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Review Article • Rev. Soc. Bras. Med. Trop. 55 • 2022 • https://doi.org/10.1590/0037-8682-0741-2021 linkcopy

Open-access The health-related quality of life in patients with post-COVID-19 after hospitalization: a systematic review

AuthorshipSCIMAGO INSTITUTIONS RANKINGS

    ABSTRACT

    Symptoms in post-COVID-19 patients who require hospitalization can persist for months, significantly affecting their health-related quality of life (HRQoL). Thus, the present study aimed to discuss the main findings regarding HRQoL in post-COVID-19 patients who required hospitalization. An electronic search was performed in the MEDLINE, EMBASE, CINAHL, Web of Science, LILACS, and Scopus databases, without date and language restrictions, until July 2021. Twenty-four articles were included in the analysis. It seems that HRQoL partially improved soon after hospital discharge, although the negative impact on HRQoL may persist for months. The physical and mental aspects are affected because patients report pain, discomfort, anxiety, and depression. The HRQoL of COVID-19 infected patients was worse than that of uninfected patients. Additionally, HRQoL seemed worse in patients admitted to the intensive care unit than in those who remained in the ward. Improvements in HRQoL after hospital discharge are independent of imaging improvement, and there seems to be no association between HRQoL after hospital discharge and disease severity on hospital admission. Many factors have been identified as determinants of HRQoL, with women and advanced age being the most related to worse HRQOL, followed by the duration of invasive mechanical ventilation and the need for intensive care. Other factors included the presence and number of comorbidities, lower forced vital capacity, high body mass index, smoking history, undergraduate education, and unemployment. In conclusion, these findings may aid in clinical management and should be considered in the aftercare of patients.

    Keywords: COVID-19; SARS-CoV-2; Hospitalization; Quality of life

    INTRODUCTION

    COVID-19 is an acute respiratory infection caused by the potentially serious SARS-CoV-2, with high transmissibility and global distribution1. SARS-CoV-2 is a beta-coronavirus that was discovered in the city of Wuhan, China, in December 2019. Coronaviruses are a large family of viruses common to different species of animals2.

    COVID-19 has generated great concern in the population due to its ability to cause serious conditions in a large proportion of infected patients3,4. Approximately 20% of hospitalized patients develop severe complications, including respiratory failure, acute respiratory distress syndrome (ARDS), shock, delirium, and multiple organ dysfunction5,6. In addition, critical patients greatly require therapies such as mechanical ventilation, which usually requires prolonged intensive care unit stays and post-COVID-19 rehabilitation7,8. Thus, such factors can decrease health-related quality of life (HRQoL) due to the physical, cognitive, and mental impairments of individuals with critical illnesses9,10.

    HRQoL provides a complete assessment of the impact of a disease on patients' daily lives11. A structured review12 was recently conducted to verify the scores from different HRQoL questionnaires in post-COVID-19 patients. However, the general aspects of HRQoL after hospital discharge still require discussion. Even with no need for hospitalization, many patients may have a worse HRQoL than non-infected individuals13. However, due to the prolonged length of hospital stay, the need for invasive mechanical ventilation, pain, and fear of death, the investigation of HRQoL among hospitalized patients is of paramount importance. Therefore, the present study proposes systematically discussing the main findings of HRQoL in patients post-COVID-19 that required hospitalization. Establishing the general aspects of the HRQoL of these patients and identifying their determinants can help in the management of patients after hospital discharge.

    METHODS

    Study design

    This systematic review aimed to discuss the main findings on the HRQoL of post-COVID-19 patients after hospitalization. The study was edited following the PRISMA checklist14 and Cochrane recommendations15. The protocol was prospectively registered in the open science framework (https://osf.io/k9pu6/).

    Search strategy and study selection

    Search strategies were conducted using the Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Latin American and Caribbean Health Sciences Literature (LILACS), and Scopus databases. There were no language restrictions from their inception until July 2021. The following strategy was be used for the PubMed search - [("COVID-19" OR "SARS-CoV-2" OR "post-acute COVID-19 syndrome" OR "SARS-CoV-2 variants" OR "COVID-19 post-intensive care syndrome" OR "COVID-19 stress syndrome") AND ("Quality of Life" OR "Life Quality" OR "Health-Related Quality Of Life" OR "Health Related Quality Of Life" OR "HRQOL")], being modified for each database. After the searches, the retrieved references were exported to an Endnote® file, removing duplicates. Two independent reviewers checked for full texts using titles and abstracts. Studies that met our eligibility criteria were included in the review, and discrepancies between reviewers were resolved by a third reviewer.

    Eligibility criteria

    This review included published observational studies, such as cross-sections, cohort, or control case studies, which assessed HRQoL in post-COVID-19 patients, after hospitalization, from both sexes, and at any age. Eligibility criteria included studies a) that evaluated patients post-COVID-19 after hospitalization; b) and assessed HRQoL. The exclusion criteria were articles in duplicate, studies that did not report the questionnaire used, papers that aimed to verify the improvement of HRQoL after rehabilitation, and those that did not match the objective of this review. In addition, studies that assessed only the questionnaire’s psychometric properties were also excluded, as it is not yet possible to establish a gold standard.

    Quality assessment

    Two independent reviewers (EABF and WTS) assessed the methodological quality of the included studies using the Newcastle-Ottawa Scale16. This scale assigns a maximum of ten points for the lowest risk of bias and zero for the highest risk of bias. Newcastle-Ottawa scores the risk of study bias in three domains: 1) selection of study groups (four points), 2) group comparability (two points), and 3) verification of exposure and results (three points) for case-control and cohort studies, respectively.

    For cross-sectional studies, Newcastle-Ottawa Scale has a maximum score of ten stars, divided into the topics "selection,” "comparability," and "results"17. To assess the risk of bias, studies that scored in all domains (selection, comparability, and outcome) were classified as high quality18. Those who did not score in at least one of the domains were classified as low-quality. All studies found in the electronic search, regardless of the methodological quality, were included in the review.

    Outcome and data analysis

    The extracted data included the year of publication, sample characteristics, HRQoL questionnaire used, and results. We did not perform a meta-analysis, and the results were presented as descriptive data. The corresponding author was contacted in the presence of any missing data.

    RESULTS OF THE ELECTRONIC SEARCH

    We retrieved 4757 titles, of which 1513 were duplicates and excluded. The remaining 3244 studies were screened, and 57 references were selected for inclusion in the study. Of these, 24 met our inclusion criteria. Figure 1 outlines the flow of the review papers.

    FIGURE 1:
    Flow diagram of studies through the review.

    Seven questionnaires were used in the included studies: generic (Short-form Health Survey [SF-36]/Rand-36, 12-item Short Form [SF-12]), Euro Quality of Life 5 dimensions 5 levels [EQ-5D-5L], Euro Quality of Life 5 dimensions 3 levels [EQ-5D-3L], World Health Organization Quality of Life [WHOQOL-Bref], 15D], and airways disease-specific [St George's Respiratory Questionnaire (SGRQ)].

    The SF-36/Rand-36 is a generic questionnaire that encompasses 36 items grouped into eight domains: physical functioning, physical, bodily pain, general health, social functioning, role-emotional, vitality, and mental health. The total score ranges from 0 (lowest HRQL) to 100 (highest HRQL), and the higher the score, the better the patient's HRQoL19,20. The SF-12 is a generic HRQoL assessment instrument composed of a 12-item subset of SF-36. It assesses the same eight HRQoL domains of SF-3621,22.

    The 5-level EQ-5D (EQ-5D-5L) has two parts: the EQ-5D descriptive system and the EQ visual analog scale (EQ-VAS). The descriptive system had five dimensions: mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. In addition, the questionnaire allowed five levels of response: no problems, slight problems, moderate problems, severe problems, and extreme problems. Higher values indicate better health. The EQ-VAS records the patient's self-rated health on a vertical visual analogue scale, where the endpoints are labeled from “The best health you can imagine” to “The worst health you can imagine”23. Another version, EQ-5D-3L, is similar to the EQ-5D-5L. However, it has three response levels: no problems, some problems, and extreme problems.

    The WHOQOL-Bref is a general instrument comprising 26 questions. The first question referred to the general HRQoL, the second to self-satisfaction, and the other 24 to the physical, psychological, social relations, and environment domains24. The higher the score, the better the HRQoL of the patient.

    The 15D is a generalist instrument that covers 15 dimensions: breathing, mental function, speech (communication), vision, mobility, usual activities, vitality, hearing, eating, elimination, sleeping, distress, discomfort and symptoms, sexual activity, and depression. It is a questionnaire designed to be administered within 10 minutes25. Higher scores indicate worse HRQoL.

    Saint George's Respiratory Questionnaire (SGRQ) is one of the leading HRQoL assessment questionnaires specific to respiratory diseases. It comprises items divided into three sessions: symptoms, activity, and impacts (which cover a range of aspects concerned with social and psychological functioning). The score for each session and the total score can be calculated26. The higher the score, the worse is the HRQoL.

    GENERAL ASPECTS OF THE HRQOL OF POST-COVID-19 PATIENTS

    Eleven studies (Table 1) verified the general aspects of HRQoL in patients post-COVID-19 after hospitalization27-36. The mean score for the quality of studies was 6 (range, 5-8). Six studies were classified as low-quality, while five were classified as high-quality. The questionnaires used were EQ-5D-5L, EQ-5D-3L, SGRQ, SF-12, WHOQOL-Bref, and SF-36.

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    TABLE 1:
    General aspects of HRQoL in post COVID-19 patients (n=11).

    One study34 verified the changes in the HRQoL of post-Covid patients 15 days after hospital discharge. The authors demonstrated that 15 days were sufficient to detect significant improvements in all domains of the SGRQ (symptoms, activity, impact, and total score). However, COVID-19 symptoms commonly persist for 35 days, affecting both physical and mental health37. Despite the improvement after hospital discharge, Mendéz et al.29 demonstrated by the SF-12 that both the physical and mental component summaries were impaired in approximately 44.1% and 39.1% of patients, respectively, two months after hospital discharge. Even in patients with mild to moderate severity, impaired physical and mental component summaries were detected in 15.4% and 32.6% of the patients, respectively32. Therefore, the HRQoL of post-COVID-19 patients may remain worse during the months following discharge.

    Temperoni et al.38 verified the HRQoL of 64 patients aged less than 50 years post-COVID-19 and showed no difference between hospitalized and non-hospitalized patients in any SF-36 domains after one month of hospital discharge. In a small sample (n=39), Monti et al.30 reported that, after two months of intensive care unit discharge, a majority of patients showed no difficulty in walking, self-care, and usual activities in EQ-5D-5L, and only eight patients reported anxiety or moderate depression. Using the same questionnaire, with a similar follow-up period (six weeks after hospital discharge) and a small sample, Daher et al.27 showed that patients reported only slight to moderate abnormalities with mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. In contrast, three other studies found different results with larger samples and using the same questionnaire. Navarro et al.31 found that after mild to moderate COVID-19 infection, a severe decrease in HRQoL was observed in 56% of patients, mainly in usual activities and anxiety/depression. Another study35 found that 32% of patients had anxiety/depression and 38% reported worsening HRQoL three months after hospital discharge (p<0.001), especially in pain/discomfort and anxiety/depression. Finally, Walle-Hansen36 showed that 66% of patients (n=106) reported a negative change in any of the dimensions of the EQ 5D-5L when compared to the time before COVID-19. These changes are related to difficulties in performing activities of daily living, reduced mobility, and pain or discomfort. In summary, according to studies with larger samples, pain/discomfort (physical aspects) and anxiety/depression (mental aspects) were the most compromised domains in post-COVID-19 patients after hospitalization.

    More studies in post-COVID-19 patients are needed, but patient-reported pain may have multiple causes. Pain may be a consequence of a viral infection in the peripheral neuromuscular or central nervous system, or may occur as a result of invasive mechanical ventilation, or may be secondary to associated syndromes, such as Guillain-Barré syndrome39. Joint pain, chest pain, headache, and myalgia are among the most cited symptoms by patients40,41.

    Regarding the mental aspects, according to Mendéz et al.29, anxiety, depression, and post-traumatic stress disorder were detected in 29.6%, 26.8%, and 25.1% of patients, respectively. In addition, 39.1% of patients had psychiatric impairments. Another study33 demonstrated that HRQoL was impaired in 31% of patients, and symptoms of depression, anxiety, and post-traumatic stress disorders were detected in 11%, 25%, and 11% of the patients, respectively. Maheshwari et al.28 also found that fear of reinfection by hospital exposure and social stigma was experienced by 51% and 49% of plasma donors, respectively. These results suggest that not only the physical aspects but also the mental health, anxiety, depression, and fear of post-COVID-19 patients should be addressed in post-discharge follow-up.

    Thus, the results suggest that (1) some improvements in HRQoL are detectable a few days after hospital discharge, (2) poor HRQoL may persist for months after discharge, and (3) impairments in both physical (pain and discomfort) and mental (anxiety and depression) aspects are present and must be addressed in patient management.

    COMPARISON BETWEEN HRQOL BETWEEN PATIENTS WITH POST-COVID-19 AND UNINFECTED POPULATION.

    Six included studies32,42-46 compared the HRQoL between post-Covid patients and uninfected individuals (Table 2). The questionnaires used were SF-36, 15D, SF-12, and SGRQ. The mean quality score was 7 (range, 6-8). Five were classified as high-quality, while only one was of low quality.

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    TABLE 2:
    HRQoL between post-COVID-19 patients and the general population (n=6).

    Two studies compared the HRQoL evaluated by SF-36 between patients post-COVID-19 and data about the general Chinese population. One study42 demonstrated that the HRQoL of post-COVID-19 patients was reduced in all SF-36 domains, except for physical functioning, one month after hospital discharge. Another one32 reported that the HRQoL of post-COVID-19 patients was worse in many domains, except for general health, after three months of hospital discharge. In the Dutch population, it was demonstrated that the HRQoL evaluated by SF-36 was reduced in many domains after six weeks of hospital discharge, except for bodily pain46.

    In Italian and Finnish populations, Gamberini et al.43 demonstrated that the HRQoL assessed using the 15D instrument was also worse when compared to data from the general population. In a small sample, another study44 demonstrated that HRQoL was significantly reduced in patients with post-COVID-19-related pneumonia when compared to the general population three months after hospital admission.

    Finally, Raman et al.45 selected 58 patients diagnosed with COVID-19 and assessed HRQoL using SF-36 from two to three months after symptom onset and compared the HRQoL with a control group (n=30 uninfected individuals matched for age, sex, body mass index, and risk factors). The authors demonstrated that HRQoL was worse in all the SF-36 domains.

    Briefly, all included data were consistent, with good methodological quality, and showed that the HRQoL of post-COVID-19 patients was worse than that of the uninfected group even after hospital discharge. These findings can be explained by factors such as pulmonary impairment47, fatigue, muscular pain37, and anxiety31.

    THE HRQOL OF POST-COVID-19 PATIENTS ADMITTED AND NOT ADMITTED TO THE INTENSIVE CARE UNIT

    Five studies38,41,48-51 compared HRQoL between patients admitted and those not admitted to the intensive care unit (Table 3). The questionnaires used were WHOQOL-Bref and EQ-5D-5L. The mean quality score was 6.4 (ranging, 5-7), were classified as high-quality.

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    TABLE 3:
    Comparison between the HRQoL of post-COVID-19 patients admitted and not admitted into intensive care unit (n=5).

    Halpin et al.49 were the first to verify the HRQoL of patients with post-COVID-19 admitted to the ward and in the intensive care unit. They demonstrated that in a short period, there was a significant improvement in HRQoL assessed by EQ-5D-5L in both groups. Using the same questionnaire, Garrigues et al.41 demonstrated no difference between groups of patients admitted to the ward and intensive care unit after 10 days after hospital discharge. Using the WHOQoL-Bref, Albu et al.48 also found no difference in HRQoL between patients with persistent symptoms admitted (n=16) and those not admitted (n=14) to the intensive care unit after three months of hospital discharge. Based on these results, it seems that being in the intensive care unit or adopting more invasive treatment strategies does not influence the HRQoL of patients after COVID-19. However, prolonged mechanical ventilation is associated with a more extended intensive care unit and hospital stays52, as well as significant and lasting physical and psychological dysfunction in critically ill survivors53.

    Corroborating this sentence, two other studies demonstrated differences in HRQoL between patients admitted and not admitted to the intensive care unit, both using the EQ-5D-5L questionnaire. Huang et al.50 described, in a larger sample, that patients who needed supplemental oxygen, high-flow nasal cannula, non-invasive mechanical ventilation, or invasive mechanical ventilation had worse scores in the mobility, pain or discomfort, and anxiety or depression domains when compared to those without supplemental oxygen. Finally, Lerum et al.51 reported that the HRQoL of patients admitted to the intensive care unit was worse after prolonged hospital discharge (greater than three months) in the usual activities domain than that of patients admitted only to regular wards.

    The results are conflicting, despite the high methodological quality. However, four studies, using regression analysis, demonstrated that the need for intensive care unit35,54 or duration of invasive mechanical ventilation43,55 were independent determinants of the HRQoL of post-COVID-19 patients. Thus, it seems that patients admitted to the intensive care unit have a worse HRQoL than those not admitted, even after hospital discharge.

    FACTORS ASSOCIATED AND DETERMINANTS OF HRQOL IN PATIENTS WITH POST-COVID-19

    Identifying factors associated with the HRQoL of post-Covid patients is required to assist in patient stratification and guide clinical management. Nine included studies (Table 4) verified the factors associated with HRQoL in post-COVID-1932,35,42-44,48,54-56, with a mean score of 6.6 (ranging, 5-8). Seven of these were classified as high quality. The questionnaires used were WHOQOL-Bref, SF-12, EQ-5D-5L, SF-36, 15D, SGRQ, RAND-36, and EQ-5D-3L.

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    TABLE 4:
    Factors associated and determinants of HRQoL in patients with post-COVID-19 (n=9).

    One study44 reported no difference in SF-12 and SGRQ scores between groups who improved their chest computed tomography scan (n=31) and those who did not (n=8) after three months of hospital admission. Thus, there seems to be no association between imaging improvements and HRQoL after the follow-up period. Anastasio et al.56 also reported that there was no significant correlation between the physical or mental component summary of the SF-12 and lung function, development of pneumonia, acute respiratory distress syndrome, invasive mechanical ventilation, partial oxygen saturation/fraction of inspired oxygen ratio, or pneumonia severity index four months after COVID-19 diagnosis (n=379). Another study43 showed that clinical severity at admission was poorly correlated with HRQoL three months after intensive care unit discharge. According to these results, HRQOL was not associated with clinical measures. This can be explained by the fact that COVID-19 encompasses biological, psychological, and social factors, such as stigma and discrimination between various groups, as previously demonstrated57. However, many studies have reported fatigue and mental health issues in post-COVID-19 patients. Albu et al.48 showed a significant correlation between poor HRQoL, fatigue, and anxiety/depression.

    Another six studies32,35,42,43,54,55 verified the independent determinants of HRQoL of patients in the post-COVID-19 period. The main determinants of the poor physical component of HRQoL were obesity and overweight42, female sex, older age (≥60 years), and the presence of physical symptoms after hospital discharge32. On the other hand, the independent determinants of poor mental components were women42 and the presence of physical symptoms after hospital discharge32. Thus, physical symptoms after hospital discharge and female sex were determinants of poor HRQoL in both physical and mental components in post-COVID-19 patients.

    In fact, in all six studies, female sex and old age were determinants of poor HRQoL in the post-COVID-19 period. It has been previously demonstrated that men have higher rates of disease severity and case-fatality58, but women suffer more from long-term symptoms than men55. Additionally, old age contributes to poor physical and mental health recovery status32.

    Other determinants of poor HRQoL in post-COVID-19 patients include clinical subtype of the disease42, chronic kidney disease42, length of hospital stay42, smoking history42, forced vital capacity42, number of comorbidities43, acute respiratory distress syndrome class43, duration of invasive mechanical ventilation43,55, occupational status43, and intensive care requirement35,54, body mass index55, sleep apnea55, undergraduate education54, unemployment status54, presence of diabetes54, and heart failure diagnosis54. Taken together, the recognition of these factors can help identify patients with worse HRQoL and should be considered when managing patients to improve their HRQoL.

    FINAL CONSIDERATIONS

    In summary, the present study suggests that, in post-COVID-19 patients who required hospitalization, (1) HRQoL partially improved soon after hospital discharge; (2) HRQoL impairment persists for months, both in physical and mental aspects; (3) the HRQoL in patients who were infected is worse when compared to uninfected individuals, even months after hospital discharge; (4) the HRQoL seems to be worse in patients admitted to the intensive care unit when compared to those who remained in the ward; (5) improvement in the HRQoL of patients after hospital discharge is independent of imaging improvement; (6) there is no evidence to support the association between HRQoL after hospital discharge and disease severity on hospital admission; (7) women and old age are the most established determinants of HRQoL; and (8) other clinical, demographic, and lifestyle factors may be associated with the HRQoL of patients and should be used to develop tailored strategies in their clinical management.

    REFERENCES

    • 1 Hu B, Guo H, Zhou P, Shi Z-L. Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol. 2021;19(3):141-54.
    • 2 Phelan AL, Katz R, Gostin LO. The novel coronavirus originating in Wuhan, China: challenges for global health governance. JAMA. 2020;323(8):709-10.
    • 3 Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
    • 4 Mahase E. Covid-19: most patients require mechanical ventilation in first 24 hours of critical care. BMJ. 2020;368:m1201.
    • 5 Yang X, Yu Y, Xu J, Shu H, Liu H, Wu Y, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-81.
    • 6 Pun BT, Badenes R, La Calle GH, Orun OM, Chen W, Raman R, et al. Prevalence and risk factors for delirium in critically ill patients with COVID-19 (COVID-D): a multicentre cohort study. Lancet Respir Med . 2021;9(3):239-50.
    • 7 Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020;323(16):1574-81.
    • 8 Frota AX, Vieira MC, Soares CCS, da Silva PS, da Silva GMS, Mendes FSNS, et al. Functional capacity and rehabilitation strategies in covid-19 patients: Current knowledge and challenges. Rev Soc Bras Med Trop. 2021;54:1-8.
    • 9 Bein T, Bienvenu OJ, Hopkins RO. Focus on long-term cognitive, psychological and physical impairments after critical illness. Intensive Care Med. 2019;45(10):1466-8.
    • 10 Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, et al. One-year outcomes in survivors of the acute respiratory distress syndrome . N Engl J Med. 2003;348(8):683-93.
    • 11 Cella D, Nowinski CJ. Measuring quality of life in chronic illness: the functional assessment of chronic illness therapy measurement system. Arch Phys Med Rehabil. 2002;83:S10-S7.
    • 12 Poudel AN, Zhu S, Cooper N, Roderick P, Alwan N, Tarrant C, et al. Impact of Covid-19 on health-related quality of life of patients: A structured review. PLoS One. 2021;16(10):e0259164.
    • 13 Meys R, Delbressine JM, Goërtz YMJ, Vaes AW, Machado FVC, Van Herck M, et al. Generic and Respiratory-Specific Quality of Life in Non-Hospitalized Patients with COVID-19. J Clin Med. 2020;9(12):3993.
    • 14 Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol. 2009;62(10):e1-e34.
    • 15 Higgins JP, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions: John Wiley & Sons; 2019.
    • 16 Herzog R, Álvarez-Pasquin MJ, Díaz C, Del Barrio JL, Estrada JM, Gil Á. Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health. 2013;13(1):1-17.
    • 17 Modesti PA, Reboldi G, Cappuccio FP, Agyemang C, Remuzzi G, Rapi S, et al. Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PloS One. 2016;11(1):e0147601.
    • 18 Lee J, Park JH, Jwa H, Kim YH. Comparison of Efficacy of Intravenous Peramivir and Oral Oseltamivir for the Treatment of Influenza: Systematic Review and Meta-Analysis. Yonsei Med J. 2017;58(4):778-85.
    • 19 Ware J, Kosinski M, Bjorner JB, Turner-Bowker DM, Gandek B, Maruish ME. SF-36v2 health survey: Administration guide for clinical trial Investigators. Lincoln, RI: QualityMetric Incorporated. 2008:1-34.
    • 20 Hays RD, Sherbourne CD, Mazel RM. The RAND 36-Item Health Survey 1.0. Health Econ. 1993;2(3):217-27.
    • 21 Ware Jr JE, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34(3):220-33.
    • 22 Ware John E, Kosinski M, Keller S. SF-12: How to score the SF-12 physical and mental health summary scales. 2th ed. Boston: The Health Institute of New England Medical Center. 1995.
    • 23 EuroQol Research Foundation. EQ-5D [Internet]. Available from: https://euroqol.org/eq-5d-instruments/eq-5d-5l-about/
      » https://euroqol.org/eq-5d-instruments/eq-5d-5l-about/
    • 24 Fleck M, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, et al. Aplicação da versão em português do instrumento abreviado de avaliação da qualidade de vida" WHOQOL-bref". Rev Saude Publica. 2000;34(2):178-83.
    • 25 Sintonen H. The 15D instrument of health-related quality of life: properties and applications. Ann Med. 2001;33(5):328-36.
    • 26 Jones P, Quirk F, Baveystock C. The St George's Respiratory Questionnaire. Respir Med. 1991;85(Suppl B):25-31.
    • 27 Daher A, Balfanz P, Cornelissen C, Müller A, Bergs I, Marx N, et al. Follow up of patients with severe coronavirus disease 2019 (COVID-19): Pulmonary and extrapulmonary disease sequelae. Respir Med . 2020;174:106197.
    • 28 Maheshwari A, Varshney M, Gupta K, Bajpai M. Psychological assessment and lived experiences of recovered COVID-19 patients who presented for convalescent plasma donation . Transfus Clin Biol. 2021; 28(3):254-7.
    • 29 Méndez R, Balanzá-Martínez V, Luperdi SC, Estrada I, Latorre A, González-Jiménez P, et al. Short-term neuropsychiatric outcomes and quality of life in COVID-19 survivors. J Intern Med. 2021;290(3):621-31.
    • 30 Monti G, Leggieri C, Fominskiy E, Scandroglio AM, Colombo S, Tozzi M, et al. Two-months quality of life of COVID-19 invasively ventilated survivors; an Italian single-center study. Acta Anaesthesiol Scand. 2021; 65(7):912-20.
    • 31 Navarro C, Yáñez AM, Garcia A, Seguí A, Gazquez F, Antonio Marino J, et al. Effectiveness of a healthy lifestyle promotion program as adjunctive teletherapy for treatment-resistant major depression during COVID 19 pandemic: A randomized clinical trial protocol. Medicine. 2020;99(45):1-8.
    • 32 Qu G, Zhen Q, Wang W, Fan S, Wu Q, Zhang C, et al. Health-related quality of life of COVID-19 patients after discharge: A multicenter follow-up study. J Clin Nurs. 2021;30(11/12):1742-50.
    • 33 Rass V, Beer R, Schiefecker AJ, Kofler M, Lindner A, Mahlknecht P, et al. Neurological outcome and quality of life 3 months after COVID-19: A prospective observational cohort study. Eur J Neurol. 2021; 28(10):3348-59.
    • 34 Santus P, Tursi F, Croce G, Di Simone C, Frassanito F, Gaboardi P, et al. Changes in quality of life and dyspnoea after hospitalization in COVID-19 patients discharged at home. Multidiscip Respir Med . 2020;15(1):713.
    • 35 Todt BC, Szlejf C, Duim E, Linhares AOM, Kogiso D, Varela G, et al. Clinical outcomes and quality of life of COVID-19 survivors: A follow-up of 3 months post hospital discharge. Respir Med . 2021;184:106453.
    • 36 Walle-Hansen MM, Ranhoff AH, Mellingsæter M, Wang-Hansen MS, Myrstad M. Health-related quality of life, functional decline, and long-term mortality in older patients following hospitalisation due to COVID-19. BMC Geriatr. 2021;21(1):199.
    • 37 Jacobs LG, Gourna Paleoudis E, Lesky-Di Bari D, Nyirenda T, Friedman T, Gupta A, et al. Persistence of symptoms and quality of life at 35 days after hospitalization for COVID-19 infection. PLoS One . 2020;15(12):e0243882.
    • 38 Temperoni C, Grieco S, Pasquini Z, Canovari B, Polenta A, Gnudi U, et al. Clinical characteristics, management and health related quality of life in young to middle age adults with COVID-19. BMC Infect Dis. 2021;21(1):134.
    • 39 Meyer-Friessem CH, Gierthmuhlen J, Baron R, Sommer C, Uceyler N, Enax-Krumova EK. Pain during and after COVID-19 in Germany and worldwide: a narrative review of current knowledge. Pain Rep. 2021;6(1):e893.
    • 40 Carfi A, Bernabei R, Landi F, Gemelli Against C-P-ACSG. Persistent Symptoms in Patients After Acute COVID-19. JAMA. 2020;324(6):603-5.
    • 41 Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, et al. Post-discharge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect. 2020;81(6):e4-e6.
    • 42 Chen KY, Li T, Gong FH, Zhang JS, Li XK. Predictors of Health-Related Quality of Life and Influencing Factors for COVID-19 Patients, a Follow-Up at One Month. Front Psychiatry. 2020;11:668.
    • 43 Gamberini L, Mazzoli CA, Sintonen H, Colombo D, Scaramuzzo G, Allegri D, et al. Quality of life of COVID-19 critically ill survivors after ICU discharge: 90 days follow-up. Qual Life Res. 2021;30(10):2805-17.
    • 44 Gianella P, Rigamonti E, Marando M, Tamburello A, Grazioli Gauthier L, Argentieri G, et al. Clinical, radiological and functional outcomes in patients with SARS-CoV-2 pneumonia: a prospective observational study. BMC Pulm Med. 2021;21(1):136.
    • 45 Raman B, Cassar MP, Tunnicliffe EM, Filippini N, Griffanti L, Alfaro-Almagro F, et al. Medium-term effects of SARS-CoV-2 infection on multiple vital organs, exercise capacity, cognition, quality of life and mental health, post-hospital discharge. EClinicalMedicine. 2021;31:100683.
    • 46 van der Sar-van der Brugge S, Talman S, Boonman - de Winter LJM, de Mol M, Hoefman E, van Etten RW, et al. Pulmonary function and health-related quality of life after COVID-19 pneumonia. Respir Med . 2021;176:106272.
    • 47 Munker D, Veit T, Barton J, Mertsch P, Mümmler C, Osterman A, et al. Pulmonary function impairment of asymptomatic and persistently symptomatic patients 4 months after COVID-19 according to disease severity. Infection. 2021:1-12.
    • 48 Albu S, Zozaya NR, Murillo N, Garcia-Molina A, Chacón CAF, Kumru H. What's going on following acute covid-19? Clinical characteristics of patients in an out-patient rehabilitation program. NeuroRehabilitation. 2021;48(4):469-80.
    • 49 Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross-sectional evaluation. J Med Virol. 2021;93(2):1013-22.
    • 50 Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220-32.
    • 51 Lerum TV, Aaløkken TM, Brønstad E, Aarli B, Ikdahl E, Lund KMA, et al. Dyspnoea, lung function and CT findings 3 months after hospital admission for COVID-19. Eur Respir J. 2021;57(4):2003448.
    • 52 Stevens RD, Dowdy DW, Michaels RK, Mendez-Tellez PA, Pronovost PJ, Needham DM. Neuromuscular dysfunction acquired in critical illness: a systematic review. Intensive Care Med . 2007;33(11):1876-91.
    • 53 Cheung AM, Tansey CM, Tomlinson G, Diaz-Granados N, Matte A, Barr A, et al. Two-year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med. 2006;174(5):538-44.
    • 54 Arab-Zozani M, Hashemi F, Safari H, Yousefi M, Ameri H. Health-related quality of life and its associated factors in COVID-19 patients. Osong Public Health Res Perspect. 2020;11(5):296-302.
    • 55 Lindahl A, Aro M, Reijula J, Makela MJ, Ollgren J, Puolanne M, et al. Women report more symptoms and impaired quality of life: a survey of Finnish COVID-19 survivors. Infect Dis. 2022;54(1):53-62.
    • 56 Anastasio F, Barbuto S, Scarnecchia E, Cosma P, Fugagnoli A, Rossi G, et al. Medium-term impact of COVID-19 on pulmonary function, functional capacity and quality of life. Eur Respir J . 2021;58(3):2004015.
    • 57 Chopra K, Arora V. Covid-19 and social stigma: Role of scientific community. Indian J Tuberc. 2020;67(3):284-5.
    • 58 Forsblom E, Silen S, Kortela E, Ahava M, Kreivi HR, Holmberg V, et al. Male predominance in disease severity and mortality in a low Covid-19 epidemic and low case-fatality area - a population-based registry study. Infect Dis . 2021;53(10):789-99.
    • Financial Support: This article was partly supported by grants from Conselho Nacional do Desenvolvimento Científico e Tecnológico (CNPq), Brasília, Brazil.

    Publication Dates

    • Publication in this collection
      28 Mar 2022
    • Date of issue
      2022

    History

    • Received
      30 Dec 2021
    • Accepted
      22 Feb 2022
    Creative Common - by 4.0
    This is an open-access article distributed under the terms of the Creative Commons Attribution License
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