: 5.1%). The mean value of EQ-VAS score was 26.76 ± 20.26 at admission, and it was 78.84 ±16.15 at third month. Statistically significant differences were recorded between the disease onset and third month in terms of pain-VAS fatigue-VAS, and EQ-VAS scores (p < 0.001). Female gender, ICU admission, long duration of hospitalization, older age, higher BMI scores, multiple comorbidities, fatigue and pain severity were related to the decrease in QoL scores.

Conclusions: Hospitalized COVID-19 survivors need ongoing support for pain, fatigue complaints and impaired QoL after discharge. The factors that cause poor QoL should be taken into account during post-COVID-19 follow up.

Keywords

• COVID-19
• pain
• fatigue
• visual analog scale (VAS)
• quality of life
• EQ-5D-3L

References

1. 1. Coronavirus [Internet]. [ 13 September 2021]. https://www.who.int/westernpacific/health-topics/coronavirus.
2. 2. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021;397:220-32.
3. 3. Overview | COVID-19 rapid guideline: managing the long-term effects of COVID-19 | Guidance | NICE [Internet]. NICE; [26 August 2021]. https://www.nice.org.uk/guidance/ng188.
4. 4. Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect 2020;81:e4-6.
5. 5. Sykes DL, Holdsworth L, Jawad N, Gunasekera P, Morice AH, Crooks MG. Post-COVID-19 symptom burden: what is long-COVID and how should we manage it? Lung 2021;199:113-9.
6. 6. Jacobs LG, Gourna Paleoudis E, Lesky-Di Bari D, Nyirenda T, Friedman T, Gupta A, et al. Persistence of symptoms and quality of life at 35 days after hospitalization for COVID-19 infection. PloS One 2020;15:e0243882.
7. 7. Galal I, Hussein AAM, Amin MT, Saad MM, Zayan HEE, Abdelsayed MZ, et al. Determinants of persistent post-COVID-19 symptoms: value of a novel COVID-19 symptom score. Egypt J Bronchol 2021;15:1-8.
8. 8. Carfì A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. JAMA 2020;324:603-5.

9. 9. EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy 1990;16:199-208.
10. 10. Scott J, Huskisson EC. Graphic representation of pain. Pain 1976;2:175-84.
11. 11. Shah R, Ali FM, Nixon SJ, Ingram JR, Salek SM, Finlay AY. Measuring the impact of COVID-19 on the quality of life of the survivors, partners and family members: a cross-sectional international online survey. BMJ Open 2021;11:e047680.
12. 12. Murat S, Karatekin BD, Icagasioglu A, Ulasoglu C, İçten S, Incealtin O. Clinical presentations of pain in patients with COVID-19 infection. Ir J Med Sci 2020;190:913-7.
13. 13. Tuzun S, Keles A, Okutan D, Yildiran T, Palamar D. Assessment of musculoskeletal pain, fatigue and grip strength in hospitalized patients with COVID-19. Eur J Phys Rehabil Med 2021;57:653-62.
14. 14. Graham EL, Clark JR, Orban ZS, Lim PH, Szymanski AL, Taylor C, et al. Persistent neurologic symptoms and cognitive dysfunction in non‐hospitalized Covid-19 “long haulers”. Ann Clin Transl Neurol 2021;8:1073-85.
15. 15. Orrù G, Bertelloni D, Diolaiuti F, Mucci F, Di Giuseppe M, Biella M, et al. Long-COVID Syndrome? A study on the persistence of neurological, psychological and physiological symptoms. Healthcare (Basel) 2021;9:575.
16. 16. Todt BC, Szlejf C, Duim E, Linhares AO, Kogiso D, Varela G, et al. Clinical outcomes and quality of life of COVID-19 survivors: A follow-up of 3 months post hospital discharge. Respir Med 2021;184:106453.
17. 17. Walle-Hansen M, Ranhoff A, Mellingsæter M, Wang-Hansen M, Myrstad M. Health-related quality of life, functional decline, and long-term mortality in older patients following hospitalisation due to COVID-19. BMC Geriatr 2021;21:199.
18. 18. Taboada M, Moreno E, Cariñena A, Rey T, Pita-Romero R, Leal S, et al. Quality of life, functional status, and persistent symptoms after intensive care of COVID-19 patients. Br J Anaesth 2021;126:e110-3.
19. 19. Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID‐19 infection: a cross‐sectional evaluation. J Med Virol 2021;93:1013-22.
20. 20. Mandal S, Barnett J, Brill SE, Brown JS, Denneny EK, Hare SS, et al. ‘Long-COVID’: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19. Thorax 2021;76:396-8.
21. 21. Townsend L, Dyer AH, Jones K, Dunne J, Mooney A, Gaffney F, et al. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. Plos One 2020;15:e0240784.
22. 22. Arab-Zozani M, Hashemi F, Safari H, Yousefi M, Ameri H. Health-related quality of life and its associated factors in COVID-19 patients. Osong Public Health Res Perspect 2020;11:296-302.