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Original research
Changing characteristics of post-COVID-19 syndrome: Cross-sectional findings from 458 consultations using the Stanford Hall remote rehabilitation assessment tool
  1. Andrew Houston1,
  2. C Tovey2,
  3. K Rogers-Smith2,
  4. K Thompson3,
  5. P Ladlow1,
  6. R Barker-Davies1,4,
  7. S Bahadur2,
  8. D Goodall2,
  9. M Gough2,
  10. J Norman2,
  11. R Phillip2,
  12. P Turner2,
  13. M Cranley2 and
  14. O O'Sullivan1,5
  1. 1Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough, UK
  2. 2Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
  3. 3Headquarters Army Medical Services (HQ AMS), Camberley, UK
  4. 4Loughborough University, Loughborough, UK
  5. 5Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
  1. Correspondence to Maj O O'Sullivan, Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC) Stanford Hall, Loughborough LE12 5QW, UK; oliver_osullivan{at}hotmail.com

Abstract

Background In the UK, there have been multiple waves of COVID-19, with a five-tier alert system created to describe the transmission rate and appropriate restrictions. While acute mortality decreased, there continued to be a significant morbidity, with individuals suffering from persistent, life-restricting symptoms for months to years afterwards. A remote rehabilitation tool was created at the Defence Medical Rehabilitation Centre (DMRC) Stanford Hall to assess post-COVID-19 symptoms and their impact on the UK military.

This study aims to understand changes in post-COVID-19 syndrome between wave 1 and wave 2, identify interactions between alert level and symptoms and investigate any predictive nature of acute symptoms for postacute symptomology in a young, physically active population.

Methods Cross-sectional study of 458 consecutive remote rehabilitation assessments performed at DMRC Stanford Hall between 2 April 2020 and 29 July 2021. Consultations were coded, anonymised, and statistical analysis was performed to determine associations between acute and postacute symptoms, and between symptoms, alert levels and waves.

Results 435 assessments were eligible; 174 in wave 1 and 261 in wave 2. Post-COVID-19 syndrome prevalence reduced from 43% to 2% between the waves. Acutely, widespread pain was more prevalent in wave 2 (p<0.001). Postacutely, there was increased anxiety (p=0.10) in wave 1 and increased sleep disturbance (p<0.001), memory/concentration issues (p<0.001) and shortness of breath/cough (p=0.017) in wave 2. Increasing alert level was associated with increased postacute symptom prevalence (p=0.046), with sleep disturbance increasing at higher alert level (p=0.016). Acute symptoms, including fatigue, sleep disturbance and myalgia, were associated with multiple postacute symptoms.

Conclusions This study reports the overall prevalence and symptom burden in the UK military in the first two waves of COVID-19. By reporting differences in COVID-19 in different waves and alert level, this study highlights the importance of careful assessment and contextual understanding of acute and postacute illnesses for individual management plans.

  • COVID-19
  • PRIMARY CARE
  • REHABILITATION MEDICINE

Data availability statement

All data relevant to the study are included in the article. All data used in the analysis of this study are included in the manuscript. The data sets relate to serving members of the UK Ministry of Defence and therefore are sensitive. Reasonable data requests should be directed to the corresponding author and permissions can be sought if appropriate.

This article is made freely available for personal use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/military-2022-002248

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    Data availability statement

    All data relevant to the study are included in the article. All data used in the analysis of this study are included in the manuscript. The data sets relate to serving members of the UK Ministry of Defence and therefore are sensitive. Reasonable data requests should be directed to the corresponding author and permissions can be sought if appropriate.

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    Footnotes

    • Contributors OOS and RBD conceived the study idea. OOS and AH refined the study design and analysis plan. SB, MC, MG, JN, RP, PT and AH performed the VTC consultations. CT, KRS and KT performed the data collection. AH performed the analysis, including all statistical tests. OOS, AH and PL drafted the manuscript with help from RBD. All authors agreed to the final version, with OOS acting as the guarantor for this study.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.