key: cord-0962632-0cqr239p
authors: Leite, Lara Costa; Carvalho, Letícia; de Queiroz, Darsayanne Marcos; Farias, Maria do Socorro Quintino; Cavalheri, Vinicius; Edgar, Dale W.; Nery, Bruno Ribeiro do Amaral; Barros, Natalia Vasconcelos; Maldaner, Vinicius; Campos, Nataly Gurgel; Mesquita, Rafael
title: Can the Post-COVID-19 Functional Status scale discriminate between patients with different levels of fatigue, quality of life and functional performance?
date: 2022-01-12
journal: Pulmonology
DOI: 10.1016/j.pulmoe.2022.01.001
sha: e01035c17e9b98ef12871e1817f65d2f8ceb64c2
doc_id: 962632
cord_uid: 0cqr239p

nan

Conflicts of interest: None.

Remarkable mortality and increasing reports of prolonged morbidity have been observed worldwide since the beginning of the coronavirus disease 2019 (COVID-19) pandemic. 1 Hundreds of thousands of individuals have managed to recover from the disease, 2 and functional and psychological sequelae in these people have been described in the literature. 3 The Post-COVID-19 Functional Status (PCFS) is a simple and rapid self-report scale that allows monitoring of the functional impact of the disease, adding value beyond binary outcomes such as mortality. 3 The PCFS was recently validated by Machado et al., 4 who demonstrated its construct validity in a large sample of adults with confirmed or presumed COVID-19. However, so far it is unknown whether this scale is able to discriminate between patients with different characteristics. The aim of the present study was, at the time of hospital discharge following acute recovery from a SARS-CoV-2 infection, to compare fatigue, health-related quality of life The following variables and outcomes were assessed in this study at the time of hospital discharge: sociodemographic, anthropometric, and clinical characteristics (including self-reported regular physical activity); fatigue symptoms via the Fatigue Severity Scale (FSS), 5 HRQoL via the EuroQol 5 dimensions -5 response level (EQ-5D-5L), 5, 6 and functional performance via the 1-minute sit-to-stand test (1STS). 7 Functional status after COVID-19 was assessed using the PCFS scale, which has four questions to classify each patient into one of five categories with different degrees of functional limitation. 3, 4 The Shapiro-Wilk test was used to assess the distribution of the data.

The chi-square, one-way ANOVA or Kruskal-Wallis tests were used to compare outcomes across the PCFS groups. A logistic regression model with calculation of the odds ratio (OR) and 95% confidence intervals (95% CI) was undertaken to identify the predictors of poorer functional status at hospital discharge (i.e. PCFS grade [3] [4] . Variables related to the pre-hospitalization period and the hospital length of stay (LOS) were included in the univariate models, and those that reached p<0.20 were subsequently included in the multivariate model. The statistical program SPSS version 22.0 (IBM, Armonk, NY, USA) was used, and the significance level adopted was p<0.05.

One hundred and thirty-three individuals with a confirmed diagnosis of COVID-19 were included (75 from Fortaleza-CE and 58 from Brasília-DF). Table 1 shows the characteristics of the participants. The mean age was 60 ± 15 years, and they were on average overweight. The majority of the sample had at least one comorbidity, and the most prevalent comorbidities were This study showed that the PCFS scale is a simple and rapid self-report instrument which is valuable for discriminating between groups with various physical and psychological health outcomes. In addition, variables that could predict a poorer functional status and potentially, the need for rehabilitation at the time of hospital discharge, were identified.

Machado et al. 4 also compared the EQ-5D-5L scores and the intensity of fatigue symptoms between PCFS grades and observed similar results.

However, functional performance was not investigated in their study. 4 Our study supports the validity of the PCFS scale by showing that individuals in higher PCFS grades showed a lower 1STS (expressed as % predicted) than those in lower grades. The fact that there was no significant difference in functional performance at discharge when assessed by the 1STS test total number of repetitions, but there was a significant difference when using the 1STS test % predicted, can be explained by the larger proportion of male subjects in the group of participants with PCFS grade 1/2. This larger proportion of males might have led to a greater number of 1STS repetitions in this group, which prevented the comparison of total number of repetitions to reach statistical significance.

Another study suggests that the PCFS tracks responses to pulmonary rehabilitation, as six out of 10 patients with perceived restrictions due to COVID-19 at baseline showed no restrictions (i.e. PCFS 0) in the post-rehabilitation assessment. 8 We also confirmed that LOS was the only predictor of a higher PCFS grade and reduced function at hospital discharge in a multivariate model. That is, our findings suggest that an increase of one day in hospital LOS is associated with a 17% increased risk of presenting with poor functional status at the time of hospital discharge. Our findings also reinforce the compounding influence of COVID-19 severity and detrimental impact of increasing duration of hospitalization on the patient's functional status, and further highlight the importance of applying preventive interventions such as early mobilization. The main limitations of this study are the cross-sectional design, which prevents a cause-and-effect analysis, the small sample size from only two centers, and the absence of a non-hospitalized group. Moreover, we were not able to characterize the sample regarding the type of treatment received during hospitalization (e.g. mechanical ventilation). Future studies including the repeated application of the PCFS after discharge are warranted to determine, define and compare the duration to functional recovery after COVID-19 and similar illnesses resulting in hospitalization.

In conclusion, the PCFS scale was demonstrated to be a discriminatory instrument for groups with measured varying degrees of fatigue, HRQoL, and functional performance. In addition, hospital LOS was the only predictor of a poorer functional status at hospital discharge. 

World Health Organization. WHO Coronavirus (COVID-19) Dashboard

Characterisation of the first 250 000 hospital admissions for COVID-19 in Brazil: a retrospective analysis of nationwide data

The post-COVID-19 functional status scale: A tool to measure functional status over time after COVID-19

Construct validity of the Post-COVID-19 Functional Status Scale in adult subjects with COVID-19

Life AfTER covid-19 (LATER-19): a protocol for a prospective, longitudinal, cohort study of symptoms, physical function and psychological outcomes in the context of a pandemic

An EQ-5D-5L value set based on Uruguayan population preferences

Reference values and equations for seven simple functional tests: a multicentre study

Feasibility of an outpatient training program after covid-19