Long COVID-19 Syndrome: Effect on Functional Capacity, Balance and Cognitive Functions

Yıl 2023, Sayı: 20, 522 - 535, 09.09.2023

Meltem Kaya , Esra Nur Arslan

https://doi.org/10.38079/igusabder.1268039

Öz

Aim: Although COVID-19 infection predominantly affects the respiratory system, it is a disease which is a high mortality rate that causes multisystem sequelae in the long term. The aim of this study is to compare the long-term functional capacity, fatigue severity, balance, and cognitive functions of individuals with Long COVID-19 Syndrome with healthy individuals.
Method: Thirty patients aged 50 years and over who were diagnosed with COVID-19 and had at least 6 months after the negative test result, had one or more of the persistent or progressive common Long COVID-19 symptoms, and 30 healthy individuals with a similar mean age were included in the study. The functional capacities of the participants were evaluated with 30-second Sit-to-Stand Test (30STS), perception of fatigue with Fatigue Severity Scale, balance with the Single Leg Stance Test, and cognitive functions with Montreal Cognitive Assessment (MoCA). For non-normally distributed data with Mann Whitney U test and for normal distribution data with Independent Samples T-test were performed to analyze between-group differences.
Results: A statistically significant difference was found between the two groups’ 30STS, Fatigue Severity Scale score, and Single Leg Stance Test. There was no statistically significant difference between the groups in terms of MoCA score.
Conclusion: Our study has found that individuals with Long COVID-19 Syndrome had lower functional capacities and balance parameters and higher fatigue severity compared to healthy controls. As a result, it is recommended that patients be evaluated comprehensively and directed to rehabilitation programs to be planned individually in Long COVID-19 Syndrome.

Anahtar Kelimeler

Long COVID-19 Syndrome, functional capacity, balance, fatigue

Uzamış COVID-19 Sendromu: Fonksiyonel Kapasite, Denge ve Kognitif Fonksiyonlar Üzerine Etkisi

Öz

Amaç: COVID-19 enfeksiyonu ağırlıklı olarak solunum sistemini etkilemesine rağmen uzun vadede multisistemik sekellere neden olan mortalite oranı yüksek bir hastalıktır. Bu çalışmanın amacı; Uzamış COVID-19 Sendromu olan bireylerde uzun dönemde fonksiyonel kapasite, yorgunluk şiddeti, denge ve kognitif fonksiyonları sağlıklı bireyler ile karşılaştırmaktır.
Yöntem: COVID-19 tanısı almış ve negatif test sonucu üzerinden en az 6 ay geçmiş, kalıcı veya ilerleyici yaygın görülen uzamış COVID-19 semptomlarından bir veya birkaçına sahip 50 yaş ve üzerindeki 30 hasta ile, benzer yaş ortalaması olan 30 sağlıklı birey çalışmaya dahil edildi. Katılımcıların fonksiyonel kapasiteleri 30-saniye Otur-Kalk Testi (30-sn OKT), yorgunluk algıları Yorgunluk Şiddet Ölçeği, dengeleri Tek Ayak Üzerinde Durma Testi (TAÜDT), kognitif fonksiyonları Montreal Bilişsel Değerlendirme Ölçeği (MoCA) ile değerlendirildi. Normal dağılım göstermeyen gruplar arası veriler Mann Whitney U testi, normal dağılım gösteren veriler Independent Samples T-test ile karşılaştırıldı.
Bulgular: İki grup arasında 30-sn OKT tekrar sayısı, Yorgunluk Şiddet Ölçeği skoru ve TAÜDT süreleri arasında istatistiksel olarak anlamlı fark bulundu. Gruplar arasında MoCA puan ortalamaları açısından istatistiksel olarak anlamlı bir fark saptanmadı.
Sonuç: Çalışmamızda Uzamış COVID-19 Sendromu olan bireylerin sağlıklı kontrollere kıyasla fonksiyonel kapasitelerinin ve denge parametrelerinin daha düşük, yorgunluk şiddetlerinin ise daha yüksek olduğu bulunmuştur. Sonuç olarak; Uzamış COVID-19 Sendromu’nda hastaların kapsamlı olarak değerlendirilmesi ve kişiye özel planlanacak rehabilitasyon programlarına yönlendirilmesi önerilmektedir.

Anahtar Kelimeler

Uzamış COVID-19 Sendromu, fonksiyonel kapasite, denge, yorgunluk

Kaynakça

• Organization WHO. Situation Report 58: Coronavirus disease 2019 (COVID-19). In:2020.
• Carfì A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. Jama. 2020;324(6):603-605.
• Crook H, Raza S, Nowell J, Young M, Edison P. Long covid—mechanisms, risk factors, and management. BMJ. 2021;374.
• Raman B, Bluemke DA, Lüscher TF, Neubauer S. Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus. European Heart Journal. 2022;43(11):1157-1172.
• Del Rio C, Collins LF, Malani P. Long-term health consequences of COVID-19. Jama. 2020;324(17):1723-1724.
• Jimeno-Almazán A, Pallarés JG, Buendía-Romero Á, et al. Post-COVID-19 syndrome and the potential benefits of exercise. International Journal of Environmental Research and Public Health. 2021;18(10):5329.
• Soriano J, Murthy S, Marshall J, Relan P, Diaz J. WHO Clinical Case Definition Working Group on Post-COVID-19 Condition. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2021;3099(21):00703-00709.
• Townsend L, Dyer AH, Jones K, et al. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PloS one. 2020;15(11):e0240784.
• Yan Z, Yang M, Lai CL. Long COVID-19 syndrome: a comprehensive review of its effect on various organ systems and recommendation on rehabilitation plans. Biomedicines. 2021;9(8):966.
• Pascarella G, Strumia A, Piliego C, et al. COVID‐19 diagnosis and management: a comprehensive review. Journal of Internal Medicine. 2020;288(2):192-206.
• Bellan M, Soddu D, Balbo PE, et al. Respiratory and psychophysical sequelae among patients with COVID-19 four months after hospital discharge. JAMA Network Oopen. 2021;4(1):e2036142-e2036142.
• González J, Benítez ID, Carmona P, et al. Pulmonary function and radiologic features in survivors of critical COVID-19: a 3-month prospective cohort. Chest. 2021;160(1):187-198.
• Huang Y, Tan C, Wu J, et al. Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Respiratory Research. 2020;21:1-10.
• Gurses HN, Zeren M, Denizoglu Kulli H, Durgut E. The relationship of sit-to-stand tests with 6-minute walk test in healthy young adults. Medicine (Baltimore). 2018;97(1):e9489.
• Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Research Quarterly for Exercise and Sport. 1999;70(2):113-119.
• Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD. The fatigue severity scale: application to patients with multiple sclerosis and systemic lupus erythematosus. Archives of Neurology. 1989;46(10):1121-1123.
• Gencay-Can A, Can SS. Validation of the Turkish version of the fatigue severity scale in patients with fibromyalgia. Rheumatology International. 2012;32(1):27-31.
• Briggs RC, Gossman MR, Birch R, Drews JE, Shaddeau SA. Balance performance among noninstitutionalized elderly women. Physical Therapy. 1989;69(9):748-756.
• Nasreddine Z. Montreal Cognitive Assessment (MoCA): administration and scoring instructions. Montreal Cognitive Assessment website. 2010.
• Selekler K, Cangöz B, Uluç S. Montreal bilişsel değerlendirme ölçeği (MOBİD)'nin hafif bilişsel bozukluk ve Alzheimer hastalarını ayırt edebilme gücünün incelenmesi. Türk Geriatri Dergisi. 2010;13(3):166-171.
• Gökşen A, Kocaman H. Fatigue in post Covid period and strategies for coping with fatigue: a pilot study. Tarsus Üniversitesi Uygulamalı Bilimler Fakültesi Dergisi. 2022;2(2):120-129.
• King’s College London. New research identifies those most at risk from ‘long COVID. https://www.kcl.ac.uk/news/study-identifies-those-most-risk-long-COVID. Published 21 October 2020. Accessed 13 March 2023.
• Tenforde MW, Kim SS, Lindsell CJ, et al. Symptom duration and risk factors for delayed return to usual health among outpatients with COVID-19 in a multistate health care systems network—United States, March–June 2020. Morbidity and Mortality Weekly Report. 2020;69(30):993-998.
• Seeßle J, Waterboer T, Hippchen T, et al. Persistent symptoms in adult patients 1 year after coronavirus disease 2019 (COVID-19): a prospective cohort study. Clinical Infectious Diseases. 2022;74(7):1191-1198.
• Thompson EJ, Williams DM, Walker AJ, et al. Risk factors for long COVID: analyses of 10 longitudinal studies and electronic health records in the UK. MedRxiv. 2021:2021.2006. 2024.21259277.
• Huang C, Huang L, Wang Y, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. The Lancet. 2021;397(10270):220-232.
• Daher A, Balfanz P, Cornelissen C, et al. Follow up of patients with severe coronavirus disease 2019 (COVID-19): Pulmonary and extrapulmonary disease sequelae. Respiratory Medicine. 2020;174:106197.
• Sirayder U, Inal-Ince D, Kepenek-Varol B, Acik C. Long-term characteristics of severe COVID-19: respiratory function, functional capacity, and quality of life. International Journal of Environmental Research and Public Health. 2022;19(10):6304.
• Guzik A, Wolan-Nieroda A, Kochman M, Perenc L, Drużbicki M. Impact of mild COVID-19 on balance function in young adults, a prospective observational study. Scientific Reports. 2022;12(1):12181.
• Núñez-Cortés R, Flor-Rufino C, Martínez-Arnau FM, et al. Feasibility of the 30 s Sit-to-stand test in the telehealth setting and its relationship to persistent symptoms in non-hospitalized patients with long COVID. Diagnostics. 2023;13(1):24.
• Warden SJ, Liu Z, Moe SM. Sex- and age-specific centile curves and downloadable calculator for clinical muscle strength tests to ıdentify probable sarcopenia. Physical Therapy. 2021;102(3).
• Ganesh R, Ghosh AK, Nyman MA, et al. PROMIS scales for assessment of persistent post-COVID Symptoms: a cross sectional study. Journal of Primary Care & Community Health. 2021;12:21501327211030413.
• Salari N, Khodayari Y, Hosseinian-Far A, et al. Global prevalence of chronic fatigue syndrome among long COVID-19 patients: A systematic review and meta-analysis. BioPsychoSocial medicine. 2022;16(1):21.
• Van Herck M, Goërtz YM, Houben-Wilke S, et al. Severe fatigue in long COVID: web-based quantitative follow-up study in members of online long COVID support groups. Journal of Medical Internet Research. 2021;23(9):e30274.
• Del Corral T, Menor‐Rodríguez N, Fernández‐Vega S, Díaz‐Ramos C, Aguilar‐Zafra S, López‐de‐Uralde‐Villanueva I. Longitudinal study of changes observed in quality of life, psychological state cognition and pulmonary and functional capacity after COVID‐19 infection: A six‐to seven‐month prospective cohort. Journal of Clinical Nursing. 2022;00:1–14.
• Rudroff T, Fietsam AC, Deters JR, Bryant AD, Kamholz J. Post-COVID-19 fatigue: potential contributing factors. Brain sciences. 2020;10(12):1012.
• Morgul E, Bener A, Atak M, et al. COVID-19 pandemic and psychological fatigue in Turkey. International Journal of Social Psychiatry. 2021;67(2):128-135.
• Bai F, Tomasoni D, Falcinella C, et al. Female gender is associated with long COVID syndrome: a prospective cohort study. Clinical Microbiology and Infection. 2022;28(4):611. e619-611. e616.
• Akyıldız HÇ, Kiraz EDE, Özmen A. Covid-19’un iklim değişikliği ve cinsiyet perspektifinden değerlendirilmesi. City Health Journal. 2020;1(1):06-11.
• Tödt K, Skargren E, Kentson M, Theander K, Jakobsson P, Unosson M. Experience of fatigue, and its relationship to physical capacity and disease severity in men and women with COPD. International Journal of Chronic Obstructive Pulmonary Disease. 2014:17-25.
• Giannaki CD, Aristotelous P, Stefanakis M, et al. Restless legs syndrome in Multiple Sclerosis patients: a contributing factor for fatigue, impaired functional capacity, and diminished health-related quality of life. Neurological Research. 2018;40(7):588-594.
• Wolvers M, Leensen M, Groeneveld I, Frings-Dresen M, De Boer A. Longitudinal associations between fatigue and perceived work ability in cancer survivors. Journal of Occupational Rehabilitation. 2019;29:540-549.
• Morelli N, Parry SM, Steele A, et al. Patients surviving critical COVID-19 have impairments in dual-task performance related to post-intensive care syndrome. Journal of Intensive Care Medicine. 2022;37(7):890-898.
• Udina C, Ars J, Morandi A, Vilaró J, Cáceres C, Inzitari M. Rehabilitation in adult post-COVID-19 patients in post-acute care with therapeutic exercise. The Journal of Frailty & Aging. 2021;10:297-300.
• Yılmaz O, Mutlu BÖ, Yaman H, Bayazıt D, Demirhan H, Bayazıt YA. Assessment of balance after recovery from Covid-19 disease. Auris Nasus Larynx. 2022;49(2):291-298.
• Hugon J, Msika EF, Queneau M, Farid K, Paquet C. Long COVID: cognitive complaints (brain fog) and dysfunction of the cingulate cortex. Journal of Neurology. 2022;269(1):44-46.
• Bohannon RW, Tudini F. Unipedal balance test for older adults: a systematic review and meta-analysis of studies providing normative data. Physiotherapy. 2018;104(4):376-382.
• Morlino P, Balbi B, Guglielmetti S, et al. Gait abnormalities of COPD are not directly related to respiratory function. Gait & Posture. 2017;58:352-357.
• Xavier R, Caporali AC, Lopes A, et al. Identification of functional phenotypes in people with COPD: influence of postural balance, physical activity, sedentary behaviour and quadriceps muscle strength. In: Eur Respiratory Soc; 2019.
• Sasannejad C, Ely EW, Lahiri S. Long-term cognitive impairment after acute respiratory distress syndrome: a review of clinical impact and pathophysiological mechanisms. Critical Care. 2019;23:1-12.
• Ceban F, Ling S, Lui LM, et al. Fatigue and cognitive impairment in Post-COVID-19 Syndrome: A systematic review and meta-analysis. Brain, Behavior, and Immunity. 2022;101:93-135.
• Garrigues E, Janvier P, Kherabi Y, et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. Journal of Infection. 2020;81(6):e4-e6.
• Almeria M, Cejudo JC, Sotoca J, Deus J, Krupinski J. Cognitive profile following COVID-19 infection: Clinical predictors leading to neuropsychological impairment. Brain, Behavior, & Immunity-Health. 2020;9:100163.
• Woo MS, Malsy J, Pöttgen J, et al. Frequent neurocognitive deficits after recovery from mild COVID-19. Brain Communications. 2020;2(2):fcaa205.
• Mattioli F, Piva S, Stampatori C, et al. Neurologic and cognitive sequelae after SARS-CoV2 infection: Different impairment for ICU patients. Journal of the Neurological Sciences. 2022;432:120061.
• Vannorsdall TD, Brigham E, Fawzy A, et al. Cognitive dysfunction, psychiatric distress, and functional decline after COVID-19. Journal of the Academy of Consultation-liaison Psychiatry. 2022;63(2):133-143.
• Öksüz Çapanoğlu MŞ. Covid-19 Geçiren Hastalarda Uzun Dönemde Egzersiz Kapasitesi, Periferik Kas Kuvveti, Denge, Kognitif Durum ve Yaşam Kalitesinin Değerlendirilmesi. [yüksek lisans tezi]. Ankara, Türkiye: Kalp ve Solunum Fizyoterapisi ve Rehabilitasyon Ana Bilim Dalı, Sağlık Bilimleri Enstitüsü, Hacettepe Üniversitesi; 2022.