Enhancing EQ-5D-5L Sensitivity in Capturing the Most Common Symptoms in Post-COVID-19 Patients: An Exploratory Cross-Sectional Study with a Focus on Fatigue, Memory/Concentration Problems and Dyspnea Dimensions
Abstract
:1. Introduction
2. Materials and Methods
2.1. The Study Design and Cohorts
2.2. EQ-5D-5L
2.3. Persistent Symptoms and Their Severity
2.4. Covariates
2.5. Ethics
2.6. Statistical Analysis
3. Results
3.1. Study Population and Health Outcomes
3.2. Distribution of Patients on EQ-5D-5L Dimensions for Fatigue, Memory/Concentration Problems and Dyspnea
3.3. Correlation of EQ-5D-5L Dimensions and Utility Scores with Fatigue, Memory/Concentration Problems, and Dyspnea
3.4. Multiple Regression Analyses
3.5. Explanatory Power of EQ-5D-5L with and without Symptoms for EQ-VAS
4. Discussion
4.1. Main Findings
4.2. Comparison to Previous Studies
4.3. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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All Patients | Fatigue Severity | Memory/Concentration Problems Severity | Dyspnea Severity | ||||
---|---|---|---|---|---|---|---|
No/Milder (0–6) | Severe (7–10) | No/Milder (0–6) | Severe (7–10) | No/Milder (0–6) | Severe (7–10) | ||
Age, mean (SD) | 52.2 (11.5) | 53.7 (10.6) | 50.2 (12.2) | 53.8 (10.6) | 50.0 (12.3) | 52.3 (11.5) | 51.7 (11.2) |
Female, n (%) | 98 (56) | 49 (51) | 49 (63) | 52 (51) | 46 (62) | 85 (55) | 13 (65) |
Country of birth, n, (%) Sweden | 144 (82) | 74 (76) | 70 (90) | 78 (77) | 66 (89) | 125 (81) | 19 (95) |
Education level, n (%) Up to secondary school Vocational education University | 80 (47) 27 (16) 64 (37) | 42 (43) 16 (16) 39 (40) | 38 (51) 11 (15) 25 (33) | 47 (46) 18 (18) 36 (35) | 33 (47) 9 (13) 28 (40) | 73 (48) 24 (16) 54 (36) | 7 (35) 3 (15) 10 (50) |
Working status, n (%) Working Unemployed On sick leave Retired Student Other | 119 (68) 5 (3) 30 (17) 13 (7) 6 (3) 3 (2) | 74 (75) 3 (3) 8 (8) 8 (8) 6 (6) 0 | 45 (58) 2 (3) 22 (29) 5 (6) 0 3 (4) | 73 (72) 1 (1) 12 (12) 10 (10) 5 (5) 1 (1) | 46 (62) 4 (5) 18 (24) 3 (4) 1 (1) 2 (3) | 107 (69) 4 (3) 25 (16) 13 (8) 4 (3) 3 (2) | 12 (60) 1 (5) 5 (25) 0 2 (10) 0 |
Marital status, n (%) Married Living together Divorced Widower Single | 95 (54) 42 (24) 15 (8) 1 (1) 24 (14) | 60 (61) 17 (17) 10 (10) 1 (1) 11 (11) | 35 (45) 25 (32) 5 (6) 0 13 (17) | 59 (57) 22 (21) 10 (10) 1 (1) 11 (11) | 36 (49) 20 (27) 5 (7) 0 13 (18) | 81 (52) 39 (25) 14 (9) 1 (1) 22 (14) | 14 (70) 3 (15) 1 (5) 0 2 (10) |
Smoking, n (%) Never smoked Ex-smoker Current smoker | 117 (66) 54 (31) 5 (3) | 67 (68) 28 (29) 3 (3) | 50 (64) 26 (33) 2 (3) | 69 (68) 30 (29) 3 (3) | 48 (65) 24 (32) 2 (3) | 103 (66) 49 (31) 4 (3) | 14 (70) 5 (25) 1 (5) |
Hospitalized, n (%) | 86 (50) | 62 (64) | 24 (32) | 60 (61) | 26 (36) | 80 (53) | 6 (30) |
Hypertension Heart disease Hypo/hyperthyroidism Diabetes mellitus Lung disease Cancer Immunosuppressive treatment Depression/Anxiety Chronic pain | 62 (35) 12 (7) 18 (10) 14 (8) 48 (27) 6 (3) 8 (5) 64 (36) 38 (21) | 35 (35) 6 (6) 8 (8) 10 (10) 26 (26) 4 (4) 5 (5) 28 (28) 16 (16) | 27 (35) 6 (8) 10 (13) 4 (5) 22 (28) 2 (3) 3 (4) 36 (46) 22 (28) | 34 (33) 8 (8) 10 (10) 10 (10) 26 (25) 6 (6) 5 (5) 24 (23) 15 (15) | 28 (38) 4 (5) 8 (11) 4 (5) 22 (30) 0 3 (4) 40 (54) 23 (31) | 55 (35) 8 (5) 14 (9) 12 (8) 42 (27) 6 (4) 7 (4) 56 (36) 33 (21) | 7 (35) 4 (20) 4 (20) 2 (10) 6 (30) 0 1 (5) 8 (40) 5 (25) |
BMI, mean (SD) | 28.9 (5.7) | 28.9 (5.3) | 28.9 (6.2) | 28.5 (5) | 29.4 (6.5) | 28.9 (5.3) | 28.9 (8.5) |
Symptom severity at onset, median (IQR) | 4 (1) | 4 (1) | 4 (1) | 4 (1) | 4 (1) | 4 (1) | 4 (1) |
Mean number of persistent symptoms, mean (SD) | 2.3 (1.8) | 1.2 (1.1) | 3.6 (1.6) | 1.4 (1.4) | 3.4 (1.7) | 2.0 (1.6) | 4.1 (2.0) |
EQ-VAS, median (IQR) | 5 (4) | 6 (3) | 3 (4) | 6 (3) | 3.5 (4) | 6 (4) | 3 (5) |
The best health EQ-5D-5L (11111), n (%) | 12 (7) | 11 (11) | 1 (1) | 12 (12) | 0 | 12 (8) | 0 |
Utility score EQ-5D-5L, mean (SD) | 0.77 (0.22) | 0.87 (0.14) | 0.65 (0.25) | 0.86 (0.17) | 0.66 (0.24) | 0.8 (0.22) | 0.61 (0.23) |
Mobility | Self-Care | Usual Activities | Pain/ Discomfort | Anxiety/ Depression | Dyspnea | Memory/ Concentration Problems | Utility Score | |
---|---|---|---|---|---|---|---|---|
Fatigue | 0.46 ** | 0.37 ** | 0.65 ** | 0.40 ** | 0.39 ** | 0.47 ** | 0.75 ** | −0.62 ** |
Memory/ concentration problems | 0.35 ** | 0.27 ** | 0.72 ** | 0.36 ** | 0.45 ** | 0.29 ** | - | −0.65 ** |
Dyspnea | 0.29 ** | 0.32 ** | 0.30 ** | 0.19 * | 0.18 * | - | - | −0.33 ** |
Fatigue | Memory/Concentration Problems | Dyspnea | |||
---|---|---|---|---|---|
Independent Variables | Unstandardized Beta (95% CI) | Independent Variables | Unstandardized Beta (95% CI) | Independent Variables | Unstandardized Beta (95% CI) |
Intercept | 1.76 (0.84, 2.67) ** | Intercept | 0.99 (0.12, 1.86) * | Intercept | 1.48 (0.52, 2.43) ** |
Mobility level 2 | 0.07 (−0.88, 1.01) | Mobility level 2 | −0.57 (−1.46, 0.33) | Mobility level 2 | 0.19 (−0.79, 1.18) |
Mobility level 3 | 0.80 (−0.31, 1.91) | Mobility level 3 | −0.36 (−1.42, 0.69) | Mobility level 3 | 0.39 (−0.77, 1.55) |
Mobility level 4 | −0.08 (−2.02, 1.86) | Mobility level 4 | −1.29 (−3.14, 0.56) | Mobility level 4 | 1.78 (−0.25, 3.81) |
Mobility level 5 | −1.41 (6.46, 3.64) | Mobility level 5 | −4.37 (−9.19, 0.45) | Mobility level 5 | 3.18 (−0.25, 3.81) |
Self-care level 2 | 0.58 (−0.53, 1.69) | Self-care level 2 | 0.16 (−0.90, 1.22) | Self-care level 2 | 1.46 (0.30, 2.62) * |
Self-care level 3 | 1.02 (−0.60, 2.65) | Self-care level 3 | 0.56 (−0.99, 2.11) | Self-care level 3 | 0.14 (−1.56, 1.84) |
Self-care level 4 | −4.54 (−7.99, −1.09) * | Self-care level 4 | −3.86 (−7.15, −0.58) * | Self-care level 4 | −0.54 (−4.14, 3.07) |
Usual activities level 2 | 1.29 (0.13, 2.44) * | Usual activities level 2 | 2.14 (1.04, 3.24) ** | Usual activities level 2 | −0.07 (−1.28, 1.14) |
Usual activities level 3 | 2.72 (1.58, 3.86) ** | Usual activities level 3 | 4.06 (2.98, 5.15) ** | Usual activities level 3 | 0.64 (−0.55, 1.83) |
Usual activities level 4 | 3.95 (2.68, 5.23) ** | Usual activities level 4 | 5.43 (4.21, 6.64) ** | Usual activities level 4 | 1.08 (−0.25, 2.41) |
Usual activities level 5 | 5.65 (3.65, 7.64) ** | Usual activities level 5 | 7.04 (5.13, 8.94) ** | Usual activities level 5 | 1.55 (−0.54, 3.64) |
Pain/discomfort level 2 | −0.02 (−1.08, 1.04) | Pain/discomfort level 2 | 0.04 (−0.97, 1.05) | Pain/discomfort level 2 | 0.52 (−0.58, 1.63) |
Pain/discomfort level 3 | 0.98 (0.00, 1.97) | Pain/discomfort level 3 | 0.78 (−0.16, 1.72) | Pain/discomfort level 3 | 0.66 (−0.38, 1.69) |
Pain/discomfort level 4 | 0.95 (−0.49, 2.40) | Pain/discomfort level 4 | 0.99 (−0.38, 2.37) | Pain/discomfort level 4 | −0.73 (−2.24, 0.78) |
Pain/discomfort level 5 | 2.82 (−1.23, 6.87) | Pain/discomfort level 5 | 3.68 (−0,18, 7.55) | Pain/discomfort level 5 | −0.64 (−4.88, 3.59) |
Anxiety/depression level 2 | 0.72 (−0.18, 1.63) | Anxiety/depression level 2 | 1.01 (0.15, 1.87) * | Anxiety/depression level 2 | 0.42 (−0.53, 1.37) |
Anxiety/depression level 3 | 0.60 (−0.52, 1.72) | Anxiety/depression level 3 | 1.12 (0.05, 2.19) * | Anxiety/depression level 3 | −0.22 (−1.40, 0.95) |
Anxiety/depression level 4 | 0.75 (−0.94, 2.44) | Anxiety/depression level 4 | 0.84 (−0.77, 2.44) | Anxiety/depression level 4 | 1.00 (−0.76, 2.77) |
Anxiety/depression level 5 | −0.27 (−3.56, 3.03) | Anxiety/depression level 5 | −0.91 (−4.05, 2.23) | Anxiety/depression level 5 | 3.08 (−0.36, 6.52) |
Adj R-squared | 0.47 | Adj R-squared | 0.55 | Adj R-squared | 0.14 |
Dependent Variable | Independent Variables | Adjusted R2 | F Value |
---|---|---|---|
EQ VAS | Utility score ** | 0.376 | 106.7 ** |
MO *-ADL **-AC **-PA *-AN * 1 | 0.577 | 13.63 ** | |
MO *-ADL **-AC **-PA-AN-FA ** 2 | 0.632 | 16.1 ** | |
MO *-ADL **-AC **-PA-AN-MC * 3 | 0.587 | 13.48 ** | |
MO-ADL **-AC **-PA-AN *-DY 4 | 0.585 | 13.38 ** | |
MO *-ADL **-AC **-PA-AN-FA **-MC 5 | 0.630 | 15.26 ** | |
MO *-ADL **-AC **-PA-AN-FA **-DY 6 | 0.630 | 15.24 ** | |
MO *-ADL **-AC **-PA-AN-MC-DY 7 | 0.591 | 13.1 ** | |
MO *-ADL **-AC **-PA-AN-MC-DY-FA ** 8 | 0.628 | 14.48 ** |
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Janols, H.; Wadsten, C.; Forssell, C.; Raffeti, E.; Janson, C.; Zhou, X.; Kisiel, M.A. Enhancing EQ-5D-5L Sensitivity in Capturing the Most Common Symptoms in Post-COVID-19 Patients: An Exploratory Cross-Sectional Study with a Focus on Fatigue, Memory/Concentration Problems and Dyspnea Dimensions. Int. J. Environ. Res. Public Health 2024, 21, 591. https://doi.org/10.3390/ijerph21050591
Janols H, Wadsten C, Forssell C, Raffeti E, Janson C, Zhou X, Kisiel MA. Enhancing EQ-5D-5L Sensitivity in Capturing the Most Common Symptoms in Post-COVID-19 Patients: An Exploratory Cross-Sectional Study with a Focus on Fatigue, Memory/Concentration Problems and Dyspnea Dimensions. International Journal of Environmental Research and Public Health. 2024; 21(5):591. https://doi.org/10.3390/ijerph21050591
Chicago/Turabian StyleJanols, Helena, Carl Wadsten, Christoffer Forssell, Elena Raffeti, Christer Janson, Xingwu Zhou, and Marta A Kisiel. 2024. "Enhancing EQ-5D-5L Sensitivity in Capturing the Most Common Symptoms in Post-COVID-19 Patients: An Exploratory Cross-Sectional Study with a Focus on Fatigue, Memory/Concentration Problems and Dyspnea Dimensions" International Journal of Environmental Research and Public Health 21, no. 5: 591. https://doi.org/10.3390/ijerph21050591