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Factors influencing medium- and long-term occupational impact following COVID-19
O O'Sullivan1,2, A Houston1, P Ladlow1,3
1Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough LE12 5QW, UK.
Insights
Many individuals face challenges returning to work after COVID-19. Factors like fatigue, shortness of breath, and cognitive issues predict prolonged medical downgrading, enabling targeted recovery interventions.
Area of Science:
- Occupational Medicine
- Rehabilitation Medicine
- Public Health
Background:
- Many individuals experience difficulties returning to work post-acute coronavirus disease 2019 (COVID-19).
- The UK Military established the Defence COVID-19 Recovery Service (DCRS) for safe return-to-work pathways.
- Medical Deployment Status (MDS) categorizes individuals as fully deployable (FD) or medically downgraded (MDG).
Purpose of the Study:
- To identify factors differentiating individuals who are fully deployable (FD) versus medically downgraded (MDG) 6 months post-COVID-19.
- To determine early predictors of persistent medical downgrading at 12 and 18 months within the downgraded cohort.
Main Methods:
- Analysis of comprehensive clinical assessments and electronic medical records from 222 participants in the DCRS.
- Extraction of Medical Deployment Status (MDS) at 6, 12, and 18 months post-acute COVID-19.
- Statistical analysis of 57 predictors to identify associations with initial and prolonged medical downgrading.
Main Results:
- Initially downgraded individuals were more likely to report shortness of breath (SoB), fatigue, exercise intolerance, cognitive impairment, and mental health symptoms.
- Fatigue, SoB, cognitive impairment, and mental health symptoms were associated with MDG at 12 months.
- Cognitive impairment and mental health symptoms showed associations with MDG at 18 months; cardiopulmonary function also showed modest associations with sustained downgrading.
Conclusions:
- Identifying factors associated with initial and sustained inability to return to work is crucial.
- This understanding facilitates the development of individualized and targeted interventions for post-COVID-19 recovery.
- Early identification of symptoms like fatigue, SoB, and cognitive issues can guide rehabilitation strategies.
Background:
Significant numbers of individuals struggle to return to work following acute coronavirus disease 2019 (COVID-19). The UK Military developed an integrated medical and occupational pathway (Defence COVID-19 Recovery Service, DCRS) to ensure safe return to work for those with initially severe disease or persistent COVID-19 sequalae. Medical deployment status (MDS) is used to determine ability to perform job role without restriction ('fully deployable', FD) or with limitations ('medically downgraded', MDG).
Aims:
To identify which variables differ between those who are FD and MDG 6 months after acute COVID-19. Within the downgraded cohort, a secondary aim is to understand which early factors are associated with persistent downgrading at 12 and 18 months.
Methods:
Individuals undergoing DCRS had comprehensive clinical assessment. Following this, their electronic medical records were reviewed and MDS extracted at 6, 12 and 18 months. Fifty-seven predictors taken from DCRS were analysed. Associations were sought between initial and prolonged MDG.
Results:
Three hundred and twenty-five participants were screened, with 222 included in the initial analysis. Those who were initially downgraded were more likely to have post-acute shortness of breath (SoB), fatigue and exercise intolerance (objective and subjective), cognitive impairment and report mental health symptoms. The presence of fatigue and SoB, cognitive impairment and mental health symptoms was associated with MDG at 12 months, and the latter two, at 18 months. There were also modest associations between cardiopulmonary function and sustained downgrading.
Conclusions:
Understanding the factors that are associated with initial and sustained inability to return to work allows individualized, targeted interventions to be utilized.
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