Life after COVID-19: the road from intensive care back to living – a prospective cohort study

• Published in: BMJ open 2022-11, Vol.12 (11), p.e062332-e062332
• Main Authors: Wiertz, Carolina M H, Hemmen, Bena, Sep, Simone J S, van Santen, Susanne, van Horn, Yvette Y, van Kuijk, Sander M J, Verbunt, Jeanine A
• Format: Article
• Language: English
• Subjects: Adult intensive & critical care; Anxiety; Cohort analysis; Coping; Coronaviruses; COVID-19; Intensive care; Post traumatic stress disorder; Rehabilitation; Rehabilitation Medicine
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-062332

ObjectivesThe aim of the study was to evaluate recovery of participation in post-COVID-19 patients during the first year after intensive care unit (ICU) discharge. The secondary aim was to identify the early determinants associated with recovery of participation.DesignProspective cohort study.SettingCOVID-19 post-ICU inpatient rehabilitation in the Netherlands, during the first epidemic wave between April and July 2020, with 1-year follow-up.ParticipantsCOVID-19 ICU survivors ≥18 years of age needing inpatient rehabilitation.Main outcome measuresParticipation in society was assessed by the ‘Utrecht Scale for Evaluation of Rehabilitation-Participation’ (USER-P) restrictions scale. Secondary measures of body function impairments (muscle force, pulmonary function, fatigue (Multidimensional Fatigue Inventory), breathlessness (Medical Research Council (MRC) breathlessness scale), pain (Numerical Rating Scale)), activity limitations (6-minute walking test, Patient reported outcomes measurement information system (PROMIS) 8b), personal factors (coping (Utrecht Proactive Coping Scale), anxiety and depression (Hospital Anxiety and Depression Scale), post-traumatic stress (Global Psychotrauma Screen—Post Traumatic Stress Disorder), cognitive functioning (Checklist for Cognitive Consequences after an ICU-admission)) and social factors were used. Statistical analyses: linear mixed-effects model, with recovery of participation levels as dependent variable. Patient characteristics in domains of body function, activity limitations, personal and social factors were added as independent variables.ResultsThis study included 67 COVID-19 ICU survivors (mean age 62 years, 78% male). Mean USER-P restrictions scores increased over time; mean participation levels increasing from 62.0, 76.5 to 86.1 at 1, 3 and 12 months, respectively. After 1 year, 50% had not fully resumed work and restrictions were reported in physical exercise (51%), household duties (46%) and leisure activities (29%). Self-reported complaints of breathlessness and fatigue, more perceived limitations in daily life, as well as personal factors (less proactive coping style and anxiety/depression complaints) were associated with delayed recovery of participation (all p value