The health impact of long COVID: a cross-sectional examination of health-related quality of life, disability, and health status among individuals with self-reported post-acute sequelae of SARS CoV-2 infection at various points of recovery

OBJECTIVE

The novel Coronavirus (COVID-19) has continued to present a significant burden to global public health efforts. The purpose of this study was to estimate the health-related quality of life, disability, and health status of individuals with self-reported long COVID at various lengths of recovery.

METHODS

We conducted a cross-sectional online survey of individuals with self-reported long COVID. Participants were asked to complete the five-item EuroQOL EQ-5D-5L and EQ visual analog scale, the 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 and the 10-item Patient Reported Outcome Measurement Information System (PROMIS) Global Health v1.2 short form. Descriptive and inferential statistics were used to characterize the responses and differences across groups.

RESULTS

Eighty-two participants from 13 countries completed the EQ-5D-5L, 73 completed the WHODAS 2.0 and 80 participants completed the PROMIS. The mean EQ-5D-5L utility score was 0.51. The mean WHODAS score was 49.0. In the previous 30 days, participants reported their symptoms affected them for a mean of 24 days, they were totally unable to carry out usual activities for 15 days, and they cut back or reduced activities for 26 days. The mean PROMIS physical health and mental health scores were 10.7 and 8.6, respectively, corresponding to below-average health. No significant differences were detected across time or according to severity of acute infection.

CONCLUSIONS

Long COVID presents a significant chronic health burden to adults in the US and abroad. This health burden may persist for many months post-acute infection.

Life according to ME: Caught in the ebb-tide

In this article, we explore the role of ‘place’ in shaping people’s illness experiences through a data-led inductive case-study based on experiential data from people living with myalgic encephalomyelitis (ME) in Norway. Our main aim is to understand how they experience, interpret and attach meaning to various places in which they reside, and how they construct the course of a life influenced by chronic illness. The study is based on stories containing photographs and written texts, received from 10 women and men. In their stories, they describe those places where they experience their illness in the least and most taxing ways. Through a narrative and photographic analysis of their stories, we explore how they perceive the relationship between place and illness as experienced, managed and endured. Our analysis is based on a place-sensitive sociology, in which we approach place both as physicality and a symbolic construction. The participants describe how a wide range of places are intimately linked to their illness experiences, and they interpret these links by referring to both physical and symbolic factors. They describe their lives in terms of a need for equilibrium between activity and rest. Risk is a strong underlying theme: whatever they do, they risk losing something. Most of all, the participants describe how they are looking for places to escape to and from. Places to escape to are those places where privacy and peace can be found, which primarily revolve around being at home. Places to escape from are those places that make their energy ‘slowly ebb away’.

Concept Analysis of Health Care Transition in Adolescents with Chronic Conditions

Children with chronic conditions are living into adulthood and present with unique needs. One such need is their transition from pediatric to adult health care. This paper examined the literature to analyze and synthesize the concept of transition within two contexts, health care and adolescents with chronic conditions. Fifty multidisciplinary sources were included for analysis. A refined, working definition of the concept of health care transition in adolescents with chronic conditions is presented. Results will enable the scientific community to discuss salient issues using well-defined, uniform terminology. Nursing implications are delineated to ensure that these youths thrive into adulthood.

Financial turning points and transitions for people with multiple sclerosis: Towards sustainable employment outcomes

People with disability experience significant levels of economic disadvantage potentially resulting in their poverty, social exclusion and dependence on welfare. Low labour participation rates are a large contributor to such economic and social exclusion. This study was conducted in Australia where 45% of people with disability are living at or below the poverty line. Within this context, this article first defines and examines the constructs of Financial Turning Points and Financial Transitions experienced by people with disability, an area not previously examined in the literature. Then, a collective case study is presented portraying the experiences of Financial Turning Points and Financial Transitions for people with multiple sclerosis (MS). Concluding remarks are directed towards the need to critically re-evaluate ways of thinking about work to enable people with disability to remain productive participants in employment, to better facilitate of their financial futures.

Financial turning points and transitions for people with multiple sclerosis: Towards sustainable employment outcomes

People with disability experience significant levels of economic disadvantage potentially resulting in their poverty, social exclusion and dependence on welfare. Low labour participation rates are a large contributor to such economic and social exclusion. This study was conducted in Australia where 45% of people with disability are living at or below the poverty line. Within this context, this article first defines and examines the constructs of Financial Turning Points and Financial Transitions experienced by people with disability, an area not previously examined in the literature. Then, a collective case study is presented portraying the experiences of Financial Turning Points and Financial Transitions for people with multiple sclerosis (MS). Concluding remarks are directed towards the need to critically re-evaluate ways of thinking about work to enable people with disability to remain productive participants in employment, to better facilitate of their financial futures.

Chronic illness: the process of integration

AIM

The aim of this study was to explore how adults with a chronic illness integrate the illness experience into their life context.

BACKGROUND

Adults with chronic illnesses are challenged to learn self-management strategies to prevent complications and achieve an acceptable quality of life. Integration represents the process undertaken by an individual to achieve a sense of balance in self-managing a chronic illness and living a personally meaningful life.

DESIGN

A mixed-method descriptive design was employed to recruit English-speaking adults with a chronic illness. A semi-structured interview was completed, transcribed verbatim and content analysed. Descriptive data were collected on demographics, co-morbidity and depressive symptoms. The research was undertaken in Connecticut, USA.

RESULTS

The sample (n = 26) was diverse with respect to age (25-80 years), education (8-24 years), duration of illness (1-39 years), gender (63% female) and ethnicity (63% white). Participants reported a mean of four chronic illnesses and 31% of the sample had increased depressive symptoms. The process of integration was complex and multifactorial. Themes of integration included: shifting sands, staying afloat, weathering the storms, rescuing oneself and navigating life. Numerous factors including treatment side effects, a progressive or uncertain illness trajectory, co-morbidity, bad days, financial hardships and interpersonal/environmental challenges contributed to a disruption or difficulty in the integration process.

CONCLUSION

All participants made considerable effort to integrate the illness into their life context and participate in a personally meaningful life. However, it was easy to be consumed with 'living an illness' as the daily tasks, the changing symptoms and the fluctuating emotions could be overwhelming. There was a complex co-existence between 'living a life' and 'living an illness'.

RELEVANCE TO CLINICAL PRACTICE

There were numerous challenges to the process of integration and ongoing self-management, psychosocial, vocational and existential support appears indicated, particularly with individuals with multiple chronic illnesses, progressive chronic illnesses and limited resources.

Maintaining hope in transition: a theoretical framework to guide interventions for people with heart failure

Theoretical frameworks provide a structure for the planning and delivery of nursing care and for research. Heart failure (HF), a condition of increasing prevalence in communities internationally, is responsible for high rates of morbidity, mortality, and great societal burden. The HF illness trajectory can be unpredictable and uncertain. Markers of transition, such as functional decline and increasing dependence, can signal the need for transition to a more palliative approach. This transition challenges clinicians to deliver information and interventions and to support patients and their families not only in relation to their physical status but also in the social, psychological, and existential dimensions. This article describes a theoretical framework, Maintaining Hope in Transition, informed by transition theory, to assist patients to cope with a diagnosis of HF and to guide development of nursing interventions. Transition theory provides a useful context to assist clinicians, patients, and their families adjust to the challenges inherent in a diagnosis of HF and negotiating the illness trajectory. Key factors acknowledged in the Maintaining Hope in Transition framework that determine its utility in models of care for HF patients are (1) acknowledging the changing of life circumstances, (2) restructuring reality, (3) dealing with vulnerability, (4) achieving normalization, and (5) resolving uncertainty. It is likely that incorporation of these factors in care planning, information, and interventions can facilitate patients' and their families' abilities to negotiate the HF illness trajectory, particularly in the advanced stages.

Using a matrix in life transition research

Life transitions can be planned or can occur unexpectedly. They can cause a major change to a person's life patterns and well-being. Older adulthood is a time for many life transitions as a result of changes in life roles and health status. In this exploratory study, the authors investigate the transition involved in driving cessation for older people. In analyzing and organizing the data, they develop a matrix that incorporated descriptive and temporal factors associated with the transition. This matrix is useful in organizing and communicating the findings as a whole and could be used in describing individual experiences. It might be of use for the organization of qualitative data about other life transitions such as illness, retirement, and the development and adoption of new behaviors.