Background
There is currently very limited information on the nature and prevalence of post‐COVID‐19 symptoms after hospital discharge.
Methods
A purposive sample of 100 survivors discharged from a ...large University hospital were assessed 4 to 8 weeks after discharge by a multidisciplinary team of rehabilitation professionals using a specialist telephone screening tool designed to capture symptoms and impact on daily life. EQ‐5D‐5L telephone version was also completed.
Results
Participants were between 29 and 71 days (mean 48 days) postdischarge from hospital. Thirty‐two participants required treatment in intensive care unit (ICU group) and 68 were managed in hospital wards without needing ICU care (ward group). New illness‐related fatigue was the most common reported symptom by 72% participants in ICU group and 60.3% in ward group. The next most common symptoms were breathlessness (65.6% in ICU group and 42.6% in ward group) and psychological distress (46.9% in ICU group and 23.5% in ward group). There was a clinically significant drop in EQ5D in 68.8% in ICU group and in 45.6% in ward group.
Conclusions
This is the first study from the United Kingdom reporting on postdischarge symptoms. We recommend planning rehabilitation services to manage these symptoms appropriately and maximize the functional return of COVID‐19 survivors.
Highlights
This is the first UK study reporting on longer term symptoms in individuals recovering from COVID‐19.
New illness‐related fatigue, breathlessness and psychological distress were commonly reported at 7 weeks after discharge from hospital with a clinically significant drop in the quality of life of many individuals.
Symptoms were present in both ward and ICU managed individuals, the prevalence being higher in those who required ICU care.
Rehabilitation care for COVID‐19 survivors must therefore be need‐focused, delivered by specialist multidisciplinary team and planned for the longer term to meet the needs of these individuals.
Symptoms compatible with irritable bowel syndrome (IBS) may co-exist in patients with inflammatory bowel disease (IBD), presenting a clinical dilemma for physicians. We conducted a systematic review ...and meta-analysis to examine this issue.
MEDLINE, EMBASE, and EMBASE Classic were searched (through February 2012) to identify cross-sectional surveys or case-control studies reporting the prevalence of symptoms meeting diagnostic criteria for IBS in ≥50 unselected adult IBD patients. The number of individuals with symptoms meeting criteria for IBS was extracted for each study, and pooled prevalence and odds ratios (ORs), with 95% confidence intervals (CIs), were calculated.
The search identified 3,045 articles. Thirteen studies, containing 1,703 patients, were eligible. The pooled prevalence for IBS in all IBD patients was 39% (95% CI 30-48%), with an OR compared with controls of 4.89 (95% CI 3.43-6.98). In IBD patients in remission, the OR was 4.39 (95% CI 2.24-8.61). For IBD patients with active disease, the pooled prevalence of IBS was 44%, compared with 35% in those felt to be in remission (OR 3.89; 95% CI 2.71-5.59). The prevalence in patients with Crohn's disease (CD) was higher than in those with ulcerative colitis (UC; 46 vs. 36%, OR 1.62; 95% CI 1.21-2.18).
Symptoms compatible with IBS were significantly higher in patients with IBD compared with non-IBD controls, even among those felt to be in remission. IBS-type symptoms were also significantly more common in CD than in UC patients, and in those with active disease. Management strategies for IBD patients with symptoms suggestive of IBS are required.
To determine long-term clinical outcomes in survivors of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronavirus infections after hospitalization or intensive ...care unit admission.
Ovid MEDLINE, EMBASE, CINAHL Plus, and PsycINFO were searched.
Original studies reporting clinical outcomes of adult SARS and MERS survivors 3 months after admission or 2 months after discharge were included.
Studies were graded using the Oxford Centre for Evidence-Based Medicine 2009 Level of Evidence Tool. Meta-analysis was used to derive pooled estimates for prevalence/severity of outcomes up to 6 months after hospital discharge, and beyond 6 months after discharge.
Of 1,169 identified studies, 28 were included in the analysis. Pooled analysis revealed that common complications up to 6 months after discharge were: impaired diffusing capacity for carbon monoxide (prevalence 27%, 95% confidence interval (CI) 15–45%); and reduced exercise capacity (mean 6-min walking distance 461 m, CI 450–473 m). The prevalences of post-traumatic stress disorder (39%, 95% CI 31–47%), depression (33%, 95% CI 20–50%) and anxiety (30%, 95% CI 10–61) beyond 6 months after discharge were considerable. Low scores on Short-Form 36 were identified beyond 6 months after discharge.
Lung function abnormalities, psychological impairment and reduced exercise capacity were common in SARS and MERS survivors. Clinicians should anticipate and investigate similar long-term outcomes in COVID-19 survivors.
As our understanding of the nature and prevalence of post‐coronavirus disease 2019 (COVID‐19) syndrome (PCS) is increasing, a measure of the impact of COVID‐19 could provide valuable insights into ...patients' perceptions in clinical trials and epidemiological studies as well as routine clinical practice. To evaluate the clinical usefulness and psychometric properties of the COVID‐19 Yorkshire Rehabilitation Scale (C19‐YRS) in patients with PCS, a prospective, observational study of 187 consecutive patients attending a post‐COVID‐19 rehabilitation clinic was conducted. The C19‐YRS was used to record patients' symptoms, functioning, and disability. A global health question was used to measure the overall impact of PCS on health. Classical psychometric methods (data quality, scaling assumptions, targeting, reliability, and validity) were used to assess the C19‐YRS. For the total group, missing data were low, scaling and targeting assumptions were satisfied, and internal consistency was high (Cronbach's α = 0.891). Relationships between the overall perception of health and patients' reports of symptoms, functioning, and disability demonstrated good concordance. This is the first study to examine the psychometric properties of an outcome measure in patients with PCS. In this sample of patients, the C19‐YRS was clinically useful and satisfied standard psychometric criteria, providing preliminary evidence of its suitability as a measure of PCS.
COVID-19 is a multisystem illness that has considerable long-term physical, psychological, cognitive, social and vocational sequelae in survivors. Given the scale of this burden and lockdown measures ...in most countries, there is a need for an integrated rehabilitation pathway using a tele-medicine approach to screen and manage these sequelae in a systematic and efficient way.
A multidisciplinary team of professionals in the UK developed a comprehensive pragmatic telephone screening tool, the COVID-19 Yorkshire Rehabilitation Screen (C19-YRS), and an integrated rehabilitation pathway, which spans the acute hospital trust, community trust and primary care service within the National Health Service (NHS) service model.
The C19-YRS telephone screening tool, developed previously, was used to screen symptoms and grade their severity. Referral criteria thresholds were applied to the output of C19-YRS to inform the decision-making process in the rehabilitation pathway. A dedicated multidisciplinary COVID-19 rehabilitation team is the core troubleshooting forum for managing complex cases with needs spanning multiple domains of the health condition.
The authors recommend that health services dealing with the COVID-19 pandemic adopt a comprehensive telephone screening system and an integrated rehabilitation pathway to manage the large number of survivors in a timely and effective manner and to enable the provision of targeted interventions.
The National Institute for Health and Care Excellence (NICE) describe “post COVID-19 syndrome” or “Long COVID” as a set of persistent physical, cognitive and/or psychological symptoms that continue ...for more than 12 weeks after illness and which are not explained by an alternative diagnosis. These symptoms are experienced not only by patients discharged from hospital but also those in the community who did not require inpatient care. To support the recovery of this group of people, a unique integrated rehabilitation pathway was developed following extensive service evaluations by Leeds Primary Care Services, Leeds Community Healthcare NHS Trust and Leeds Teaching Hospital NHS Trust. The pathway aligns itself to the NHS England “Five-point plan” to embed post-COVID-19 syndrome assessment clinics across England, supporting the comprehensive medical assessment and rehabilitation intervention for patients in the community. The pathway was first of its kind to be set up in the UK and comprises of a three-tier service model (level 1: specialist MDT service, level 2: community therapy teams and level 3: self-management). The MDT service brings together various disciplines with specialist skill sets to provide targeted individualized interventions using a specific core set of outcome measures including C19-YRS (Yorkshire Rehabilitation Scale). Community and primary care teams worldwide need such an integrated multidisciplinary comprehensive model of care to deal with the growing number of cases of post-COVID-19 syndrome effectively and in a timely manner.
Systematic review.
To systematically review the evidence for the effectiveness of telerehabilitation as an intervention for people with spinal cord injury (SCI) in low-and middle-income countries ...(LMICs).
Not applicable.
MEDLINE (Ovid), Embase (Ovid), Pubmed and Global Health databases were used to identify studies published between 1946-2020 meeting the following criteria: (1) patients with SCI diagnosis; (2) in LMIC; (3) an outcome measuring clinical functional ability, quality of life or all-cause mortality reduction. The risk of bias in studies was graded using revised Cochrane risk-of-bias tool in randomised trials (RoB 2) and risk-of-bias tool in non-randomised trials (ROBINS-I). Evidence levels were graded with Grading of Recommendations, Assessment, Development and Evaluations (GRADE).
In total, 107 articles were identified from the initial search. After screening, five studies were included. Some significant improvements to quality of life and pressure ulcer management were observed, alongside some improvement in functional ability with suggested improvement to depression scores. Telerehabilitation alleviated participants' sense of social isolation, improved satisfaction scores and assisted them to remember techniques for SCI management. Telerehabilitation was valued by health professionals. There was no reduction in all-cause mortality.
There is insufficient evidence to recommend telerehabilitation as an intervention to treat and manage SCI in LMICs, although there is an indication of potential patient benefit. Further research is required to better understand the causal mechanisms underpinning the use of telerehabilitation and establish its efficacy, in the context of resource-limited settings.
The underlying pathophysiology of post-coronavirus disease 2019 (long-COVID-19) syndrome remains unknown, but increased cardiometabolic demand and state of mitochondrial dysfunction have emerged as ...candidate mechanisms. Cardiovascular magnetic resonance (CMR) provides insight into pathophysiological mechanisms underlying cardiovascular disease and 31-phosphorus CMR spectroscopy (
P-CMRS) allows non-invasive assessment of the myocardial energetic state. The main aim of the study was to assess whether long COVID-19 syndrome is associated with abnormalities of myocardial structure, function, perfusion and energy metabolism.
Prospective case-control study. A total of 20 patients with a clinical diagnosis of long COVID-19 syndrome (seropositive) and no prior underlying cardiovascular disease (CVD) and 10 matching healthy controls underwent
P-CMRS and CMR at 3T at a single time point. All patients had been symptomatic with acute COVID-19, but none required hospital admission.
Between the long COVID-19 syndrome patients and matched contemporary healthy controls there were no differences in myocardial energetics (phosphocreatine to ATP ratio), in cardiac structure (biventricular volumes), function (biventricular ejection fractions, global longitudinal strain), tissue characterization (T
mapping and late gadolinium enhancement) or perfusion (myocardial rest and stress blood flow, myocardial perfusion reserve). One patient with long COVID-19 syndrome showed subepicardial hyperenhancement on late gadolinium enhancement imaging compatible with prior myocarditis, but no accompanying abnormality in cardiac size, function, perfusion, extracellular volume fraction, native T1, T2 or cardiac energetics.
In this prospective case-control study, the overwhelming majority of patients with a clinical long COVID-19 syndrome with no prior CVD did not exhibit any abnormalities in myocardial energetics, structure, function, blood flow or tissue characteristics.
The primary aim was to explore the perceived barriers that lower limb amputees and service providers face when accessing or providing rehabilitation services. The secondary aim was to describe the ...lower limb amputations performed in public hospitals in the Western Area of Sierra Leone in 2018.
A mixed methodology was employed, involving the collection of amputation data from surgical logbooks and interviews with amputees (n = 10) and group discussion and interviews with service providers (n = 11).
Of the 37 primary lower limb amputations (49% men, 51% women; median age 56 years; 62% transtibial and 35% transfemoral amputations) 86% were for diabetic and vascular causes. Barriers to accessing services included poor transportation access, high service fees, rural living, gender and a lack of government support. Insufficient funding and supplies, skilled staff shortages and a lack of local training programmes were frequently reported barriers to providing rehabilitation services.
A low prioritisation means rehabilitation services are underfunded, resulting in numerous barriers to both accessing and providing amputee rehabilitation services. Subsidised services and an outreach programme may improve access for patients. Increased funding and local training programmes are needed to improve service delivery.
Implications for Rehabilitation
Comprehensive and accessible amputee rehabilitation services can enable people with amputations to regain their independence and aid their participation in their community and workplace.
There are numerous barriers to both accessing and providing amputee rehabilitation services in the Western Area, Sierra Leone, chiefly financial.
We recommend a revised effort by the Sierra Leonean government to implement the progressive policies on disability they have already adopted into law, which will aid the improvement of amputee rehabilitation services.
New education and training programmes for all levels of prosthetic and orthotic professions are needed to secure the future of prosthetics and orthotics in Sierra Leone.
This study explores the experiences of care received and management of disability for individuals with spinal cord injury and stroke following discharge from a specialty rehabilitation center, ...alongside perspectives on the potential role of telerehabilitation. We employed qualitative in-depth face-to-face interviews with patients who had accessed and been discharged from a specialist rehabilitation center in Nepal were used. Interviews sought perspectives of adjusting to, living with, and managing disability alongside the potential role of telerehabilitation in the community setting. Inductive thematic analysis was used to derive themes. A total of 17 participants with spinal cord injuries or stroke were interviewed. Four generated themes included: (i) Difficulties accessing support and perceived mismanagement following initial neurological injury; (ii) Realizing the magnitude and impact of an injury in the absence of clear routes to support; (iii) A multi-faceted symptom burden and its impact; and (iv) The nature and types of interaction with health professionals post-discharge and the potential role of telerehabilitation. We detail accounts of suspended periods with minimal or no support provided from healthcare providers for people with spinal cord injury and stroke following initial acute management. Telerehabilitation could be a worthwhile approach to enhance access to rehabilitation in the community setting but must accompany national efforts to enhance the provision of specialist rehabilitation.
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