ESTIMATES OF CAUSES AND ATTITUDES OF PATIENTS WITH POST-COVID-19 SYNDROME AND MUSCULOSKELETAL SYMPTOMS REFERRED FOR OUTPATIENT REHABILITATION
Keywords:
Rehabilitation, Post- COVID-19, Musculoskeletal symptoms, Functional activityAbstract
The purpose of the study is to assess the causes and attitudes of patients with post-COVID-19 syndrome
(PCS) and musculoskeletal symptoms referred to outpatient rehabilitation. Materials and methods: The study
includes 138 recovery phase patients, after COVID-19 with persistent musculoskeletal symptoms, referred to
outpatient rehabilitation. Data were collected regarding demographic characteristics of the patients, educational
status, occupation, practice of sports, period since COVID-19, treatment (inpatient or home-outpatient), symptoms
and period during which the musculoskeletal symptoms persisted, comorbidities, reasons for visiting a physical
medicine specialist, active approach towards rehabilitation. Results: The average duration of musculoskeletal
symptoms Me(Range) in patients referred for rehabilitation was 13 (7-20) weeks, respectively for women it was 13
(7-20) weeks, for men - 12 (7-19) weeks. 35.5% (49) of the patients were hospitalized due to acute COVID-19
illness, respectively 30.8% (28) of all women and 44.7% (21) of all men. No relationship was found between gender
and the severity of the disease, hospital versa home treatment, as well as between patients' BMI and hospitalization.
76.1% (105) of the patients were in active working age, 33.3% (46) of all were workers, 42.8% (59) – office
employees, 14.5% (20) – retired workers and 9.4% (13) – retired employees. 4.3% (6) of all patients were actively
involved in sports, 28.3% (39) were amateur sportsmen, and 67.4% (93) did not practice any sport activities. On the
occasion of persistent post-COVID-19 rheumatic and musculoskeletal complaints, 40.6% (56) of the patients were
referred for rehabilitation after examination by a family physician and at his/her discretion. Those actively seeking
rehabilitation and referred by a GP for outpatient rehabilitation were 24.6% (34), including 33.0% (30) of all women
and 8.5% (4) of all men. 28.3% (39) were referred for rehabilitation by a specialist physician. At the specialist's
discretion, 28.6% (26) of women and 27.7% (13) of men were referred for treatment with physical modalities, of
whom only 6.5% (9) of women actively sought rehabilitation. 31% (43) of all referred patients, actively sought
rehabilitation with physical modalities. 46.4% (64) of all patients had no prior physiotherapy treatment, of whom
34.1% (31) were women and 70.2% (33) were men. Treatment with physical modalities on other occasion was
performed by 53.6% (74), respectively 65.9% (60) women and 29.8% (14) men. The leading causes for visiting
Physical and Rehabilitation Medicine (PRM) specialist by 68.8% (95) of the patients was back pain, followed by
fatigue 46.4% (64), myalgia - 38. 4% (53), limited ability to work - 29.7% (41), arthralgia - 23.9% (33), physical
activity difficulties - 20.3% (28). Other causes were mentioned by 10.1% (14) of the patients and shortness of breath
was experienced by 6.5% (9) of all patients referred for rehabilitation. Fatigue was more pronounced as a symptom
by female patients. Myalgia was prevalent, as a symptom in both genders, no difference was found between genders
in arthralgia. 15% (21) of patients during their first visit to a PRM physician pointed out one reason, 39% (54) - two
reasons, and 45% (63) of all patients referred for rehabilitation indicated three or more reasons. More than 80% of
the patients had a comorbidity: 50% (69) had one comorbidity, 18% (25) had two comorbidities, and 16.3% (23) had
three or more comorbidities. 5.8% (8) had concomitant cardiovascular disease, 30.4% (42) had hypertensive disease,
16.7% (23) had neurological disease, 9.4% (13) had diabetes mellitus, 59.4%(82) reported pre-existing spondylosis
and 19.6% (27) had other diseases. Conclusion: Time-persistent musculoskeletal symptoms (fatigue, myalgia,
arthralgia, back pain) are a common reason for rehabilitation in patients with Post-COVID-19 (PCS) syndrome. The
results of the study showed that more than two-thirds of patients reported more than one reason for seeing PRM
specialist, with comorbidities seen in three-quarters of patients. One-third of the patients actively wanted to be
referred for rehabilitation. Patient education and the formation of active behaviors in the recovery phase after
COVID-19 could reduce the negative health consequences in patients with musculoskeletal symptoms of post-
COVID-19 syndrome.
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