Exploring the post-acute sequelae of COVID-19 in rehabilitated patients

In a recent study published in the Archives of Physical Medicine and Rehabilitation, researchers explored the cognitive and psychological functioning among patients that received outpatient rehabilitation for post-coronavirus disease (COVID) sequelae.

Background

In the months after acute sickness has subsided, people with COVID-19 frequently continue to experience persistent symptoms. Roughly 10% to 30% of COVID-19 patients experience these ongoing symptoms, collectively known as post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC), even if their initial infection was mild.

Outpatient rehabilitation programs may be ideally suited to lessen the incapacitating effects of COVID-19 and associated problems. Despite their advantages and significant exceptions, there is a shortage of information on the sociodemographic, cognitive, and psychological traits of PASC patients who seek rehabilitation. 

About the study

In the present study, a cohort of COVID-19 survivors that received outpatient therapy at an urban COVID recovery clinic was profiled concerning sociodemographic features and cognitive and psychological presenting problems.

All consecutive, distinct individuals who sought PASC symptom relief between June 2020 and April 2021 at the study health system's post-COVID clinic were included. Data was gathered from medical records and formal surveys completed during the initial visit. Age, sex, race/ethnicity, and health insurance status were some of the demographic factors assessed.

Concerning COVID-19, the team collected data on whether the patient was admitted to a hospital or an intensive care unit. The researchers also determined the number of weeks that passed since the COVID-19 diagnosis based on the dates of the initial COVID test that was positive and the first post-COVID clinic visit. The patients were labeled post-COVID syndrome if their symptoms persisted for more than 12 weeks.

The same standardized evaluation was performed on all patients, and it comprised a detailed examination of the symptoms and impairments associated with COVID-19. To diagnose anxiety and depression, the validated 14-item Hospital Anxiety and Depression Scales (HADS-A and HADS-D) were used. In contrast, the Impact of Event Scale (IES-6), an epidemiological screening tool employed for post-traumatic stress disorder (PTSD), was used to determine the severity of COVID-19-related traumatic experiences. The Montreal Cognitive Assessment (MoCA-Blind), which was a 12-item test of overall cognitive performance, identified moderate cognitive dysfunction to evaluate cognitive functioning.

Results

From June 2020 to April 2021, the post-COVID-19 clinic of the study health system evaluated 324 patients, 58.6% of whom were under 50 years old, and 68.8% were female. Moreover, 16% of the population identified as African American, 5.2% as Latino or Hispanic, and 10.5% as belonging to another race. One in eight individuals had only completed high school, while approximately 9.1% were below the poverty line,  as determined by Medicaid enrollment.

In each of the four cognitive and psychological metrics, more than one-third of the sample had scores that indicated dysfunction, including 17.5% with cognitive impairment, 31.8% with symptoms of severe depression, 43% with moderate to severe PTSD symptoms, and 37.9% with severe anxiety.

The team found no differences in the demographics of COVID-19 survivors with severe anxiety, severe depression, or moderate to severe PTSD symptoms. However, a greater proportion of individuals with cognitive dysfunction were older, of the female gender, and identified as African American or Black as compared to those that did not report cognitive dysfunction. Notably, compared to 17.9% and 21% of people with severe anxiety and PTSD, almost 30% and 38% of individuals with severe depression and cognitive impairment were hospitalized due to COVID-19.

Time since the acute viral infection showed no correlation to patients' experiences of serious mental health, psychological, or cognitive deficits, except for a slightly greater chance of PTSD symptoms among those 12 to 29 weeks following COVID diagnosis. A higher risk of cognitive impairment and severe depression was linked to the severity of the acute infection, as assessed by whether the patient was hospitalized for COVID-19.

On the other hand, neither the severity of acute infection nor the occurrence of moderate to severe PTSD symptoms was related.

Overall, the study findings showed that even among patients with access to post-acute COVID-19 rehabilitation therapy, there was persistent evidence of racial and socioeconomic differences in results, which has important ramifications for PASC policy.

Written by

Bhavana Kunkalikar

Bhavana Kunkalikar is a medical writer based in Goa, India. Her academic background is in Pharmaceutical sciences and she holds a Bachelor's degree in Pharmacy. Her educational background allowed her to foster an interest in anatomical and physiological sciences. Her college project work based on ‘The manifestations and causes of sickle cell anemia’ formed the stepping stone to a life-long fascination with human pathophysiology.