Prevalence of musculoskeletal manifestations in post-acute COVID 19 patients and their quality-of-life at Kenyatta National Hospital, Nairobi, Kenya

Abstract

Background: Since its discovery in Wuhan, China, severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) ravaged the globe on an  unprecedented scale. While coronavirus disease (COVID-19) was initially thought to be an acute disease only, protracted  symptomatology led to the characterization of post-acute COVID-19 syndrome (PACS). The prevalence of musculoskeletal (MSK)  manifestations in PACS has been demonstrated in different populations with fibromyalgia (FM) in post-acute COVID-19 identified as a  new facet of PACS. MSK manifestations have decreased the quality of life (QoL) of patients affecting their livelihood.

Objective: To  determine the prevalence of MSK manifestations in post-acute COVID-19 syndrome patients and their quality of life at Kenyatta National Hospital (KNH).

Methods: A descriptive cross-sectional study. Following screening for eligibility, PACS patients were scheduled for  physical participation after chart review. MSK manifestations were identified, and diagnosis of FM was done using the American College  of Rheumatology (ACR) criteria. Assessment of QoL was done using the 36-item short form (SF 36) questionnaire.

Results: The prevalence  of MSK manifestations in PACS was 57.4% (95% CI 47.5% - 66.3%), the most common being fatigue, arthralgia and myalgia. The prevalence of FM was documented as 10.9% (95% CI 5.9% - 17.8%). Patients with MSK manifestations were 6.8 times more likely to have  poor QoL than those without MSK manifestations. All the 8 domains of the SF 36 were adversely impaired among PACS patients with MSK  manifestations; physical health (mean score 5.3±4.5) and emotional wellness (mean score 10.4±5.8) being the most affected categories.  PACS patients with MSK manifestations were more likely to be female (p<0.001), who had a high BMI (p<0.001) and long duration of  hospital stay (p<0.001) where they were treated with steroids in the acute phase (p<0.001) of COVID 19. Older age above 60 years  (p<0.007), presence of comorbidities (p<0.001) and smoking (p<0.001) were found to be additional predisposing factors to developing  MSK manifestations. There was no statistical significance found with COVID 19 vaccination status (p=0.097).