Sex differences and rehabilitation needs after hospital discharge for COVID-19: an Italian cross-sectional study

Stefania Fugazzaro, Monica Denti, Carlotta Mainini, Monia Allisen Accogli, Ginevra Bedogni, Daniele Ghizzoni, Anna Bertolini, Otmen Esseroukh, Cecilia Gualdi, Margherita Schiavi, Luca Braglia, Stefania Costi, Stefania Fugazzaro, Monica Denti, Carlotta Mainini, Monia Allisen Accogli, Ginevra Bedogni, Daniele Ghizzoni, Anna Bertolini, Otmen Esseroukh, Cecilia Gualdi, Margherita Schiavi, Luca Braglia, Stefania Costi

Abstract

Objectives: COVID-19 can result in persistent symptoms leaving potential rehabilitation needs unmet. This study aims to describe persistent symptoms and health status of individuals hospitalised for COVID-19 according to the International Classification of Functioning, Disability and Health domains of impairments, limitations in activity, and participation restrictions.

Design: Cross-sectional study consisting in a telephone interview 3 months after hospital discharge.

Setting: This study was conducted during the first peak of the COVID-19 pandemic by the Local Health Authority of Reggio Emilia (Italy).

Participants: Adult individuals discharged from hospital between April and June 2020 after COVID-19.

Exclusion criteria: hospitalisation for reasons other than COVID-19, inability to participate in the study, concomitant acute or chronic conditions causing disability.

Primary and secondary outcome measures: We assessed: dyspnoea (Medical Research Council), fatigue (Fatigue Severity Scale), mood disturbances (Hospital Anxiety and Depression Scale), limitations in activity (Barthel Index) and participation restrictions (Reintegration to Normal Living Index). We also collected data on sociodemographic characteristics, health status prior to COVID-19, COVID-related clinical manifestations and hospital care pathway up to discharge, rehabilitation interventions, accidental falls and emergency room access.

Results: 149 participants (men, 62%; average age 62 (±11) years) were enrolled, 35 of which (23%) were admitted to the intensive care unit (ICU) while hospitalised. Three months after hospital discharge, nearly half of the participants still suffered from dyspnoea (44%) or fatigue (39%). Almost all individuals (91.2%) recovered a good level of independence in activity of daily living, but 76% still suffered participation restrictions. Female sex was significantly associated with worse outcomes for all symptoms.

Conclusions: Individuals who had moderate or severe COVID-19 may perceive persistent symptoms which may result in reduced social participation. Sex differences should be monitored, as women may recover more slowly than men.

Trial registration number: NCT04438239.

Keywords: COVID-19; rehabilitation medicine; respiratory infections.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow diagram of the study participants.

References

    1. World Health Organisation . Weekly epidemiological update on COVID-19 – 21 December 2021, 2021. Available: [Accessed Dec 27, 2021].
    1. World Health Organisation . COVID-19 clinical management: living guidance, 2021. Available: [Accessed Jan 9, 2022].
    1. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239–42. 10.1001/jama.2020.2648
    1. Hatmi ZN. A Systematic Review of Systematic Reviews on the COVID-19 Pandemic [published online ahead of print, 2021 Jan 26]. SN Compr Clin Med 2021:1–18. 10.1007/s42399-021-00749-y
    1. Collins FS. NIH launches new initiative to study “Long COVID.” National Institutes of Health, 2021. Available: [Accessed March 30, 2021].
    1. Maxwell E. Living with Covid19: a dynamic review of the evidence around ongoing Covid19 symptoms (often called long Covid). National Institute for health research, 2020. Available: [Accessed March 30, 2021].
    1. Garrigues E, Janvier P, Kherabi Y, et al. . Post-Discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect 2020;81:e4–6. 10.1016/j.jinf.2020.08.029
    1. Goërtz YMJ, Van Herck M, Delbressine JM, et al. . Persistent symptoms 3 months after a SARS-CoV-2 infection: the post-COVID-19 syndrome? ERJ Open Res 2020;6:00542–2020. 10.1183/23120541.00542-2020
    1. van den Borst B, Peters JB, Brink M. Comprehensive health assessment three months after recovery from acute COVID-19 [published online ahead of print, 2020 Nov 21]. Clin Infect Dis 2020:ciaa1750. 10.1093/cid/ciaa1750
    1. Townsend L, Dyer AH, Jones K, et al. . Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One 2020;15:e0240784. 10.1371/journal.pone.0240784
    1. Carfì A, Bernabei R, Landi F. Gemelli against COVID-19 post-acute care Study Group. persistent symptoms in patients after acute COVID-19. JAMA 2020;324:603–5. 10.1001/jama.2020.12603
    1. Writing Committee for the COMEBAC Study Group, Morin L, Savale L, et al. . Four-Month clinical status of a cohort of patients after hospitalization for COVID-19. JAMA 2021;325:1525–34. 10.1001/jama.2021.3331
    1. Lemhöfer C, Sturm C, Loudovici-Krug D, et al. . The impact of Post-COVID-Syndrome on functioning - results from a community survey in patients after mild and moderate SARS-CoV-2-infections in Germany. J Occup Med Toxicol 2021;16:45. 10.1186/s12995-021-00337-9
    1. Boldrini P, Bernetti A, Fiore P, et al. . Impact of COVID-19 outbreak on rehabilitation services and physical and rehabilitation medicine physicians' activities in Italy. An official document of the Italian PRM Society (SIMFER). Eur J Phys Rehabil Med 2020;56:316–8. 10.23736/S1973-9087.20.06256-5
    1. World Health Organisation . International classification of functioning, disability and health (ICF), 2001. Available: [Accessed March 30, 2021].
    1. von Elm E, Altman DG, Egger M, et al. . The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007;370:1453–7. 10.1016/S0140-6736(07)61602-X
    1. Bestall JC, Paul EA, Garrod R, et al. . Usefulness of the medical Research Council (MRC) dyspnoea scale as a measure of disability in patients with chronic obstructive pulmonary disease. Thorax 1999;54:581–6. 10.1136/thx.54.7.581
    1. Krupp LB, LaRocca NG, Muir-Nash J, et al. . The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus. Arch Neurol 1989;46:1121–3. 10.1001/archneur.1989.00520460115022
    1. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67:361–70. 10.1111/j.1600-0447.1983.tb09716.x
    1. Galeoto G, Lauta A, Palumbo A. The Barthel index: Italian translation, adaptation and validation. Int J Neurol Neurother 2015;2:2378–3001.
    1. Paltrinieri S. Cross-Cultural validation of the reintegration to normal living index (RNLI) in Italian: translation and pilot study. Italy: MSc Thesis in Rehabilitation Science. University of Firenze, 2021.
    1. R Core Team (2020) . R: a language and environment for statistical computing. R foundation for statistical computing, Vienna, Austria. Available: [Accessed April 14, 2020].
    1. Chinese Association of Rehabilitation Medicine, Respiratory Rehabilitation Committee of Chinese Association of Rehabilitation Medicine, Cardiopulmonary Rehabilitation Group of Chinese Society of Physical Medicine and Rehabilitation . [Recommendations for respiratory rehabilitation of coronavirus disease 2019 in adult]. Zhonghua Jie He He Hu Xi Za Zhi 2020;43:308–14. Chinese. 10.3760/cma.j.cn112147-20200228-00206
    1. Thomas P, Baldwin C, Bissett B, et al. . Physiotherapy management for COVID-19 in the acute hospital setting: clinical practice recommendations. J Physiother 2020;66:73–82. 10.1016/j.jphys.2020.03.011
    1. McNeary L, Maltser S, Verduzco-Gutierrez M. Covid-19) in Physiatry: a can report for inpatient rehabilitation facilities. Pm R 20192020;12:512–5. 10.1002/pmrj.12369
    1. COVID-19 rapid guideline: managing the long-term effects of COVID-19 (NG188): Evidenceevidence review 5: interventions. London:: National Institute for Health and Care Excellence (UK); 2020.
    1. World Health Organisation, . Rehabilitation needs of people recovering from COVID-19 scientific brief, 2021. Available: [Accessed Jan 9,2022].
    1. World Health Organisation, . A clinical case definition of post COVID-19 condition by a Delphi consensus, 2021. Available: [Accessed Jan 9, 2022].
    1. Shah W, Hillman T, Playford ED, et al. . Managing the long term effects of covid-19: summary of NICE, sign, and RCGP rapid guideline. BMJ 2021;2021:n136. 10.1136/bmj.n136
    1. Costi S, Paltrinieri S, Bressi B, et al. . Poor sleep during the first peak of the SARS-CoV-2 pandemic: a cross-sectional study. Int J Environ Res Public Health 2021;18:306. 10.3390/ijerph18010306
    1. de Girolamo G, Polidori G, Morosini P, et al. . Prevalence of common mental disorders in Italy: results from the European study of the epidemiology of mental disorders (ESEMeD). Soc Psychiatry Psychiatr Epidemiol 2006;41:853–61. 10.1007/s00127-006-0097-4
    1. JAMA medical news audio: an inside look at a Post–COVID-19 clinic. Available: [Accessed May 7, 2021].
    1. Huang C, Huang L, Wang Y, et al. . 6-Month consequences of COVID-19 in patients discharged from Hospital: a cohort study. Lancet 2021;397:220–32. 10.1016/S0140-6736(20)32656-8
    1. Iqbal A, Iqbal K, Arshad Ali S, et al. . The COVID-19 sequelae: a cross-sectional evaluation of Post-recovery symptoms and the need for rehabilitation of COVID-19 survivors. Cureus 2021;13:e13080. 10.7759/cureus.13080
    1. Tleyjeh IM, Saddik B, AlSwaidan N, et al. . Prevalence and predictors of post-acute COVID-19 syndrome (PACS) after hospital discharge: a cohort study with 4 months median follow-up. PLoS One 2021;16:e0260568. 10.1371/journal.pone.0260568
    1. Jaffri A, Jaffri UA. Post-Intensive care syndrome and COVID-19: crisis after a crisis? Heart Lung 2020;49:883–4. 10.1016/j.hrtlng.2020.06.006
    1. Lemhöfer C, Best N, Bökel A. Satisfaction of COVID-19 sufferers with actors of the health care system and rehabilitative therapy care using the COVID-19-Rehabilitation needs questionnaire (C19-RehabNeQ) in Bavaria. Physikalische Medizin, Rehabilitationsmedizin 2021. 10.1055/a-1528-1667
    1. Wenham C, Smith J, Morgan R. And COVID-19 Working Group. COVID-19: the gendered impacts of the outbreak. Lancet 2020;395:846–8.
    1. Purdie A, Hawkes S, Buse K, et al . Sex, gender and COVID-19: disaggregated data and health disparities. Available: [Accessed March 24, 2020].
    1. Spagnolo PA, Manson JE, Joffe H. Sex and gender differences in health: what the COVID-19 pandemic can teach us. Ann Intern Med 2020;173:385–6. 10.7326/M20-1941
    1. Kelada M, Anto A, Dave K, et al. . The role of sex in the risk of mortality from COVID-19 amongst adult patients: a systematic review. Cureus 2020;12:e10114. 10.7759/cureus.10114
    1. Raparelli V, Palmieri L, Canevelli M, et al. . Sex differences in clinical phenotype and transitions of care among individuals dying of COVID-19 in Italy. Biol Sex Differ 2020;11:57. 10.1186/s13293-020-00334-3
    1. Marconi M. Gender differences in Covid-19: the importance of sex-disaggregated data. Ital J Gender-Specific Med 2021;7:4–6.
    1. Sudre CH, Murray B, Varsavsky T, et al. . Attributes and predictors of long COVID. Nat Med 2021;27:626–31. 10.1038/s41591-021-01292-y
    1. Ngo ST, Steyn FJ, McCombe PA. Gender differences in autoimmune disease. Front Neuroendocrinol 2014;35:347–69. 10.1016/j.yfrne.2014.04.004

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere