In a recent study published in JAMA Network Open, researchers evaluated the long-term impact on veterans’ activities of daily living 18 months after COVID-19 infection, comparing veterans with and without a history of COVID-19 infection.
Study: Self-reported daily functioning after COVID-19 infection. Image credit: Lightspring / Shutterstock
background
Although the World Health Organization (WHO) defines the post-COVID-19 condition as one that has a significant impact on daily life, many studies that focus on post-COVID-19 symptoms or new diagnoses overlook the functional impact. Studies comparing people with and without previous COVID-19 infection in the general population often confound the impact of the disease with predisposing risk factors. Recent studies have concluded that new diagnoses after COVID-19 result in significant long-term disability, but few directly measure disability as yet. Further studies are needed to validate the putative associations and understand the long-term functional impact of COVID-19.
About the Research
For this study, verbal informed consent was obtained from participants in a prospective survey conducted by telephone and mail among veterans 18 months after COVID-19 infection from October 2020 to April 2021. This time period was chosen to ensure that the health care system was adapting to the initial shock of the pandemic and to minimize errors in classification of COVID-19 cases by relying on facility-based testing rather than at-home testing.
The study population consisted of veterans involved in the Department of Veterans Affairs (VA) health care system, matched on several criteria, including months with or without COVID-19 infection, demographic variables, and other health-related factors. The aim of the selection process was to identify veterans with documented COVID-19 infection and match them with uninfected comparison subjects based on a comprehensive set of variables to minimize confounding effects when assessing post-COVID status.
The study stratified and randomly sampled veterans across different months and US regions, emphasizing a methodological approach that accurately represents the national veteran population. A sophisticated matching process paired each COVID-19 case with a comparison subject with no documented infection, highlighting the robustness of the study and the precision of the comparison.
The study was designed to explore the potential for COVID-19 to cause disability, comparing its impact on daily life with sepsis and pneumonia. Accurate matching and maintaining internal validity required significant resources. Carefully designed survey activities encouraged participation through incentives and use of validated tools, assessed the health and functioning of US Veterans, and ensured comprehensive data collection.
Statistical analyses included assessing covariate balance and using regression models to explore the association between COVID-19 infection and various health outcomes. Analyses were weighted to account for potential biases and accurately reflect complex sampling and response rates.
research result
The study looked at 186 pairs of veterans, one who had recovered from COVID-19 and one who had not, with the average age of participants being in their early 60s and the majority being male. When fatigue and pain were examined, it was found that both cohorts reported similar fatigue levels, with no statistically significant difference in scores. Interestingly, the proportion of veterans in the COVID-19 group who reported experiencing moderate to severe pain was slightly lower than in the uninfected group, but this difference was not statistically significant.
The study looked more closely at how activities of daily living were affected. Both groups reported a similar number of limitations in activities of daily living and instrumental activities, and there were no significant differences between the groups in the mean number of limitations reported or the likelihood of reporting multiple limitations.
Another aspect investigated was life-space mobility, measuring an individual’s geographic mobility and independence. The results showed that mobility levels were similar between those infected with COVID-19 and those without, with a significant proportion of both groups experiencing severe restrictions in their mobility. Employment rates 18 months after COVID-19 infection also did not differ significantly between the groups.
Quality of life assessments revealed participants’ subjective sense of recovery. A slightly higher proportion of people in the COVID-19 infected group felt that they had not recovered to the level of physical and mental capabilities they had at the beginning of 2020 compared to the non-infected group, but the difference was not statistically significant. Health-related quality of life was measured with the EuroQol 5-dimension 5-level scale.
(EQ-5D-5L) health utility scale also showed small differences between the two cohorts.
The study conducted sensitivity analyses to validate the findings, including evaluating without excluding certain participants and examining the potential lasting effects of COVID-19 on hospitalized patients, who showed some signs of lasting effects, including increased fatigue and functional limitations.
Furthermore, an examination of participants’ healthcare utilization revealed that while primary care utilization was slightly higher in the COVID-19 group, there were no significant differences in hospitalization, specialty care, or mental health services.