Patients Surviving Critical COVID-19 have Impairments in Dual-task Performance Related to Post-intensive Care Syndrome

Nathan Morelli; Selina M. Parry; Angela Steele; Megan Lusby; Ashley A. Montgomery-Yates; Peter E. Morris; Kirby P. Mayer

doi:10.1177/08850666221075568

Patients Surviving Critical COVID-19 have Impairments in Dual-task Performance Related to Post-intensive Care Syndrome

Nathan Morelli, Selina M. Parry, Angela Steele, Megan Lusby, Ashley A. Montgomery-Yates, Peter E. Morris, Kirby P. Mayer

Research output: Contribution to journal › Article › peer-review

20 Scopus citations

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.

Original language	English
Pages (from-to)	890-898
Number of pages	9
Journal	Journal of Intensive Care Medicine
Volume	37
Issue number	7
DOIs	https://doi.org/10.1177/08850666221075568
State	Published - Jul 2022

Bibliographical note

Publisher Copyright:
© The Author(s) 2022.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Center for Advancing Translational Sciences (grant number UL1TR001998). This publication was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR001998. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Funders	Funder number
National Institutes of Health (NIH)
National Center for Research Resources
National Center for Advancing Translational Sciences (NCATS)	UL1TR001998

Keywords

COVID-19
intensive care
mobility
physical function
post intensive care syndrome

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

Access to Document

10.1177/08850666221075568

Cite this

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title = "Patients Surviving Critical COVID-19 have Impairments in Dual-task Performance Related to Post-intensive Care Syndrome",

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.",

keywords = "COVID-19, intensive care, mobility, physical function, post intensive care syndrome",

author = "Nathan Morelli and Parry, \{Selina M.\} and Angela Steele and Megan Lusby and Montgomery-Yates, \{Ashley A.\} and Morris, \{Peter E.\} and Mayer, \{Kirby P.\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2022.",

year = "2022",

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doi = "10.1177/08850666221075568",

language = "English",

volume = "37",

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AU - Morelli, Nathan

AU - Parry, Selina M.

AU - Steele, Angela

AU - Lusby, Megan

AU - Montgomery-Yates, Ashley A.

AU - Morris, Peter E.

AU - Mayer, Kirby P.

N1 - Publisher Copyright: © The Author(s) 2022.

PY - 2022/7

Y1 - 2022/7

N2 - 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.

AB - 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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KW - physical function

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Patients Surviving Critical COVID-19 have Impairments in Dual-task Performance Related to Post-intensive Care Syndrome

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

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