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Article

Detecting Orthostatic Intolerance in Long COVID in a Clinic Setting

by
Robert Oliver Isaac
1,2,3,
Joanna Corrado
1,2,3 and
Manoj Sivan
1,2,3,*
1
National Demonstration Centre for Rehabilitation, Leeds Teaching Hospitals NHS Trust, Leeds LS7 4SA, UK
2
Long COVID Rehabilitation Service, Leeds Community Healthcare Trust, Leeds LS6 1PF, UK
3
Academic Department of Rehabilitation Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS7 4SA, UK
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2023, 20(10), 5804; https://doi.org/10.3390/ijerph20105804
Submission received: 27 January 2023 / Revised: 7 May 2023 / Accepted: 10 May 2023 / Published: 12 May 2023
(This article belongs to the Section Health Behavior, Chronic Disease and Health Promotion)

Abstract

Introduction: A likely mechanism of Long COVID (LC) is dysautonomia, manifesting as orthostatic intolerance (OI). In our LC service, all patients underwent a National Aeronautics and Space Administration (NASA) Lean Test (NLT), which can detect OI syndromes of Postural Tachycardia Syndrome (PoTS) or Orthostatic Hypotension (OH) in a clinic setting. Patients also completed the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), a validated LC outcome measure. Our objectives in this retrospective study were (1) to report on the findings of the NLT; and (2) to compare findings from the NLT with LC symptoms reported on the C19-YRS. Methods: NLT data, including maximum heart rate increase, blood pressure decrease, number of minutes completed and symptoms experienced during the NLT were extracted retrospectively, together with palpitation and dizziness scores from the C19-YRS. Mann-Witney U tests were used to examine for statistical difference in palpitation or dizziness scores between patients with normal NLT and those with abnormal NLT. Spearman’s rank was used to examine the correlation between the degree of postural HR and BP change with C19-YRS symptom severity score. Results: Of the 100 patients with LC recruited, 38 experienced symptoms of OI during the NLT; 13 met the haemodynamic screening criteria for PoTS and 9 for OH. On the C19-YRS, 81 reported dizziness as at least a mild problem, and 68 for palpitations being at least a mild problem. There was no significant statistical difference between reported dizziness or palpitation scores in those with normal NLT and those with abnormal NLT. The correlation between symptom severity score and NLT findings was <0.16 (poor). Conclusions: We have found evidence of OI, both symptomatically and haemodynamically in patients with LC. The severity of palpitations and dizziness reported on the C19-YRS does not appear to correlate with NLT findings. We would recommend using the NLT in all LC patients in a clinic setting, regardless of presenting LC symptoms, due to this inconsistency.
Keywords: post-COVID-19 syndrome (PCS); post-COVID-19 condition (PCC); post acute COVID-19 syndrome (PACS); PoTS; postural hypotension; dysautonomia; C19-Yorkshire rehabilitation scale (YRS) post-COVID-19 syndrome (PCS); post-COVID-19 condition (PCC); post acute COVID-19 syndrome (PACS); PoTS; postural hypotension; dysautonomia; C19-Yorkshire rehabilitation scale (YRS)

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MDPI and ACS Style

Isaac, R.O.; Corrado, J.; Sivan, M. Detecting Orthostatic Intolerance in Long COVID in a Clinic Setting. Int. J. Environ. Res. Public Health 2023, 20, 5804. https://doi.org/10.3390/ijerph20105804

AMA Style

Isaac RO, Corrado J, Sivan M. Detecting Orthostatic Intolerance in Long COVID in a Clinic Setting. International Journal of Environmental Research and Public Health. 2023; 20(10):5804. https://doi.org/10.3390/ijerph20105804

Chicago/Turabian Style

Isaac, Robert Oliver, Joanna Corrado, and Manoj Sivan. 2023. "Detecting Orthostatic Intolerance in Long COVID in a Clinic Setting" International Journal of Environmental Research and Public Health 20, no. 10: 5804. https://doi.org/10.3390/ijerph20105804

APA Style

Isaac, R. O., Corrado, J., & Sivan, M. (2023). Detecting Orthostatic Intolerance in Long COVID in a Clinic Setting. International Journal of Environmental Research and Public Health, 20(10), 5804. https://doi.org/10.3390/ijerph20105804

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