Mobile primary healthcare for post-COVID patients in rural areas: a proof-of-concept study

  1. Andreas Stallmach
  2. Katrin Katzer
  3. Bianca Besteher
  4. Kathrin Finke
  5. Benjamin Giszas
  6. Yvonne Gremme
  7. Rami Abou Hamdan
  8. Katja Lehmann-Pohl
  9. Maximilian Legen
  10. Jan Christoph Lewejohann
  11. Marlene Machnik
  12. Majd Moshmosh Alsabbagh
  13. Luisa Nardini
  14. Christian Puta
  15. Zoe Stallmach
  16. Philipp A. Reuken

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Abstract

Introduction

Post-COVID syndrome is increasingly recognized as a new clinical entity after SARS-CoV-2 infection. Patients living in rural areas may have to travel long with subjectively great effort to be examined using all necessary interdisciplinary tools. This problem could be addressed with mobile outpatient clinics.

Methods

In this prospective observational study, we investigated physical fitness, fatigue, depression, cognitive dysfunction, and dyspnea in patients with post-COVID syndrome in a mobile interdisciplinary post-COVID outpatient clinic. Upon referral from their primary care physician, patients were offered an appointment at a mobile post-COVID outpatient clinic close to their home.

Results

We studied 125 patients (female, n  = 79; 63.2%) in our mobile unit. All patients reported symptoms lasting for more than 12 weeks after acute infection. 88.3% and 64.1% of patients reported significant impairment in physical and mental quality of life. Patients reported a median of three symptoms. The most frequently reported symptoms were fatigue (86.4%), cognitive dysfunction (85.6%), and dyspnea (37.6%). 56.0% of patients performed at < 2.5th percentile at the 1 min sit-to-stand test compared to age- and sex-matched healthy controls, and 25 patients (20.0%) exhibited a drop in oxygen saturation. A questionnaire given to each patient regarding the mobile unit revealed a very high level of patient satisfaction.

Conclusion

There is an increasing need for high-quality and locally available care for patients with post-COVID syndrome. A mobile post-COVID outpatient clinic is a new concept that may be particularly suitable for use in rural regions. Patients’ satisfaction following visits in such units is very high.

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  1. Version published to 10.1007/s15010-022-01881-0
  2. ScreenIT

    SciScore for 10.1101/2022.04.26.22274329: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: The institutional ethics committee of Friedrich-Schiller-University Jena approved the study (2020-1978-Daten) and written informed consent was waived due to the retrospective nature of the study.
    Consent: The institutional ethics committee of Friedrich-Schiller-University Jena approved the study (2020-1978-Daten) and written informed consent was waived due to the retrospective nature of the study.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    Blood samples were obtained to assess complete blood counts, markers of renal and liver function, markers of myocardial damage, coagulation, levels of SARS-CoV-2 anti-spike antibodies, Epstein-Barr virus antibodies, and autoantibodies associated with post-COVID syndrome.
    anti-spike
    suggested: None
    Epstein-Barr virus antibodies,
    suggested: None
    Software and Algorithms
    SentencesResources
    28 Neuropsychological evaluation – assessments: Patients treated in the mobile post-COVID unit underwent a structured neuropsychological assessment, including screening for fatigue (FAS and BFI)17,18, depression (PHQ-9, depression module of the PHQ-D)19, and cognitive dysfunction via MoCA screening21 performed by a trained psychologist.
    MoCA
    suggested: (MOCA, RRID:SCR_010638)
    For the analyses, we used SPSS 26 (IBM Inc, Armonk, NY, USA) and PRISM 6 (GraphPad Inc, San Diego, CA, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)
    PRISM
    suggested: (PRISM, RRID:SCR_005375)
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    An assessment of these limitations makes sense when assessing prognosis and initiating therapeutic procedures. Classic imaging modalities do not assess the extent of functional limitation. While classic cardiopulmonary exercise tests are available, we chose the sit-to-stand test, which can be carried out easily and almost anywhere without specialized training or equipment. Of note, 70% of the patients in our cohort showed deviations from the age- and gender-specific norms; this finding is consistent with that reported previously by Núñez-Cortés et al.31 Interestingly, the degree of physical dysfunction recorded for the patients who had been hospitalized due to SARS-CoV-2 infection was not different those with mild to moderate infection that was treated on an outpatient basis. These results conflict with those reported by Núñez-Cortés et al.31 ; specifically, we observe no correlation between the results of the one-minute sit-to-stand test with initial severity of the disease. However, this may be due to the comparatively few patients in our cohort who required hospitalization with or without an ICU stay patients. Privacy within the mobile unit was ensured by the spatial separation of the examination stations. Patient concerns were recorded in a structured manner and objective data on physical fitness, lung function, cognitive dysfunction, fatigue, and depressive symptoms were collected. The number of human resources required for this effort (i.e., doctor, psychologist, medica...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

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  3. Version published to 10.1101/2022.04.26.22274329v1 on medRxiv