|Year : 2022 | Volume
| Issue : 1 | Page : 46-50
Fatigue and quality of life after 2 weeks post discharge in post-COVID-19 subjects: A cross-sectional study
Anil Muragod, Pallavi Sujit Nerurkar, Nishi Tarang Pastagia
Professor and Head of Department of Geriatric Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India
|Date of Submission||18-Mar-2021|
|Date of Decision||02-May-2022|
|Date of Acceptance||07-Jun-2022|
|Date of Web Publication||30-Jul-2022|
Dr. Anil Muragod
Professor and Head of Department of Geriatric Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka
Source of Support: None, Conflict of Interest: None
Context: Coronavirus disease (COVID-19) pandemic affected a large number of individuals globally. Fatigue follows other viral infections; many of the hospitalized persons with a moderate to severe form of COVID-19 illness report residual symptoms, contributing to activity limitations.
Aim: To assess the fatigue and quality of life (QOL) in post-COVID-19 subjects, 2 weeks after discharge.
Settings and Design: An observational study was conducted on COVID-19 subjects, 2 weeks after discharge from tertiary care hospitals.
Methodology: Subjects meeting the inclusion and exclusion criteria were recruited. Three hundred and sixteen subjects were contacted by phone call, and verbal consent was taken. The outcome measures used were the Fatigue Assessment Scale and World Health Organization QOL-BREF scale.
Statistical Analysis Used: Statistical measures such as mean and standard deviation and descriptive statistics such as percentage analysis and Pearson's correlation test were used.
Results: The correlation between fatigue and QOL was statistically significant, with a nonlinear association (P < 0.05). Hospital stay and fatigue were directly related, which was significant. Linear association demonstrated that age was negatively related to QOL and positively associated with fatigue.
Conclusion: COVID-19 subjects were more likely to have fatigue and low health-related QOL even after 2 weeks of discharge. There was a significant nonlinear correlation between fatigue and QOL in COVID-19 survivors.
Keywords: COVID-19, Fatigue, Health-related quality of life, World Health Organization quality of life-BREF
|How to cite this article:|
Muragod A, Nerurkar PS, Pastagia NT. Fatigue and quality of life after 2 weeks post discharge in post-COVID-19 subjects: A cross-sectional study. Indian J Phys Ther Res 2022;4:46-50
|How to cite this URL:|
Muragod A, Nerurkar PS, Pastagia NT. Fatigue and quality of life after 2 weeks post discharge in post-COVID-19 subjects: A cross-sectional study. Indian J Phys Ther Res [serial online] 2022 [cited 2022 Nov 29];4:46-50. Available from: https://www.ijptr.org/text.asp?2022/4/1/46/353014
| Introduction|| |
In December 2019, an outbreak of pneumonia with an unexplained cause was confirmed in Wuhan, Hubei Province, China. Inoculation of respiratory samples into human epithelial airway cells resulted in the isolation of a novel respiratory virus whose genome sequencing indicated that it was a novel severe acute respiratory syndrome coronavirus (SARS-CoV)-related coronavirus and was thus referred to as the SARS-CoV-2. The World Health Organization (WHO) announced a global coronavirus disease (COVID-19) pandemic on March 11, 2020. Coronaviruses are enveloped, positive, large, single-stranded RNA viruses infecting humans, along with a wide variety of species. SARS-CoV-2 is transmitted primarily through aerosols released by infected people when they speak, cough, or sneeze. So far, observation indicates incubation time of 5 days on an average and a median incubation period of 3 days (range: 0–24 days). The clinical conditions include acute onset of fever plus cough or acute onset of three or more signs or symptoms such as fever, cough, myalgia, odynophagia, dyspnea, and fatigue. COVID-19 involves the affection of many systems with typical extrarespiratory problems, affecting the structures of the heart, kidney, gastrointestinal, nervous, endocrine, and musculoskeletal (weakness, pain, and fatigue). Severe cases are moved to intensive care unit, and artificial ventilation is often needed. Risk factors include higher age, hypertension, kidney and heart damage, diabetes, smoking, a higher body mass index (BMI), weak immune system, cardiovascular diseases, and other demographic and lifestyle changes. Fatigue is a multifaceted health problem that includes breathlessness, cognitive dysfunction, and psychological distress. Chronic fatigue was observed in SARS patients even a year after infection. Because of their related symptomology, COVID-19 has been linked to SARS. Health-related quality of life (HRQoL) is defined as the subjective feeling by patients of the multidimensional effect of a disease. QOL is a much broader concept that encompasses both medical and psychosocial aspects, such as daily living patterns, instrumental behaviors, psychological well-being, social functioning, and health status perception, distress, and overall life satisfaction. It is known that lasting fatigue follows other viral infections such as infection due to Epstein–Barr virus, herpesvirus, human immune deficiency virus, or even the original SARS virus. Many of the hospitalized persons with a moderate to severe form of COVID-19 illness, report residual symptoms contributing to activity limitations. This has been a matter of much speculations because the day-to-day activities of the individuals would be affected. The population getting affected by COVID-19 is increasing over time in India. This study intends to assess fatigue and QOL in post-COVID-19 subjects 2 weeks after discharge. As there is a paucity of literature in this area of study, performing this research can help in planning a rehabilitation protocol.
| Subjects and Methods|| |
The design of the present study was an observational design with convenient sampling. The present study was endorsed by the ethical committee of the institution. Subjects were taken from tertiary care hospitals. The main motive of the study was elucidated and verbal informed consent was acquired from the subjects who fulfilled the inclusion and exclusion criteria. A total of 316 subjects were recruited and contacted through phone calls. Inclusion criteria were (1) post-COVID-19 subjects, 2 weeks after discharge, and (2) both males and females between the age group of 19 and 60 years. Participants were excluded if they were (1) COVID-19-positive subjects, having mild symptoms, and who were home quarantined and (2) unwilling to participate. Brief demographic data was obtained from the subjects before administering the Fatigue Assessment Scale and WHOQOL-BREF questionnaires [Figure 1].
| Results|| |
The statistical work for this thesis was performed manually as well as using the Statistical Package of Social Sciences (SPSS) version 23 (SPSS for windows, Armonk, NY: IBM corp., USA) to validate the findings. For this reason, data was entered into an excel spreadsheet and tabulated, and statistical analysis was performed. Various statistical measures such as mean and standard deviation and descriptive statistics such as percentage analysis and Pearson's correlation test were used. [Table 1] represents demographic characteristics of the study participants. The subjects in this study ranged in age from 19 to 60 years. The mean age of the subjects in the study was 42.47 ± 13.15 years. The average BMI of the participants was 24.27 ± 2.89 kg/m2. The mean hospital stay was 9.69 ± 3.08 days. [Table 2] represents the statistical notable link between fatigue and all domains of QOL (P < 0.05). It also represents the statistically significant correlation between fatigue and hospital stay. [Table 3] represents a statistically significant association between fatigue and the following symptoms: breathlessness, chest pain, and body pain. The table also represents a linear correlation of fatigue with hypertension and diabetes (P < 0.05). [Table 4] shows that age was negatively associated with HRQOL and positively associated with fatigue (P < 0.05). [Table 5] analysis demonstrated that being overweight was linearly associated with fatigue and negatively associated with QOL (P < 0.05).
|Table 2: Comparison of fatigue with Hospital stay and health related quality of life in subjects discharged from hospital following COVID-19 infection using pearson correlation analysis|
Click here to view
|Table 3: Comparison of fatigue with symptoms and comorbidities in subjects with post-COVID-19 infection using Pearson's correlation analysis|
Click here to view
|Table 4: Fatigue and health-related quality of life comparison with age in subjects with post-COVID-19 infection using Pearson's correlation analysis|
Click here to view
|Table 5: Fatigue and health-related quality of life comparison with body mass index in subjects with post-COVID-19 infection using Pearson's correlation analysis|
Click here to view
| Discussion|| |
In the present study, the mean age was 42.47 ± 13.15 years. The mean BMI of the subjects in the study was 24.27 ± 2.89 kg/m2. A similar study titled impact of COVID-19 pandemic on mental health and QOL among local residents in Liaoning Province, China: A cross-sectional study suggested a mean participant age of 37.7 ± 14.0 years and a mean BMI of 22.9 kg/m2, indicating normal BMI. As the study was conducted in China, there is a difference in ethnicity, culture, diet, physical and psychological stressors, environmental factors, and socioeconomic factors amongst the Chinese and Indian population. The results of the present study suggested that there statistically significant between fatigue and QOL. Fatigue was significant and inversely proportional to all the domains of WHOQOLBREF. A prospective cohort study of 131 COVID-19 patients discharged from a Wuhan hospital showed that 86% were symptom free 3–4 weeks after discharge, only 1.5% had breathlessness, and 0% had fatigue. The population in this sample was younger and had less comorbidities than the one in the present study. The present study's results are close to those of the Italian COVID-19 postacute care study. According to the Italian COVID-19 post-acute care report, at least one symptom remained in 87.4% of patients who recovered from COVID-19, especially fatigue and dyspnea.
The present study showed that most patients who needed hospitalization for COVID-19 infection reported fatigue even after discharge. The mean hospital stay was 9.69 ± 3.08 days. The hospital stay was directly related to the amount of fatigue experienced by the subjects; the more the length of stay in the hospital, greater was the fatigue even after 2 weeks of discharge. A similar study reported that after a mean of 110.9 days, participants continued experiencing symptoms especially fatigue and dyspnea after discharge post COVID-19 infection.
In the present study, it was observed that majority of the population that was studied complained of fatigue that included severe breathlessness, chest pain, and body pain. Another study found that a high proportion of people experienced fatigue (53.1%), dyspnea (43.4%), joint pain, (27.3%), and chest pain (21.7%). A study titled Post-COVID-19 fatigue: potential contributing factors, stated that COVID-19 has the ability to infect an extensive range of tissues, with skeletal muscle being a particularly important target. Pain, skeletal muscle weakness, and occurrence of injury are the typical symptoms of COVID-19. As a result, it is reasonable to assume that COVID-19 has a direct effect on skeletal muscle and, thus, contributes to fatigue.
In the present study, it was reported that fatigue (48.8%) was related to the presence of existing comorbidities such as hypertension (30.4%) and diabetes (21.8%). In a study done by Musharrat Noor F and Islam M, it was reported that fatigue was one of the most prevalent symptoms (33.65%) and hypertension (20.0%) and diabetes (9.78%) were the most predominant comorbidities seen in the population studied.
In the present study, fatigue was seen to be significantly higher as the age of the population advanced. The mean age of the population included in this study was 42.47 ± 13.15 years. Another study done in Dublin, Ireland, that used the Chalder Fatigue Scale (CFQ-11) which had a population with a mean age of 49.5 ± 15 years, suggested that fatigue and age were inversely related. The study reported presence of fatigue at 6 weeks after the date of last COVID-19 symptom or 6 weeks after discharge from hospital, whereas in the present study, fatigue was reported at 2 weeks postdischarge from the hospital.
In the present research, it was discovered that as the population's age increased, the QOL declined. The mean age in the present study was 42.47 ± 13.15 years (population above 60 years was excluded) and outcome measure used was WHOQOL-BREF scale. Current literature on previous coronavirus outbreak studies suggests that HRQOL was negatively affected with advancing age. One such study done in Vietnam with a population having a mean age of 44.4 ± 17.0 years (23.5% population was above 60 years) reported similar results wherein lower HRQOL scores were obtained in older population compared to the younger age groups. The study used the 36-Item Short Form Survey (SF-36) as an outcome measure. In the present study, BMI was significantly higher in subjects with fatigue. Another study conducted in the United Kingdom by Halpin et al. stated that for those with mild to extreme fatigue and those who did not have fatigue, there was no discernible variation in BMI. Few studies have investigated the association between BMI and HRQOL. In the present study, no significant relation between BMI & HRQOL was noted. Another study linking BMI and HRQOL used the EuroQol five-dimension descriptive system as an outcome measure. The results of the study suggested that BMI was negatively associated with HRQOL.
This study has some limitations. Due to the COVID-19 pandemic, researchers were unable to recruit data by personally visiting the subjects. The findings of the study stress the importance of long-term monitoring and recovery program implementation. The prospective nature of this study could be taken up in order to develop a rehabilitation protocol for the subjects who experienced fatigue and a poor QOL. In future, this study can be replicated by including different age groups. A future study could also be carried out using alternative tests such as 6-min walk test and outcome measures such as SF-36 and Chalder Fatigue Scale (CFQ-11).
| Conclusion|| |
It was noticed that during the COVID-19 pandemic, subjects with COVID-19 infection were more likely to have fatigue and low HRQoL even after 2 weeks of discharge. There was a remarkable interconnection between fatigue and QOL in COVID-19 survivors. This suggests that there is a need for the development of a rehabilitation protocol for the COVID-19 survivors.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ciotti M, Ciccozzi M, Terrinoni A, Jiang WC, Wang CB, Bernardini S. The COVID-19 pandemic. Crit Rev Clin Lab Sci 2020;57:365-88.
Karia R, Gupta I, Khandait H, Yadav A, Yadav A. COVID-19 and its modes of transmission. SN Compr Clin Med 2020;2:1798-801.
Velavan T, Meyer C. The COVID-19 epidemic. Trop Med Int Health 2020;25:278-80.
Galván-Tejada CE, Herrera-García CF, Godina-González S, Villagrana-Bañuelos KE, Amaro JDL, Herrera-García K, et al.
Persistence of COVID-19 symptoms after recovery in Mexican population. Int J Environ Res Public Health 2020;17:E9367.
Halpin S, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al
. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J Med Virol 2020;93:1013-22.
Wolff D, Nee S, Hickey NS, Marschollek M. Risk factors for COVID-19 severity and fatality: A structured literature review. Infection 2021;49:15-28.
Chen KY, Li T, Gong FH, Zhang JS, Li XK. Predictors of health-related quality of life and influencing factors for COVID-19 patients, a follow-up at one month. Front Psychiatry 2020;11:668.
Chaturvedi S, Muliyala K. The meaning in quality of life. J Psychosoc Rehabil Ment Health 2016;3:47-9.
Islam M, Cotler J, Jason L. Post-viral fatigue and COVID-19: Lessons from past epidemics. Fatigue 2020;8:61-9.
Zhang Y, Ma ZF. Impact of the COVID-19 pandemic on mental health and quality of life among local residents in Liaoning Province, China: A cross-sectional study. Int J Environ Res Public Health 2020;17:E2381.
Wang X, Xu H, Jiang H, Wang L, Lu C, Wei X, et al.
Clinical features and outcomes of discharged coronavirus disease 2019 patients: A prospective cohort study. QJM 2020;113:657-65.
Carfì A, Bernabei R, Landi F, Gemelli Against COVID-19 Post-Acute Care Study Group. Persistent symptoms in patients after acute COVID-19. JAMA 2020;324:603-5.
Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, et al.
Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect 2020;81:e4-6.
Rudroff T, Fietsam AC, Deters JR, Bryant AD, Kamholz J. Post-COVID-19 fatigue: Potential contributing factors. Brain Sci 2020;10:E1012.
Musharrat Noor F, Islam M. Prevalence of clinical manifestations and comorbidities of coronavirus (COVID-19) infection: A meta-analysis. Fortune J Health Sci 2020;01:55-97.
Townsend L, Dyer AH, Jones K, Dunne J, Mooney A, Gaffney F, et al.
Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One 2020;15:e0240784.
Nguyen HC, Nguyen MH, Do BN, Tran CQ, Nguyen TT, Pham KM, et al.
People with suspected COVID-19 symptoms were more likely depressed and had lower health-related quality of life: The potential benefit of health literacy. J Clin Med 2020;9:E965.
Park S. Pathways linking obesity to health-related quality of life. Qual Life Res 2017;26:2209-18.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]