To explore the long-term impact of COVID-19 and PCC on self-reported symptoms, functional status, self-reported physical activity, health-related quality of life (HRQoL), sick leave and overall recovery.
A longitudinal prospective observational study was conducted. Adult patients at the post-covid outpatient clinic were enrolled in the study in connection to a first clinical assessment between June 2020 and December 2022. In 2024, an electronic follow-up survey was sent out to all participants (n=610). At first assessment and in the follow-up survey, data was collected regarding self-reported symptoms, dyspnea (mMRC≥2), depression (PHQ-9≥10), anxiety (GAD-7≥10), functional status (PCFS), self-reported physical activity (Frändin/Grimby activity scale), HRQoL (EQ VAS) and sick leave. At the follow-up survey , participants were also asked to rate their overall recovery on a scale from 0-100 (0 = not recovered at all, 100 = fully recovered).
A total of 386 (63%) out of 610, responded to the follow-up survey. Of those who responded, 36% were men, mean age 51 (SD ± 12), 42% had two or more comorbidities prior to COVID-19, 43% had been hospitalized and 70% had higher education. Before COVID-19, 3% were on sick leave, the median PCFS grade was 0 (IQR 0) (absence of any functional limitation) and had high levels of physical activity. The median time from COVID-19 to first visit was 9.5 months (IQR 10) and 50 months (IQR 7) from illness to follow-up survey.
The most common self-reported symptoms at first assessment were fatigue (70%), dyspnea (62%), joint pain (48%), paraesthesia (42%) and chest tightness (42%). At the follow-up survey the most common symptoms were reduced physical capacity (67%), fatigue (66%), impaired memory (53%), Post external malaise (PEM) (51%) and sleep difficulties (50%).
From first assessment to follow-up survey there was a significant reduction in participants with dyspnea (58 to 48%), depression (48 to 28%), anxiety (28 to 21%) and significant improvements in self-reported physical activity, functional status and HRQoL (50 to 65 in median) (all p0.05). No significant differences were seen in sick leave rate (30 to 31%). At the follow-up survey, participants rated their overall recovery to 54 out of 100 (SD ± 30) .
Significant improvements in dyspnea, mental health, self-reported physical activity, functional status and health-related quality of life could be seen over time. However, four years after COVID-19 several symptoms persisted, one third were still on sick leave and a large variation in recovery rate was seen.
The findings highlight the importance of a long-term comprehensive assessment to evaluate persistent symptoms, mental and physical functions and rehabilitation needs in this population.
Recovery
