Functional limitations and late musculoskeletal pain in individuals with long COVID

Abstract

Introduction: The acute clinical repercussions of SARS-COV-2 infection have been widely studied today due to the scenario of the COVID-19 pandemic. However, the possible late repercussions, characteristic of long COVID, have not yet been well defined in the literature. Objective: To identify functional limitations and possible variables associated with late musculoskeletal pain in individuals with LONG COVID. Methods: In this cross-sectional observational study, individuals with a positive test for COVID-19 treated at the Central Hospital of the Military Police of Rio de Janeiro (HCPM-RJ) were included. Clinical data were collected, and the following
measurement instruments were applied: numerical pain scale (NPS); Post-COVID Functional Status Scale (PCFS); fatigue pictogram, Berg Scale, and 10-meter Walk Test. Correlation analyses were performed between the variables and also a comparison of subgroups, comparing the means between individuals with pain and without pain for the clinical variables collected, and another comparing the means between hospitalized and non-hospitalized individuals for the same clinical variables. A linear regression analysis was also performed, considering pain intensity as a dependent variable and the variables length of hospital stay, ICU time, and orotracheal tube time as independent variables. Results: We evaluated 195 patients with a mean age of 54,74 years (±11,12 years). The population had an average of 119,8 (±1,9) days after diagnosis, considering the evaluation time. Of the participants included, 112 (57,43%) presented musculoskeletal pain. The mean NPS was 2,2 (± 2,3) points. It was observed that the group with pain had high levels of fatigue, greater functional limitation in PCFS, higher risk of fall on the BERG scale, and lower gait speed
compared to the pain-free group. The group of individuals who were hospitalized also presented worse rates of functionality. Significant correlations were found between pain and the following variables: time of oxygen support (r=0,21; p=0,003); ICU time
(r=0,22; p=0,002); invasive mechanical ventilation time (r=0,35; p=0,00) and fatigue (r=0,50; p=0,00). Hospitalized individuals showed a higher chance of presenting late musculoskeletal pain when compared to non-hospitalized individuals (OR=1,42: 95%CI 1,09-2,04). It was identified that the variables time in ICU (β=0,234: P=0,001) and orotracheal intubation time (β=0,764: P=0,001) were predictors of pain intensity [F(2,192)=18,559; R2=0,231; P=0,001]. Conclusion: Individuals affected by COVID19 presented musculoskeletal pain, fatigue, and functional limitation even after three months from the diagnosis. There was a correlation between musculoskeletal pain with oxygen support time, ICU time, and invasive mechanical ventilation time. Individuals who were hospitalized showed a higher chance of presenting musculoskeletal pain, and the variables time of hospitalization in ICU and supportive time on invasive mechanical ventilation were predictors of the intensity of late musculoskeletal pain.