Association factors and self-perception about musculoskeletal pain in individuals discharged from hospital after COVID-19

Abstract

Introduction: Due to the COVID-19 pandemic and the severity of many affected patients, several studies have focused on investigating the acute repercussions of SARS-Cov-2. However, there is still a gap regarding the main repercussions after hospital discharge for these patients. Objective: The objective of this study is to identify the occurrence rate and factors associated with musculoskeletal pain after hospital discharge due to COVID-19 and self-perception of pain, general health status and disability in these individuals. Methods: This is a mixed study, with a quali-quanti approach. The quantitative approach took place through a cross-sectional observational study. Individuals who were discharged after hospitalization for COVID-19 were included. Individuals responded to an electronic questionnaire made available through a link on digital media. Variables such as: age, sex, previous comorbidities, presence of pain during hospitalization and level of previous physical activity were collected. A regression analysis was performed and two models analyzed. A first, assumed the presence of pain as an outcome, and a second, assumed the intensity of pain as an outcome. The qualitative approach was carried out through the application of a semi-structured interview, including the themes of pain, general health status and disability. Results: In the study with a quantitative approach, we recruited 247 participants through social media and telephone contact. An electronic questionnaire containing sociodemographic, clinical characteristics, lifestyle, pain intensity and characteristics was used to collect data. The occurrence rate of pain after hospital admission for COVID-19 was 87% (215). The average age was 44 (SD 10.5) years, the average years of study of the participants was 13 (SD: 3.1) years. The average hospital discharge time considering the time of collection was 404 (SD: 227.6) days, the average hospitalization time was 25 (SD: 32.4) days and the average time of use of invasive mechanical ventilation was 20 (SD: 13.6) days. The average pain intensity indicated by the numerical pain scale was 5 (SD: 3) points and the number of pain areas was 2 (SD: 1.6) regions. The regions with pain complaints were: head and neck (23%), trunk (51%), right (28%) and left upper limb (24%) and right (44%) and left lower limb (45%). Logistic regression showed that female sex (OR= 4.51 95% CI 1.83-11.13), low family income (OR= 4.62 95% CI 1.75-12.22), pain in the acute phase disease, mechanical ventilatory support, hospital discharge less than 1 year ago (OR= 4.62 95% CI 1.73-12.32) and presence of comorbidities (OR= 0.22 95% CI 0.08-0. 61) are associated with the occurrence of pain. The presence of comorbidities is a protective factor for the occurrence of pain. This model explained 31% of the outcome. Female sex (OR= 3.46 95% CI 1.71-7.02), low family income, hospital discharge less than 1 year ago, longer hospital stay (OR= 1.02 95% CI 1.00 -1.03), 2 or more areas of pain (OR= 2.51 95% CI 1.40-4.52) and mechanical ventilation support (OR= 0.37 95% CI 0.16-0.84) are associated with higher levels of pain intensity. Mechanical ventilatory support is a protective variable for higher levels of pain intensity. This model explained 21% of the outcome. In the study with a qualitative approach, 10 participants were recruited. Participants reported several symptoms that were not present before they contracted COVID-19. Most participants reported fatigue, pain and anxiety symptoms. A perception of health-related fragility was also reported. Participants reported a positive expectation regarding the evolution of general health levels. Participants' reports were grouped into 4 main themes with 6 subthemes: (1) perception of fragile health; (2) post-COVID sequelae (delayed pain, fatigue and tiredness, multisystem impact); (3) psychosocial impact of COVID-19 (interference with activities of daily living, post-COVID-19 habit change, anxiety symptoms); (4) positivist expectation for the future. Conclusion: The rate of pain occurrence is considerably high in individuals who were hospitalized for COVID-19, even 12 months after hospital discharge. Factors such as female sex, low family income, ventilatory support, hospital discharge time and comorbidities are associated with the presence of pain. COVID-19 has lasting effects on the physical and mental health of patients, impacting social life and functional activities. However, patients have a positive expectation of improvement in general health.