Swallow, communication, voice, and cognitive problems are common after hospitalization for COVID-19, according to a study in BMJ Open Respiratory Research.
Investigators prospectively analyzed questionnaire data on the prevalence of self-reported swallowing, communication, voice, and cognitive problems post-COVID-19 infection among adult patients discharged from a ward or admissions unit at 64 hospital trusts in the United Kingdom.
All participants in the study, known as the Post-Hospitalisation COVID-19 (PHOSP-COVID) study, had a confirmed diagnosis of COVID-19 and were asked to complete 2 research visits — at 2 to 7 months postdischarge (visit 1) and at 10 to 14 months postdischarge (visit 2) — during which time questionnaires asking about various symptoms/conditions were administered.
The outcomes of interest were self-reported communication issues and cognitive issues at visits 1 and 2, as well as self-reported voice and swallow problems in an intensive care unit (ICU) stay. Only patients who were treated in the ICU were asked if they had voice or swallow problems.
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[S]wallow, communication, voice and cognitive problems are prevalent post hospitalisation for COVID-19 and were commonly associated with being younger, female and living in socially deprived areas.
A total of 4,394 participants attended visit 1 and 2,499 attended visit 2. Among those with questionnaire responses related to communication, 23.2% (527/2,275) reported communication issues at visit 1 and 22.5% (399/1,771) reported communication issues at visit 2. Cognitive problems were reported by 70.2% of respondents (1,598/2,275) at visit 1 and by 69.6% (1231/1768) at visit 2.
A total of 966 participants had received ICU care during their COVID-19 hospitalization. Among those who provided questionnaire responses, 20% (188/955) reported swallowing problems and 34% (319/946) reported voice problems. Among patients treated in the ICU who provided questionnaire responses regarding swallowing, those reporting swallowing problems were more likely to have had invasive mechanical ventilation (IMV; P <.001), to have had prone positioning (P =.039), to be younger (median age, 57 vs 60; P =.001), and to be female (P =.041).
Voice problems were reported by 34% (319/946) of respondents. These individuals were more likely than those who reported not having voice problems to have asthma (23% vs 15%, respectively; P =.003), and to have received continuous positive airway pressure (59% vs 47%, respectively; P =.001), noninvasive ventilation (16% vs 10%, respectively; P =.021), and IMV (65% vs 36%, respectively).
About 23% (527/2375) of patients reported communication issues at visit 1, and these patients vs those who reported not to have communication issues were more often younger (median age, 56 vs 60 years), female (48% vs 36%), and from more deprived areas (27% vs 22%). At visit 2, 23% (399/1771) reported communication issues; these patients vs those who reported not having communication issues were more likely to have been admitted to the ICU (42% vs 36%) and to report headache (33% vs 26%) or sore throat (20% vs 14%).
More than two-thirds of participants who took part in visit 1 (1598/2275;70%) reported cognitive issues; respondents reporting cognitive issues vs those reporting no cognitive issues were more likely to be female (44% vs 27%), White (78% vs 68%), have education that did not go beyond the secondary school level (32% vs 25%), and to have been shielding (ie, isolating/wearing masks; 32% vs 24%). At visit 2, a similar proportion of respondents self-reported cognitive issues (1231/1768, 70%); these individuals vs those reporting no cognitive issues were more likely to be female (43% vs 26%), to be White (80% vs 71%), to report shielding (32% vs 25%), and to be from more deprived areas (24% vs 19%).
Among several limitations, only patients admitted to the ICU were asked to report on their swallowing and voice, and direct laryngoscopy and assessment of swallow were not performed. Also, detailed information on swallow was lacking, data were collected during the first year posthospitalization but not beyond, and some data were missing.
“[S]wallow, communication, voice and cognitive problems are prevalent post hospitalisation for COVID-19 and were commonly associated with being younger, female and living in socially deprived areas,” study authors concluded. “Future research and phenotype determination need to capture swallow, communication, voice and cognition subtypes, using detailed assessments and measurements of these important symptoms so we can improve outcomes,” researchers added.
Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
