Functional Status Scale Research Articles

Effect of early mobilization on functional recovery in ICU patients with post-COVID ARDS

Background. The COVID-19 pandemic has significantly increased the number of patients requiring intensive care unit (ICU) admissions due to severe complications such as acute respiratory distress syndrome (ARDS). Prolonged ICU stays, often associated with immobility, lead to muscle weakness, ICU-acquired weakness (ICU-AW), and reduced functional status, which impede recovery. Early mobilization in the ICU has been proposed as a beneficial intervention to mitigate these effects, but its impact on patients with post-COVID ARDS remains underexplored. Objective. This study aimed to evaluate the effect of early mobilization on functional recovery in ICU patients with post-COVID ARDS. Methods. A prospective, randomized controlled trial was conducted at Saveetha Medical College and Hospital, Chennai, from August 2021 to August 2024. Two hundred patients with post-COVID ARDS were randomly assigned to either an early mobilization or standard care group. The early mobilization group received structured physical therapy interventions within 48 hours of ICU admission. Functional status was measured using the ICU Mobility Scale (IMS) and Functional Status Scale ICU (FSS ICU) at baseline, weekly, and discharge. Secondary outcomes included the duration of ICU stay, mechanical ventilation, and incidence of ICU-AW. Results. Patients in the early mobilization group demonstrated significantly higher functional recovery, with a mean IMS score of 7.8 ± 1.2 compared to 4.3 ± 1.5 in the standard care group (p < 0.001). The FSS ICU score was also significantly higher in the early mobilization group (90.6 ± 8.3) than in the standard care group (65.4 ± 10.7; p < 0.001). Additionally, early mobilization reduced the mean ICU stay (14.5 ± 3.2 vs. 19.8 ± 4.1 days, p < 0.001), shortened the duration of mechanical ventilation (10.1 ± 2.9 vs. 13.7 ± 3.6 days, p < 0.001), and decreased the incidence of ICU-AW (20% vs. 45%, p = 0.002). Conclusion. Early mobilization significantly improves functional recovery, reduces ICU stay and mechanical ventilation duration, and lowers ICU-AW risk in post-COVID ARDS patients. These findings highlight the importance of integrating early mobility into standard ICU care to enhance patient outcomes.

Is Dorso-Volar Kinesiotape Added to the Home Exercise Program Effective in the Treatment of Carpal Tunnel Syndrome? Randomized Controlled Electrodiagnostic Study

Abstract Objective We aimed to compare the short- and medium-term efficacy of dorso-volar kinesiotape (KT) added to home exercises (HE) with sham-KT and HE alone in the treatment of mild or moderate carpal tunnel syndrome (CTS) in terms of pain, symptom severity, function, gripping strength, and electrophysiological parameters. Materials and Methods A total of 120 patients (99 females, 21 males) were divided into three groups dorso-volar KT and HE (n=40), sham-KT and HE (n=40), and HE (n=40). Pain (The visual analog scale [VAS]), symptom severity (Boston symptom severity scale [SSS]), functional status (Boston functional status scale [FSS]), nerve conduction study (NCS), hand, finger muscle strength were evaluated pretreatment, at the end of treatment (4th week), and in the third month posttreatment. Results There were statistically significant improvements in VAS (p<0.001), Boston SSS (except HE group) (p<0.001), and Boston FSS (p<0.001) in all groups posttreatment compared to pretreatment, and more in the dorso-volar KT group than pretreatment and the posivite improvement continued at a decreasing rate in the third month posttreatment. At the end of treatment the dorso-volar KT group showed statistically significant improvement in Boston SSS (p<0.001, p<0.001) and Boston FSS (p<0.001, p<0.001) compared to the sham-KT and HE groups. Conclusions The combination of dorso-volar KT and HE program makes a more effective and durable contribution to the improvement of CTS symptom severity, pain and functional status, as well as handgrip strength and NCS parameters compared with sham-KT and HE program.

Magnetic resonance imaging and tractography of sensorimotor tracts in fetuses with intraventricular hemorrhage: feasibility and added prognostic value.

To assess the feasibility, characteristics and prognostic value of prenatal visualization of the corticospinal tracts (CSTs) using diffusion-weighted magnetic resonance imaging (MRI)-based tractography in fetuses with intraventricular hemorrhage (IVH). This was a retrospective single-center cohort study of singleton fetuses diagnosed with IVH on MRI from January 2011 to December 2018. The left and right CSTs were reconstructed according to an in-utero diffusion tensor imaging sequence using a multi-region of interest (ROI) deterministic tractography approach. The CSTs were segmented by two polygonal ROI: at the level of the posterior limb of the internal capsule and the crus cerebri. The morphology and integrity of the CSTs were assessed visually. Internal capsule and crus cerebri apparent diffusion coefficient and fractional anisotropy values were measured. Postnatal motor function data were obtained from the parents using the functional status scale. A total of 35 fetuses with IVH (mean gestational age, 29.1 ± 5.1 (range, 19.9-38.9) weeks) were included in the analysis. Parenchymal involvement on T2-weighted sequences was demonstrated in 19(54%) of the cohort. CST involvement correlated significantly with the presence of parenchymal damage on T2-weighted imaging (P = 0.02). Among liveborn cases, the rate of motor impairment was 14% (1/7) in children with intact CSTs compared with 100% (5/5) in cases in which the CSTs were impaired (P = 0.015). Fetal corticospinal tractography is feasible technically and offers valuable prognostic information. It enhances parental counseling by providing insights into potential motor outcome, underscoring its utility in complementing fetal neurosonography in cases of prenatal IVH. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The Impact of Lymphatic Drainage and Nerve Mobilization Techniques on Nerve Morphology in Mild-to-Moderate Carpal Tunnel Syndrome: A Randomized Controlled Trial.

To investigate whether nerve mobilization related to nerve mobility or the removal of edema using lymphatic drainage affects the cross-sectional area of the nerve, hand function, and symptom severity in carpal tunnel syndrome. The study is a prospective randomized controlled trial. Data were analyzed between groups using ANOVA, Chi-squared test, and Kruskal-Wallis test. Treatment lasted 4 weeks. Splint group wore the splint daily. Splint+manual lymphatic drainage received lymphatic drainage 5 days a week. Splint+nerve mobilization performed neuromobilization exercises as home exercises 5 days a week. Evaluations were conducted before and after 4 weeks of treatment. The study included 80 patients with mild-to-moderate carpal tunnel syndrome. The patients were randomly divided into three groups: splint (n = 27), splint+manual lymphatic drainage (n = 27), or the splint+nerve mobilization (n = 26). The main outcome measures were ultrasound assessments and the Boston Carpal Tunnel Questionnaire (Symptom Severity Scale and Boston Functional Status Scale). Compared to the other groups, the nerve cross-sectional area decreased at both the carpal tunnel (p = 0.003) and mid-forearm (p = 0.014) levels in the drainage group. Nerve mobilization did not result in a significant change in the nerve cross-sectional area. All groups showed significant improvements in both symptom severity and functional status scores (p < 0.001). The reduction of edema through lymphatic drainage contributes to a decrease in the cross-sectional area of the median nerve. Additionally, all three methods appear to positively impact the functional capacity of the hand and alleviate symptoms.

Physical, Cognitive, Emotional, and Social Health Outcomes of Children in the First 6 Months After Childhood Critical Illness: A Prospective Single-Center Study

Objectives: To describe physical, cognitive, emotional, and social health outcomes of children and their trajectory in the first 6 months after PICU discharge. Design: Prospective, longitudinal observational cohort study. Setting: PICU in a tertiary pediatric hospital in Singapore from January 2021 to June 2022. Patients: One hundred thirty-five children (1 mo to 18 yr), admitted for greater than or equal to 48 hours with at least one organ dysfunction and received PICU therapy. Interventions: None. Measurements and Main Results: Serial self/parent proxy-reported assessments were obtained at: PICU admission, PICU discharge, and 1, 3, and 6 months after PICU discharge. The Pediatric Quality of Life Inventory (PedsQL) scale, Functional Status Scale (FSS), and measures of post-traumatic stress disorder (PTSD) using the Young Child PTSD Screen and the Child and Adolescent PTSD Screen-Parent Version were used. Trajectory groups were identified using group-based trajectory model. One hundred thirty-five children (mean [sd] age, 5.6 yr [5.5 yr]) were recruited. Seventy-eight (52%) were male. The mean (sd) Pediatric Index of Mortality III score was 3.2 (4.1) and PICU length of stay was 10.0 days (21.0 d). The mean (sd) PedsQL total scores were 66.5 (21.1) at baseline, 69.7 (21.4), 75.6 (19.7), and 78.4 (19.8) at 1, 3, and 6 months after PICU discharge, respectively. Overall, the PedsQL and FSS plateaued at 3 months. Our model revealed three distinct trajectory groups. Seventeen and 103 children in the mild and moderate trajectory groups, respectively, demonstrated recovery to baseline. Fifteen children in the severe trajectory group were older in age (mean [sd] 8.3 yr [6.4 yr]), with higher proportion (11/15) of preexisting illness. Five of 15 children in the severe group experienced posttraumatic stress syndrome (PTSS) at 6 months post-discharge. Conclusions: In our cohort of PICU patients, we found three unique trajectory groups. Children in the severe group were older, more likely to have preexisting conditions and at increased risk for PTSS. Early identification and intervention may improve recovery in patients with severe PICU trajectories.

Pulmonary Rehabilitation for Diseases Other Than COPD.

Review the current literature regarding pulmonary rehabilitation (PR) for non-chronic obstructive pulmonary disease (COPD) diagnoses and what the evidence is regarding expected outcomes based on disease manifestations. Literature search was performed using PubMed database from March 2024 to June 2024. Terms included "pulmonary rehabilitation" and "exercise training" in conjunction with key words "interstitial lung disease (ILD)," "idiopathic pulmonary fibrosis," "asthma," "bronchiectasis," "post-acute sequalae of SARS-CoV-2 (PASC)," "long COVID," "pulmonary hypertension (PH)," and "lung cancer." Results were filtered for English language, randomized controlled trial, clinical trial, observational trial, meta-analysis, and guidelines. Emphasis was placed on more recent publications since prior reviews, where applicable. The abundance of literature involved ILD, where studies have demonstrated significant improvements in exercise capacity, health-related quality of life (HRQoL), and dyspnea, despite heterogeneity of diseases; benefits are similar to those seen with COPD. Those with milder disease have more sustained benefits longer term. Patients with asthma benefit in severe disease, lower exercise activity, elevated body mass index, or when comorbid conditions are present, and breathing exercises can improve symptoms of breathlessness. Patients with PASC have a multitude of symptoms and lack benefits in HRQoL measurements; PR improves performance on post-COVID-19 functional status scale, a more comprehensive measurement of symptoms. Those with bronchiectasis benefit from PR when airflow limitation or exacerbations are impacting symptoms and HRQoL. Those with stable PH can improve their exertional capacity without change in disease severity. PR reduces perioperative complications in those with lung cancer and preserve fitness during treatment.

Paediatric survivors of extracorporeal life support functional outcomes at one-year follow-up.

To investigate functional outcomes in children who survived extracorporeal life support at 12 months follow-up post-discharge. Some patients who require extracorporeal life support acquire significant morbidity during their hospitalisation. The Functional Status Scale is a validated tool that allows quantification of paediatric function. A retrospective study that included children placed on extracorporeal life support at a quaternary children's hospital between March 2020 and October 2021 and had follow-up encounter within 12 months post-discharge. Forty-two patients met inclusion criteria: 33% female, 93% veno-arterial extracorporeal membrane oxygenation (VA ECMO), and 12% with single ventricle anatomy. Median age was 1.7 years (interquartile range 10 days-11.9 years). Median hospital stay was 51 days (interquartile range 34-91 days), and median extracorporeal life support duration was 94 hours (interquartile range 56-142 hours). The median Functional Status Scale at discharge was 8.0 (interquartile range 6.3-8.8). The mean change in Functional Status Scale from discharge to follow-up at 9 months (n = 37) was -0.8 [95% confidence interval (CI) -1.3 to -0.4, p < 0.001] and at 12 months (n = 34) was -1 (95% confidence interval -1.5 to -0.4, p < 0.001); the most improvement was in the feeding score. New morbidity (Functional Status Scale increase of ≥3) occurred in 10 children (24%) from admission to discharge. Children with new morbidity were more likely to be younger (p = 0.01), have an underlying genetic syndrome (p = 0.02), and demonstrate evidence of neurologic injury by electroencephalogram or imaging (p = 0.05). In survivors of extracorporeal life support, the Functional Status Scale improved from discharge to 12-month follow-up, with the most improvement demonstrated in the feeding score.

Determining the Association of Hyperoxia While on Extracorporeal Life Support with Mortality in Neonates Following Norwood Operation

Background: Patients requiring extracorporeal life support (ECLS) support post-Norwood operation constitute an extremely high-risk group. Materials &amp; Methods: We retrospectively aimed to evaluate the relationship of hyperoxia with mortality and other clinical outcomes in patients who required ECLS following Norwood operation between January/2010 – December/2020 in a large volume center. Results: During the study period 65 patients required ECLS post-Norwood. Using receiver operating characteristic (ROC) curve analysis, mean PaO2 of 182 mmHg in the first 48-hours on ECLS was determined to have the optimal discriminatory ability for mortality (sensitivity 68%, specificity 70%). Of the 65 patients, 52% had PaO2&gt;182 mmHg and were designated as hyperoxia-group. Patients in the hyperoxia-group had longer cardiopulmonary bypass time (187 vs 165 minutes, p=0.023), shorter duration from CICU arrival to ECLS-cannulation (13.28 vs 132.58 hours, p=0.003), higher serum lactate within 2-hours from ECLS-canulation (14.55 vs 5.80, p=0.01), higher ECLS flows in the 1st 4-hours (152.68 vs 124.14, p=0.006), and higher mortality (77% vs 39%, p=0.005). In the unadjusted-analysis, using a derived cut-point, patients in the hyperoxia-group had 5.15-higher odds of mortality (p=0.003). However, this association was insignificant when adjusting for confounding variables (p=0.104). Using functional status scale, new morbidity (38% vs 21%), and unfavorable outcomes (13% vs 5%) were higher in the hyperoxia-group. Despite being higher in the hyperoxia group, this did not reach statistical significance. Conclusion: Neonates with hyperoxia (PaO2 &gt;182 torr) during the first 48-hours of ECLS post-Norwood operation had 5-times higher odds of mortality in the unadjusted analysis, however, this was insignificant when adjusting for confounding variables. Patients in the hyperoxia-group had shorter duration from CICU arrival to ECLS-cannulation, higher serum lactate prior to ECLS-canulation, and higher ECLS flows in the 1st 4-hours, (p&lt;0.05). Multicenter evaluation of this modifiable risk-factor is imperative to improve the care of this high-risk cohort.

Prevalence and Predictors of Carpal Tunnel Syndrome Symptoms Among Teachers in Jazan: A Cross-Sectional Study.

Background Carpal tunnel syndrome (CTS) is a common musculoskeletal condition of the hand and wrist frequently associated with repetitive hand motion and environmental considerations. Teachers are more likely to acquire CTS because of their lengthy writing and computer use. This study aimed to determine the prevalence of CTS symptoms and related variables among schoolteachers in Jazan, Saudi Arabia. Methods This study was conducted as a cross-sectional survey of teachers in Jazan, utilizing an online platform for data collection. The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was the primary tool used to determine symptom intensity and functional status. The data were rigorously analyzed using a range of statistical methods, including descriptive statistics, the Mann-Whitney U test, the Kruskal-Wallis test, Spearman's correlation, the chi-square test, Fisher's exact test, and binary logistic regression, ensuring the robustness of the findings. Results The study comprised 336 schoolteachers with a mean age of 43.3 ± 6.5 years, of whom 58.0% were female and 42.0% were male. About 8.0% of instructors reported CTS symptoms. Female gender (median Symptom Severity Scale (SSS): 15.0 vs. 12.0, p < 0.001; median Functional Status Scale (FSS): 8.0 vs. 8.0, p < 0.001), increased time spent writing (r = 0.237, p < 0.001 for SSS; r = 0.217,p < 0.001 for FSS), and presence of comorbidities such as diabetes (median SSS: 16.0, p = 0.002; median FSS: 8.0, p = 0.001) had a negative correlation with symptom severity (r = -0.174, p = 0.002) and functional impairment (r = -0.141, p = 0.011). Surgical therapy (median SSS: 32.0; median FSS: 24.0; p<0.001) and post-treatment symptom recurrence (median SSS: 28.0; median FSS: 22.0; p<0.001) were associated with increased severity and disability. According to binary logistic regression, increased writing time significantly predicted CTS diagnosis (OR = 1.151, 95% CI: 1.024-1.295, p = 0.018). Conclusion CTS symptoms are common among Jazan teachers, and various sociodemographic, vocational, and clinical variables influence their intensity and functional status. Ergonomic treatment, early identification, and suitable management measures are critical for preventing and mitigating the effects of CTS among teachers. Additional research is required to develop focused therapies and enhance the results of this occupational group.

Evaluation of the post-COVID multidisciplinary outpatient clinic at the Pulmonary Division of the Cantonal Hospital Winterthur from the patient's perspective: a mixed-methods study.

This prospective study, conducted with patients from the multidisciplinary post-COVID outpatient clinic at the Pulmonary Division of the Cantonal Hospital Winterthur, aimed to investigate changes in patients' main symptoms, elements that aided in coping with the condition and satisfaction with the consulting and therapeutic interventions. After obtaining ethical approval, fifty patients were consecutively included in this longitudinal study, which incorporated three survey times post-consultation: t1 (0-7 days), t2 (4-8 weeks) and t3 (4-6 months). The survey comprised standardised questionnaires, including the Hospital Anxiety and Depression Scale, the Post-COVID-19 Functional Status scale and the Chalder Fatigue scale, along with study-specific questions regarding symptoms and reasons for consulting the post-COVID outpatient clinic. Additionally, ten patients were invited to participate in qualitative individual interviews at t2 and t3. The study was conducted between November 2021 and February 2023. The median age of the 50 participants was 47 years (IQR: 36-55), with 66% (33/50) being female. Most participants (66% or 33/50) reported no pre-existing conditions prior to COVID-19 infection, and only six patients required hospitalisation during the acute phase of their infection. Visits to the multidisciplinary post-COVID clinic occurred approximately eight months post-infection, with referrals primarily made by primary care physicians (82% or 41/50). The majority of patients experienced persistent tiredness, exhaustion and fatigue (94% or 47/50), along with reduced physical performance (82% or 41/50), while pain or breathing difficulties were less frequently mentioned. At t1, around half of the patients were fully or partially unable to work, a proportion that reduced to around a third by t3. Symptoms generally decreased over time, with significant improvements observed between t2 and t3. However, subjectively perceived cognitive limitations worsened or were reported more frequently over time. Most patients (96% or 48/50) felt well cared for throughout their consultations. In qualitative interviews, patients highlighted the medical staff's attentiveness and the time dedicated to consultations, which made them feel that their complaints were taken seriously and that they received appropriate information. The results confirmed that the multidisciplinary post-COVID outpatient clinic met most respondents' expectations. Patients found that the attentive interprofessional coaching was most helpful in coping with their illness. However, participants also noted long waiting times and expressed a desire for earlier admission to the clinic.

A Comparative Study of Cognitive and Motor Performance in Liver Recipients.

Introduction: Neurocognitive and motor impairments are often observed both before and after liver transplantation, resulting in inefficiencies in dual-task performance. Specific aim: The aim of this study was to evaluate the motor-cognitive dual-task performance in liver recipients, with a particular emphasis on cognition, performance status, and the impact of the COVID-19 pandemic. Design: A prospective, cross-sectional, web-based design with a control group was used. The study included 22 liver transplant recipients and 23 controls. Participants completed a motor-cognitive dual-task test (timed up and go test, TUG), a cognitive assessment (mini mental state examination), and a physical performance test (5-repetition sit-to-stand test). The study also used a functional performance status scale (The Karnofsky performance status) and assessed fear of coronavirus disease (fear of COVID-19 scale). Dual-task interference was assessed and the rate of correct responses per second was calculated to assess cognitive performance. Results: The results indicated no statistically significant difference in TUG time and TUG correct responses per second between the groups (group × condition interactions; P > 0.05). There was no significant difference in cognitive and motor dual-task interference during the TUG test between the two groups (P > 0.05). The Karnofsky Performance Status score was significantly correlated with TUG motor dual-task interference (r = -0.424 and P = 0.049). Conclusion: This study suggests that dual-task performance does not differ in cognitive or motor performance between liver recipients and healthy controls under the same dual-task condition. However, further controlled studies are needed to improve the generalizability of these findings.

The Post-COVID-19 Functional Status Scale in moderate and severe COVID-19 infections in a tertiary referral hospital in Indonesia: a retrospective study

Background &amp; objective: Coronavirus disease 2019 (COVID-19) is known to have caused respiratory function derangement that can affect changes in the body's physiological conditions even after the active phase of infection is over. This study aimed to overview the Post-COVID-19 Functional Status (PCFS) scale at the 3rd and 6th months after treatment of moderate to severe COVID-19 infections in our tertiary referral hospital. Methodology: A descriptive observational study was conducted for confirmed COVID-19 patients with moderate to severe symptoms treated in Hasan Sadikin Hospital from June-August of 2021 by following them at third- and sixth-month post-infection and their PCFS was recorded. A total of 153 patients were enrolled in the study. Results: Eighty subjects (52.3%) were male, and 91 subjects (59.4%) had an average body mass index. Thirty-seven (24.2%) patients were diagnosed with severe symptoms, and 116 (75.8%) were diagnosed with moderate symptoms. In their third month post-infection, 30.7% of patients were on a scale of 0, 32.7% on a scale of 1, 20.9% on a scale of 2, 12.4% on a scale of 3, and 3.3% on a scale of 4. In their sixth month post-infection, 81.7% of patients were on a scale of 0, 15% on a scale of 1, and 3.3% on a scale of 3. Conclusion: The assessment of post-COVID-19 functional status has a significant role in understanding the pathophysiology and recovery process of the disease. The patients are recommended to have medical check-ups regarding organ function to determine the impact of COVID-19 and advised to undergo medical rehabilitation to return to their initial functional status. Keywords: COVID-19; Functional Status; PCFS; Post-Infection; Questionnaire Citation: Suwarman S, Rahman FA. The post-COVID-19 Functional Status Scale in moderate and severe COVID-19 infections in a tertiary referral hospital in Indonesia: a retrospective study. Anaesth. pain intensive care 2024;28(4):633−639; DOI: 10.35975/apic.v28i4.2505 Received: Mar 26, 2024; Reviewed: June 5, 2026; Accepted: June 6, 2026

Impact of Functional Limitation on Quality of Life among Covid-19 Survivors

Background: It has been evident that after viral infections (e.g., SARS-1), patients often sustain functional limitations over a long period after discharge from the hospital. Persisting symptoms with subsequent progression to poor functional status have been reported in a substantial proportion of these patients. These patients are susceptible to developing reduced functional status that impact their ability to care for themselves and to perform usual activities of daily living in the months following hospital admission. Previous severe acute respiratory syndrome (SARS) outbreaks showed to affect the survivors lung function, exercise capacity, health-related quality of life (HrQoL), mental health, and lead to increased symptoms of fatigue and dyspnea from 6 months to 2 years after symptom onset. This study aims to assess those recovering from COVID-19 for symptoms of functional limitation and its impact on quality of life, thus identifying a group worthy of further study and early intervention. . Objective: To determine the impact of functional limitation on quality of life among COVID– 19 survivors Methods 87 patients exposed with covid-19 virus was followed up and assessed for functional limitation and quality of life. Participants were asked on a telephone to choose an appropriate option for each question in relation to current situation from the functional status scale and WHOQOL-BREF among COVID 19 survivors. Result: Karl Pearson correlation coefficient was used to determine the impact of functional limitation on quality of life among COVID19 survivors. Impact of functional limitation on four domains of quality of life was statistically significant at p&lt;0.001. There was significantly strong negative correlation found between functional status scale and domain1 (r=-0.823) and functional status scale and domain 3 (r=-0.902) whereas there was significantly moderate negative correlation between functional status scale and domain 2 (r=0.584), functional status scale and domain 4 (r=-0.416). Conclusion: Present study concludes that there is a profound functional limitation after 6 months of post COVID. Hence the functional limitation and its associated symptoms need to be monitored and early intervention needs to be planned in post COVID19 patients.

Resilience and quality of life in patients who underwent mechanical ventilation due to COVID-19, one year after discharge: a cross-sectional study

BackgroundPatients with COVID-19 often experience severe long-term sequelae. This study aimed to assess resilience and Quality of Life (QoL) of patients who underwent mechanical ventilation due to COVID-19, one year after discharge.MethodsThis cross-sectional study enrolled patients who received mechanical ventilation for severe COVID-19 and were assessed one-year post-discharge. Participants completed a structured questionnaire via telephone comprising the Connor-Davidson Resilience Scale (CD-RISC) and the Post-COVID-19 Functional Status scale (PCFS). To establish the association between QoL and resilience, Spearman correlations were calculated between the PCFS and the CD-RISC. Linear regression models were adjusted to evaluate which factors were associated with QoL, with the total score of PCFS as the dependent variable.ResultsA total of 225 patients were included in the analysis. The CD-RISC had a median score of 83 (IQR 74–91). The PCFS results showed that 61.3% (n = 138) of the patients were able to resume their daily activities without limitations. Among them, 37.3% (n = 84) were classified as Grade 0 and 24% (n = 54) as Grade 1. Mild and moderate functional limitations were found in 33.7% of the patients, with 24.8% (n = 56) classified as Grade 2 and 8.8% (n = 20) as Grade 3. Severe functional limitations (Grade 4) were observed in 4.8% (n = 11) of the patients. High CD-RISC scores were associated with lower levels of PCFS score (p < 0.001).ConclusionsIn this cohort of critically ill patients who underwent mechanical ventilation due to COVID-19, 38% of patients experienced a significant decline in their QoL one year after hospital discharge. Finally, a high level of resilience was strongly associated with better QoL one year after discharge.

Functional status related to post-COVID 19 Syndrome in the nursing staff of a Second Level Hospital in Quito-Ecuador

Introduction: Nurses are on the front line fighting against the COVID-19 and are at high risk of infection by direct patient care. Multiple factors determine the severity of this disease and along with persistent symptoms due to subsequent infection, affect the functional status of the infected nurses. General Objective: To determine the functional status related to the post-COVID-19 in direct patient care nurses at Hospital General Docente de Calderón during 2022. Method: The research has a quantitative approach with a descriptive, observational and cross-sectional design which determined the functional status related to the post-COVID 19 syndrome in 142 respondents. For this purpose it was used the Spanish version of Post COVID 19 Functional Status Scale, previously validated. Results: The average age of the participants was 36.8 years, 110 women and 32 men. Regarding functional limitations, 54.9% had no limitations, 16.9% had minimal limitations, 5.6% had mild limitations, 12.7% had moderate limitations and 9.9% had severe limitations. By exploring possible associations between variables, a significant relationship (p&lt;0.005) was found between functional status with age and the number of infections. Conclusions: Although the largest percentage does not present functional limitations, it is worth noting that the 45.1% of nurses and auxiliary nurses, with minimal or severe functional limitations, continue to work in areas of medium or greater complexity. It constitutes an important input for the improvement of occupational health.

Relationship between anhedonia and psychosocial functioning in post-COVID-19 condition: a post-hoc analysis

Background Post-COVID-19 condition (PCC), also known as "long COVID," is characterized by persistent symptoms, negatively affecting the well-being of individuals with PCC. Anhedonia (i.e. reduced capacity for pleasure) and compromised psychosocial functioning are notable symptoms in those with PCC. We aimed to provide insights to understand the effects of anhedonia and impaired psychosocial functioning of individuals with PCC. Methods This post-hoc analysis used data from an 8-week, double-blind, randomized, placebo-controlled trial which evaluated vortioxetine for cognitive deficits in individuals with PCC (Clinicaltrials.gov Identifier: NCT05047952). A total of 147 eligible participants were randomly assigned to receive vortioxetine or matching placebo over eight weeks of double-blind treatment. Our study investigated the relationship between anhedonia, assessed by the Snaith-Hamilton Pleasure Scale (SHAPS), and psychosocial functioning, measured with the Post-COVID Functional Status (PCFS) scale. The analysis was conducted using a generalized linear model, with adjustments for relevant covariates such as age, sex, education, suspected versus confirmed COVID diagnosis, MDD diagnosis, and alcohol consumption. Results Of the 147 participants, 143 participants had available baseline data for analysis. We observed that baseline PCFS score was statistically significantly positively correlated to baseline SHAPS score (β = 0.070, p = 0.045, 95% CI). Discussions Our analysis revealed a significant relationship between measures of anhedonia and psychosocial functioning in adults with PCC. Strategies that aim to improve patient-reported outcomes with PCC need to prioritize the prevention and treatment of hedonic disturbances in patients experiencing PCC.

Long-term course of ambulatory patients with COVID-19 initially treated with enoxaparin vs no anticoagulation: final analysis of the OVID (enoxaparin for outpatients with COVID-19) randomized trial

BackgroundEarly thromboprophylaxis does not prevent hospital admissions and death among outpatients with symptomatic COVID-19. Its impact on long-term outcomes, including long COVID symptoms and performance status, is unknown. ObjectivesTo assess the long-term effects of thromboprophylaxis given at the time of acute COVID-19 in outpatients. MethodsThe OVID (enoxaparin for outpatients with COVID-19) trial randomized outpatients older than 50 years with acute COVID-19 to receive either subcutaneous enoxaparin 40 mg once daily for 14 days or standard of care (no thromboprophylaxis). In this follow-up study, we assessed the 2-year outcomes, including all-cause hospitalization and death, cardiovascular events, long COVID symptoms, and functional limitations based on the Post–COVID-19 Functional Status (PCFS) scale and EuroQol-5 Dimensions-5 Levels scale. ResultsOf 469 potentially eligible patients, 468 survived, of whom 439 (mean age 59 years; 54% men) participated in the Post-OVID study. There was no difference in terms of hospitalization and death (8.3% in the treatment group vs 10% in controls; relative risk, 0.83; 95% CI, 0.5-1.5) and of cardiovascular events between groups. The risk of presenting with long COVID symptoms was similar in the 2 groups (44% in the treatment group vs 47% in the standard of care group), with no difference between groups also concerning individual symptoms. A PCFS grade of 1 to 3, indicating light-to-moderate functional limitation, was recorded in 15% of patients in each group (odds ratio, 0.98; 95% CI, 0.6-1.7). No patients reported severe limitations (PCFS grade 4). Median EuroQol visual analog scale score was 85 on 100 points (IQR, 80-90 for the standard of care group and 75-90 for the enoxaparin group). ConclusionEarly thromboprophylaxis does not improve long-term, 2-year clinical and functional outcomes among symptomatic ambulatory patients with acute COVID-19.

Safety and effectiveness of ultrasound-guided single injection of 5% dextrose for median nerve hydrodissection in carpal tunnel syndrome

Background: In carpal tunnel syndrome (CTS), conservative management did not show satisfactory results, and some patients required revision surgery due to persistent or recurrent symptoms. Ultrasound (USG)-guided median nerve (MN) hydrodissection with a 5% dextrose injection is an advanced approach for treating symptoms of CTS. We prospectively investigated the patients to demonstrate the safety and effectiveness of this approach. Aims and Objectives: This study aims to evaluate the effect of USG-guided nerve hydrodissection using single injection of 5% dextrose on pain, MN conduction parameters, and functional status in patients with CTS of mild–to-moderate grade. The study also predicts about the safety of the procedure. Materials and Methods: A study was performed in the pain clinic of the tertiary care teaching institute of India for one year. The study included 15 patients diagnosed with mild-to-moderate CTS. The diagnosis was done on the basis of history, physical examination, and a nerve conduction velocity (NCV) study. Patients were given analgesics and NSAIDS and enrolled in the procedure. Parameters used for statistical analysis were Visual Analog Scale (VAS) scores, NCV study data (sensory conduction velocity [SNCV] and distal motor latency [DML]), and Boston carpal tunnel questionnaire (BCTQ) scores. Pre-injection parameters were compared with parameters 3 months after the injection to show the usefulness of this procedure. Results: A statistically significant reduction in VAS score was found in 74% of the cases (P&lt;0.05). The nerve conduction study parameters have shown significantly higher SNCV and lower DML latency in 60% of cases (P=0.001 and P=0.001, respectively). Improved BCTQ scores were found in 80% of cases (for the symptom severity scale, P=0.001 and for the functional status scale, P&lt;0.01). No complications such as allergic reactions, sensory loss, or paresis were recorded post-injection. However, transient injection site pain was present in all patients which did not last for more than 24 h. Conclusion: MN hydrodissection using a single injection of 5% dextrose under USG is a safe and effective approach offering pain relief, better MN conduction, and improved functional status in patients with CTS of mild-to-moderate grade.

Severe Pediatric Neurological Manifestations With SARS-CoV-2 or MIS-C Hospitalization and New Morbidity

Neurological manifestations during acute SARS-CoV-2-related multisystem inflammatory syndrome in children (MIS-C) are common in hospitalized patients younger than 18 years and may increase risk of new neurocognitive or functional morbidity. To assess the association of severe neurological manifestations during a SARS-CoV-2-related hospital admission with new neurocognitive or functional morbidities at discharge. This prospective cohort study from 46 centers in 10 countries included patients younger than 18 years who were hospitalized for acute SARS-CoV-2 or MIS-C between January 2, 2020, and July 31, 2021. Severe neurological manifestations, which included acute encephalopathy, seizures or status epilepticus, meningitis or encephalitis, sympathetic storming or dysautonomia, cardiac arrest, coma, delirium, and stroke. The primary outcome was new neurocognitive (based on the Pediatric Cerebral Performance Category scale) and/or functional (based on the Functional Status Scale) morbidity at hospital discharge. Multivariable logistic regression analyses were performed to examine the association of severe neurological manifestations with new morbidity in each SARS-CoV-2-related condition. Overall, 3568 patients younger than 18 years (median age, 8 years [IQR, 1-14 years]; 54.3% male) were included in this study. Most (2980 [83.5%]) had acute SARS-CoV-2; the remainder (588 [16.5%]) had MIS-C. Among the patients with acute SARS-CoV-2, 536 (18.0%) had a severe neurological manifestation during hospitalization, as did 146 patients with MIS-C (24.8%). Among survivors with acute SARS-CoV-2, those with severe neurological manifestations were more likely to have new neurocognitive or functional morbidity at hospital discharge compared with those without severe neurological manifestations (27.7% [n = 142] vs 14.6% [n = 356]; P < .001). For survivors with MIS-C, 28.0% (n = 39) with severe neurological manifestations had new neurocognitive and/or functional morbidity at hospital discharge compared with 15.5% (n = 68) of those without severe neurological manifestations (P = .002). When adjusting for risk factors in those with severe neurological manifestations, both patients with acute SARS-CoV-2 (odds ratio, 1.85 [95% CI, 1.27-2.70]; P = .001) and those with MIS-C (odds ratio, 2.18 [95% CI, 1.22-3.89]; P = .009) had higher odds of having new neurocognitive and/or functional morbidity at hospital discharge. The results of this study suggest that children and adolescents with acute SARS-CoV-2 or MIS-C and severe neurological manifestations may be at high risk for long-term impairment and may benefit from screening and early intervention to assist recovery.

Validity of Functional Status and Pain Assessment Scale in Hospitalized Adult SCD Patients

Validity of Functional Status and Pain Assessment Scale in Hospitalized Adult SCD Patients