Science News: Natural Course of Muscular Strength, Physical Performance, and Musculoskeletal Symptoms in Hospitalized Patients With COVID-19

Submitted by: Joshua Wilson, MD
Edited by: Nakul Katyal, MD

Karasu AU, Karataş L, Yıldız Y, Günendi Z. Natural course of muscular strength, physical performance, and musculoskeletal symptoms in hospitalized patients with COVID-19. Arch Phys Med Rehabil. 2023;104(1):18-26. doi:10.1016/j.apmr.2022.09.001

Summary: The clinical presentation of acute novel coronavirus 19 (COVID-19) is often quite heterogeneous ranging from asymptomatic infections to acute hypoxic respiratory failure. COVID has been shown to impact multiple tissue types leading to widespread multi-organ dysfunction. Furthermore, the acute illness can be followed by a prolonged convalescent period with persistent symptoms of cough, fatigue, generalized weakness, and muscle pain, part of a so-called "long haul COVID."
 
The study's authors investigated the long-term effects of COVID in 76 adult patients (aged >18 years) admitted to the hospital with confirmed COVID infections. Participants were separated by disease severity into mild, moderate, and severe infections based on clinical and radiographic findings. Factors such as the fraction of inspired oxygen (FiO2), oxygen saturation (SpO2), hand grip strength (HGS), five times sit-to-stand test (5XSTS), modified borg scale for rest and activities of daily living (mBorg-rest, mBorg-ADL), Barthel index and myalgia- VAS score were compared at baseline, one week, three weeks and 12 weeks.
 
At baseline, there was a significant difference in FiO2, SpO2, 5XSTS, mBorg-rest, and mBorg-ADL between disease severity groups. Within-group analysis showed significant improvement with time in moderate and severe disease groups, including HGS, 5XSTS, mBorg-rest, and mBorg-ADL. At the 12-week follow-up, FiO2 and m-borg rest and ADL scale differences between groups resolved; however, differences remained with 5XSTS and SpO2.
 
The results of the study show that acute coronavirus infection impacts oxygen saturation, requirements, perceived physical exertion, and physical performance. This difference was affected by disease severity. Fortunately, patients with higher levels of disease severity did show significant improvements, but at nearly three months post-infection, there remained deficits in physical performance.

Comments: Despite the reduction of COVID infections experienced by the global population, infections continue to spread at a basal rate. Identifying so-called long-haul COVID syndromes helps to characterize persistent physical impairments that limit patient reintegration into their daily activities and social roles. Studies such as this one help to highlight patient risk factors for developing persistent deficits that could help future target rehabilitative efforts.