Morelli N, Parry SM, Steele A, Lusby M, Montgomery-Yates AA, Morris PE, Mayer KP. Patients Surviving Critical COVID-19 have Impairments in Dual-task Performance Related to Post-intensive Care Syndrome.
J Intensive Care Med 2022;
37:890-898. [PMID:
35072548 PMCID:
PMC9160440 DOI:
10.1177/08850666221075568]
[Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objective
The purpose was to examine Dual Task (DT) performance in patients surviving
severe and critical COVID-19 compared to patients with chronic lung disease
(CLD). Secondarily, we aimed to determine the psychometric properties of the
Timed Up and Go (TUG) test in patients surviving COVID-19.
Design
Prospective, cross-sectional, observational study.
Setting
Academic medical center within United States.
Patients
Ninety-two patients including 36 survivors of critical COVID-19 that required
mechanical ventilation (critical-COVID), 20 patients recovering from
COVID-19 that required supplemental oxygen with hospitalization
(severe-COVID), and 36 patients with CLD serving as a control group.
Measurements and Main Results
Patients completed the TUG, DT-TUG, Short Physical Performance Battery
(SPPB), and Six Minute Walk Test (6MWT) 1-month after hospital discharge. A
subset of patients returned at 3-months and repeated testing to determine
the minimal detectable change (MDC). Critical-COVID group (16.8 ± 7.3)
performed the DT-TUG in significantly slower than CLD group (13.9 ± 4.8 s;
P = .024) and Severe-COVID group (13.1 ± 5.1 s;
P = .025). Within-subject difference between TUG and
DT-TUG was also significantly worse in critical-COVID group (−21%) compared
to CLD (−10%; P = .012), even despite CLD patients having a
higher comorbid burden (P < .003) and older age
(P < .001). TUG and DT-TUG demonstrated strong to
excellent construct validity to the chair rise test, gait speed, and 6MWT
for both COVID-19 groups (r = −0.84to 0.73, P < .05).
One- and 3-months after hospital discharge there was a floor effect of 14%
(n = 5/36) and 5.2% (n = 1/19), respectively for patients in the
critical-COVID group. Ceiling effects were noted in four (11%)
critical-COVID, six (30%) severe-COVID patients for the TUG and DT-TUG at
1-month.
Conclusion
The ability to maintain mobility performance in the presence of a cognitive
DT is grossly impaired in patients surviving critical COVID-19. DT
performance may subserve the understanding of impairments related to
Post-intensive care syndrome (PICS) for survivors of critical illness.
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