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Functional Recovery of Adults Following Acute COVID-19: A Systematic Review and Meta-Analysis
Sophie Middleton1,2,3, Christos V Chalitsios4, Tanvi Mungale1
1Nottingham Biomedical Research Centre, Clinical Sciences Building, University of Nottingham, City Hospital Campus, Hucknall Road, Nottingham, UK.
Insights
Physical function remains reduced for months after COVID-19 infection. Recovery improves over time, but long-term assessment and rehabilitation are crucial for patients experiencing protracted symptoms.
Area of Science:
- Medical rehabilitation
- Pulmonology
- Infectious diseases
Background:
- Post-acute sequelae of COVID-19 (PACS) are common, impacting patients' functional recovery.
- Objective and functional recovery in the months following acute COVID-19 infection requires further investigation.
Purpose of the Study:
- To systematically review and meta-analyze objective functional recovery in patients >3 months post-COVID-19.
- To assess recovery trajectories across different physical domains over time.
Main Methods:
- Systematic literature search of major databases (PubMed, EMBASE, etc.) up to October 2022.
- Data extraction and synthesis following PRISMA guidelines.
- Meta-analysis using random-effects models to evaluate functional outcomes.
Main Results:
- 106 studies including 20,063 patients were analyzed, with follow-up ranging from 3 to 24 months.
- Reduced 6-minute walk distance (84.3%) and peak oxygen consumption (77.3%) were observed at 3-5 months post-infection.
- Physical function, including handgrip strength, showed improvement at ≥11 months, but heterogeneity was marked across studies.
Conclusions:
- Patients exhibit diminished physical function >3 months after COVID-19.
- Longer recovery periods correlate with better functional outcomes across multiple domains.
- Clinical follow-up should include physical function assessment, with further research into rehabilitation interventions for persistent symptoms.
Objective:
This systematic review and meta-analysis aimed to investigate the objective, functional recovery of patients more than 3 months after acute coronavirus disease 2019 (COVID-19) infection.
Methods:
Comprehensive database searches of EMBASE, PubMed/MEDLINE, Cochrane COVID-19 Study Register, CINAHL, and Google Scholar in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement were carried out until October 19, 2022. Data were extracted and agreed in duplicate. Data were narratively synthesized, and a series of meta-analyses were performed using the random-effects inverse variance method.
Results:
One-hundred six papers covering 20,063 patients, who were either hospitalized or not hospitalized with acute COVID-19 and were followed-up between 3 and 24 months, were included. Percentage predicted 6-minute walk distance at 3 months to <5 months was 84.3% (95% CI = 79.2-89.3; n = 21; I2 = 98.3%) and 92.5% (95% CI = 89.8-95.3; n = 9; I2 = 94.5%) at ≥11 months. Cardiopulmonary exercise testing revealed the percentage predicted peak oxygen consumption rate ($peak\dot{\mathsf{V}}{\mathsf{o}}_{\mathsf{2}}$) at 3 months to <5 months was 77.3% (95% CI = 71.0-83.7; n = 6; I2 = 92.3%) and 95.4% (95% CI = 87.1-103.6; n = 2; I2 = 77.3%) at ≥11 months. Mean handgrip strength was greatest at ≥11 months at 31.16 kg (95% CI = 19.89-42.43; n = 2; I2 = 98.3%) of all time points. All analyses showed marked heterogeneity.
Conclusion:
Patients have reduced physical function more than 3 months after COVID-19 infection. Better physical function in multiple physical domains is found after a longer recovery time.
Impact:
Physical function as measured by the 6-minute walk test, hand grip strength, and cardiopulmonary exercise testing is reduced at 3 months after COVID-19 infection and can remain over 11 months of follow-up. This protracted recovery following acute COVID-19 infection supports the need to assess physical function at any clinical follow-up, and further research into rehabilitation programs and intervention for patients who have not recovered.
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