Rehabilitation Needs Following COVID-19: Five-Month Post-Discharge Clinical Follow-Up of Individuals With Concerning Self-Reported Symptoms

Background: This paper forms part of the Linkoping COVID-19 Study (LinCoS) which includes all 745 individuals in Region Ostergotland (RO) admitted to hospital for COVID-19 during March 1st – May 31st, 2020. This report aimed at describing and objectivizing the reported problems through clinical examination, and determining the required level of rehabilitation sevices according to rehabilitation complexity. Methods: In this ambidirectional cohort study, all 185 individuals who had reported concerning persisting symptoms were invited to a multi-professional clinical assessment of somatic, functional, affective, neuropsychological status and rehabilitation needs. Findings: A broad array of symptoms and signs attributable to COVID-19 involving respiratory, visual, auditory, motor, sensory and cognitive functions could be confirmed clinically at five months post-discharge in most patients. This translated into approximately 20% of survivors of the total regional cohort of hospitalised patients requiring further rehabilitative interventions at follow-up. Weakness in extremities was reported in 28·5%. On examination, clinically overt muscle weakness could be corroborated in 15 individuals (9·8%). 48% of cases reported cognitive symptoms, while the physician noted overt cognitive impairments in only 3%. Formal testing by a neuropsychologist showed that 39% performed 1.5 SD below the norm, indicating neurocognitive deficit. Fifty-five individuals (34·8%) reported new or aggravated pain. In three fourths of them, it exerted a ‘moderate’ detrimental effect or worse on their ability to work. Interpretation: Our study underscores the importance of providing extensive examination of cases with persisting problems after COVID-19, especially since symptoms such as fatigue and breathlessness are highly nonspecific, but may represent significant underlying functional impairments. Robust neurocognitive testing should be performed, as cognitive problems may easily be overlooked during routine medical consultation. Most rehabilitative interventions could be provided in a primary care setting. However, a substantial minority of patients should to be triaged to specialized rehabilitation services. Funding Information: The study was funded by the ALF grant and Region Ostergotland. Declaration of Interests: The authors declare no conflicts of interest. Ethics Approval Statement: The Swedish Ethical Review Authority approved the study protocol (Dnr 2020-03029 and 2020-04443).