Rehabilitation Medical Center, West China Hospital, Sichuan University, Chengdu, China.
Rehabilitation Medicine Key Laboratory of Sichuan Province, Sichuan University, Chengdu, China.
PLoS One. 2020 Dec 17;15(12):e0243883. doi: 10.1371/journal.pone.0243883. eCollection 2020.
To estimate the prevalence of disability and anxiety in Covid-19 survivors at discharge from hospital and analyze relative risk by exposures.
Multi-center retrospective cohort study.
Twenty-eight hospitals located in eight provinces of China.
A total of 432 survivors with laboratory-confirmed SARS CoV-2 infection participated in this study. At discharge, we assessed instrumental activities of daily living (IADL) with Lawton's IADL scale, dependence in activities of daily living (ADL) with the Barthel Index, and anxiety with Zung's self-reported anxiety scale. Exposures included comorbidity, smoking, setting (Hubei vs. others), disease severity, symptoms, and length of hospital stay. Other risk factors considered were age, gender, and ethnicity (Han vs. Tibetan).
Prevalence of at least one IADL problem was 36.81% (95% CI: 32.39-41.46). ADL dependence was present in 16.44% (95% CI: 13.23-20.23) and 28.70% (95% CI: 24.63-33.15) were screened positive for clinical anxiety. Adjusted risk ratio (RR) of IADL limitations (RR 2.48, 95% CI: 1.80-3.40), ADL dependence (RR 2.07, 95% CI 1.15-3.76), and probable clinical anxiety (RR 2.53, 95% CI 1.69-3.79) were consistently elevated in survivors with severe Covid-19. Age was an additional independent risk factor for IADL limitations and ADL dependence; and setting (Hubei) for IADL limitations and anxiety. Tibetan ethnicity was a protective factor for anxiety but a risk factor for IADL limitations.
A significant proportion of Covid-19 survivors had disability and anxiety at discharge from hospital. Health systems need to be prepared for an additional burden resulting from rehabilitation needs of Covid-19 survivors.
评估出院时新冠病毒（SARS-CoV-2）感染者的残疾和焦虑发生率，并分析暴露因素的相对风险。
多中心回顾性队列研究。
中国 8 个省份的 28 家医院。
共有 432 名经实验室确诊为 SARS-CoV-2 感染的幸存者参与了本研究。在出院时，我们使用 Lawton 的 IADL 量表评估工具性日常生活活动（IADL）能力，使用 Barthel 指数评估日常生活活动（ADL）依赖程度，使用 Zung 自评焦虑量表评估焦虑程度。暴露因素包括合并症、吸烟、发病地点（湖北与其他地区）、疾病严重程度、症状和住院时间。还考虑了其他风险因素，包括年龄、性别和民族（汉族与藏族）。
至少存在一项 IADL 问题的发生率为 36.81%（95%可信区间：32.39%-41.46%）。ADL 依赖的发生率为 16.44%（95%可信区间：13.23%-20.23%），28.70%（95%可信区间：24.63%-33.15%）筛查为临床焦虑阳性。IADL 受限（调整风险比 [RR] 2.48，95%可信区间：1.80-3.40）、ADL 依赖（RR 2.07，95%可信区间：1.15-3.76）和可能的临床焦虑（RR 2.53，95%可信区间：1.69-3.79）的调整风险比在重症新冠患者中均显著升高。年龄是 IADL 受限和 ADL 依赖的独立危险因素，发病地点（湖北）是 IADL 受限和焦虑的独立危险因素。藏族是焦虑的保护因素，但也是 IADL 受限的危险因素。
相当一部分新冠感染者在出院时存在残疾和焦虑。卫生系统需要为新冠幸存者康复需求带来的额外负担做好准备。
