J.E. Pompeu1, É.C. Gouveia e Silva1, C. Gil de Godoy1, D. Brancolini de Oliveira2, C.R. Fernandes de Carvalho2, A.C. Gambeta2, C. Tanaka1, E. Mendes da Silva2, C. Machado de Campos1, D. Stripari Schujmann1, A.C. Basso1, C. Fu1, C. Toufen Junior3, L. Oliveira3, L. Cassimiro3, G. Correa3, K. Hill4, N. Kondo Nakagawa1, C. Roberto Ribeiro Carvalho3
1School of Medicine/University of Sao Paulo, Department of Physical Therapy, Speech and Occupational Therapy, Sao Paulo, Brazil, 2Clinics Hospital/School of Medicine/University of Sao Paulo, Department of Physical Therapy, Sao Paulo, Brazil, 3Heart Institute (InCor)/University of Sao Paulo, Pneumology Division, Cardiopulmonary Department, Sao Paulo, Brazil, 4Monash University, School of Primary and Allied Health Care, Melbourne, Australia
Background: Together, severe COVID-19 and long hospital stays, impair structures, and functions of the body which are fundamental for daily life activities. As it is a relatively new disease, few studies assessing the impact of COVID-19 add up to the deleterious effects of hospitalization in the functionality after hospital discharge in adults and older people.
Purpose: To compare muscle strength, sarcopenia, frailty, fatigue, and mobility impairment between adults and older people after long hospital stays due to COVID-19.
Methods: This was a prospective cohort study that will follow 400 adults and older people during a period of one year. To date, we evaluated 23 adults and older people of both genders after long stays at a high complexity hospital in Brazil (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo) due to severe COVID-19. We assessed body function and structure and activity according to the International Functional Classification. As body function and structure measure, we assessed muscle strength (dynamometry and 5 times sit to stand test), sarcopenia (SARC-F), and frailty (Clinical Frailty Scale (CFS). The measures of activity were fatigue (FACIT and 1 minute Sit to Stand Test) and mobility (Timed Up and Go Test). Patients were recruited 30 days after hospital discharge. In order to compare the results between adults and older people, we used Repeated Measure ANOVA and Bonferroni post hoc, Student T-test or Mann-Whitney test depending on the variable distribution. Pearson's coefficient test was used to analyze the possible correlations between the variables. Data analysis was performed using the JASP software and a significance level of p <0.05 was adopted.
Results: We assessed 12 adults (mean age of 49,9 (6.8) years) and 11 older people ( 67,2 (5.3) years). The mean hospital stay of adults and older people was 24.2 (13.6) and 23.7 (9.9) days, respectively (independent t-test, p=0.912). There were no between-groups differences regarding muscle strength (p=0.949) and SARC-F score (p=0.184). Both adults and older people showed worsening of frailty after hospital discharge (p=0.019). There was no between-group difference regarding fatigue (FACIT, p=0.673; 1-minute sit to stand, p=0.857). Finally, there was no between-group difference in the Timed Up and go test (p=0.609). There was a positive correlation between the total time of hospital stays and fatigue (r=0.489; p=0.039). There was positive correlation between fatigue and sarcopenia (r=704; p <.001), positive correlation between mobility and muscle strength (r=0.445;p = 0.033) and negative correlation between mobility and the number of repetition in the 1 minute sit to stand test (fatigue) (r=-0.424; p = 0.044).
Conclusion(s): There was no difference between adults and older people regarding muscle strength, sarcopenia, fatigue, and mobility impairment. Adults and older people worsened frailty after hospital discharge due to severe COVID-19.
Implications: The results of this study can contribute to developing interventions to prevent functional impairment associated with long hospital stays due to COVID-19. It is important to understand the impact of severe COVID-19 on functional prognosis after discharge to develop rehabilitation strategies, specifically to minimize the negative effects on frailty, fatigue, sarcopenia, mobility and muscle strength.
Funding, acknowledgements: Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP, process number 2018/19618-8) and CNPQ (process number 402698/2020-7).
Keywords: COVID-19, long hospital stays, frailty
Topic: COVID-19
Did this work require ethics approval? Yes
Institution: University of Sao Paulo
Committee: School of Medicine of the University of Sao Paulo
Ethics number: 34115720.5.0000.0068
All authors, affiliations and abstracts have been published as submitted.
