Self-scored impairments in functioning and disability in post-COVID syndrome following mild COVID-19 infection


  • Jan-Rickard Norrefalk
  • Kristian Borg
  • Indre Bileviciute-Ljungar Karolinska Institutet, Danderyd University Hospital



postcovid syndrome, International Classification of Functioning, Disability and Health, ICF, functioning, fatigue, activity, quality of life


Objectives: To investigate functioning, activity and disability in people with post-COVID syndrome.

Design: Cross-sectional.

Subjects/patients: Participants were recruited online via Facebook and a stakeholders’ organization for post-COVID syndrome in Sweden.

Methods: Sociodemographic data and International Classification of Functioning, Disability and Health (ICF)-based questionnaire were collected via an online platform and analysed.

Results: A total of 100 participants were included (mean age 44.5 years, 82% women, 61% with higher education, and 56% working full- or part-time). For the ICF component Body Functions, the most impaired functions were: fatigability and energy drive (98–99%); higher cognitive functions (74–94%); sleep functions (98%); muscle functions (93%); respiratory functions (92%); heart functions (82%); emotional functions (80%); sexual functions (77%); pain problems (56–90%); and thermoregulatory functions (68%). For the component Activity, the most frequent limitations were: handling stressful situations (98%); remunerative employment (95%); recreation and leisure (94%); climbing the stairs (94%); doing housework (84%); and informal socializing (64%). The most frequent degrees of impairment/limitations were light and moderate, except for severe-complete for fatigue, higher cognitive functions, multitasking, handling stressful situations; and recreation and leisure activities.

Conclusion: Post-COVID syndrome following a mild COVID-19 infection can result in impaired body functions and activities. These results support the importance of a multidisciplinary rehabilitation approach for these patients.


Lay Abstract

The SARS-CoV-2 (COVID-19) pandemic has infected  several hundred million people worldwide to date.  A proportion of people with COVID-19 who develop a mild initial illness, mainly staying at home or requesting few days of hospitalization, do not subsequently recover fully. Some of them develop new persistent symptoms and an increased level of disability, affecting their functioning. This study describes functioning and disability in people with post-COVID syndrome after a mild initial infection, using a self-scored questionnaire based on the International Classification of Functioning and Disability. A total of 100 participants were included in the study. Participants were relatively young and healthy prior to the infection. The majority were female,  with a high level of education, and mostly working full- or part-time. Many disabling symptoms were found to persist, indicating the need for further research into post-COVID syndrome, and supporting the use of a multidisciplinary rehabilitation approach for these patients.


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Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA 2020; 324: 782-793.

Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun 2020; 87: 18-22.

Yachou Y, El Idrissi A, Belapasov V, Ait Benali S. Neuroinvasion, neurotropic, and neuroinflammatory events of SARS-CoV-2: understanding the neurological manifestations in COVID-19 patients. Neurol Sci 2020; 41: 2657-2669.

Masi P, Hekimian G, Lejeune M, Chommeloux J, Desnos C, Pineton De Chambrun M, et al. Systemic inflammatory response syndrome is a major contributor to COVID-19-associated coagulopathy: insights from a prospective, single-center cohort study. Circulation 2020; 142: 611-614.

Network C-IGobotR, the C-ICUI. Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study. Intensive Care Med 2021; 47: 60-73.

Raveendran AV, Jayadevan R, Sashidharan S. Long COVID: an overview. Diabetes Metab Syndr 2021; 15: 869-875.

Covid-19 "Long hauler" symptom survey report. Indiana University School of Medicine 2020 (cited 2021 Sept 20). Available from:

Carfi A, Bernabei R, Landi F. Gemelli Against C-P-ACSG. Persistent symptoms in patients after acute COVID-19. JAMA 2020; 324: 603-605.

Huang C, Huang, L, Wang, Y, Li, X, Ren, L, Gu, X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021; 397: 220-232.

Townsend L, Dyer AH, Jones K, Dunne J, Mooney A, Gaffney F, et al. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One 2020; 15: e0240784.

World Health Organization. Expanding our understanding of post COVID-19 condition. 2021 (cited 2021 Sept 20). Available from:

World Health Organization. The International Classification of Functioning, Disability and Health (ICF). 2001 (cited 2021 Sept 20). Available from:

Cieza A, Chatterji S, Andersen C, Cantista P, Herceg M, Melvin J, et al. ICF Core Sets for depression. J Rehabil Med 2004: 128-134.

Cieza A, Schwarzkopf S, Sigl T, Stucki G, Melvin J, Stoll T, et al. ICF Core Sets for osteoporosis. J Rehabil Med 2004: 81-86.

Cieza A, Stucki A, Geyh S, Berteanu M, Quittan M, Simon A, et al. ICF Core Sets for chronic ischaemic heart disease. J Rehabil Med 2004: 94-99.

Cieza A, Kirchberger I, Biering-Sorensen F, Baumberger M, Charlifue S, Post MW, et al. ICF Core Sets for individuals with spinal cord injury in the long-term context. Spinal Cord 2010; 48: 305-312.

Geyh S, Cieza A, Schouten J, Dickson H, Frommelt P, Omar Z, et al. ICF Core Sets for stroke. J Rehabil Med 2004: 135-141.

Coenen M, Cieza A, Freeman J, Khan F, Miller D, Weise A, et al. The development of ICF Core Sets for multiple sclerosis: results of the International Consensus Conference. J Neurol 2011; 258: 1477-1488.

Norrefalk JR, Svensson E. The functional barometer -a self-report questionnaire in accordance with the International Classification of Functioning, Disability and Health for pain related problems; validity and patient-observer comparisons. BMC Health Serv Res 2014; 14: 187.

Socialstyrelsen. Statistik över sjukskrivningar i samband med covid-19 under första vågen. Socialstyrelsen 2021 (cited 2021 Sept 20). Available from: (in Swedish).

Kedor C, Freitag, L, Meyer-Arndt, L, Wittke, K, Zoller, T, Steinbeis, F, et al. Chronic COVID-19 Syndrome and Chronic Fatigue Syndrome (ME/CFS) following the first pandemic wave in Germany - a first analysis of a prospective observational study. MedRxiv. 2021 (cited 2021 Sept 20). Available from:

Ahmed HPK, Greewood D, Halpin S, Lewthwaite P, Salawu A, Eyre L , et al. Long-term clinical respiratory outcomes in survivors of severe acute respiratory syndrome (SARS) and middle east respiratory syndrome (MERS) coronavirus outbreaks after hospitalization or ICU admission: a systemic review and meta-analysis. J Rehab Med 2020; 52: jrm00063.

Norrefalk JR, Borg, K. The Functional Barometer - an analysis of a self-assessment questionnaire with ICF-coding regarding functional/activity limitations and quality of life due to pain - differences in age gender and origin of pain. Scand J Pain 2017; 17C: 16-21.

Norrefalk JR, Borg, K. Limitations of long-standing non-malignant pain in functioning, activity and quality of life: a gender comparison. J Int Soc Phys Rehabil Med 2018; 1: 49-54.

Cieza A, Stucki G, Weigl M, Kullmann L, Stoll T, Kamen L, et al. ICF Core Sets for chronic widespread pain. J Rehabil Med 2004: 63-68.

Berno S, Coenen M, Leib A, Cieza A, Kesselring J. Validation of the Comprehensive International Classification of Functioning, Disability, and Health Core Set for multiple sclerosis from the perspective of physicians. J Neurol 2012; 259: 1713-1726.

Bileviciute-Ljungar I, Schult ML, Borg K, Ekholm J. Preliminary ICF core set for patients with myalgic encephalomyelitis/chronic fatigue syndrome in rehabilitation medicine. J Rehabil Med 2020; 52: jrm00074.



How to Cite

Norrefalk, J.-R., Borg, K., & Bileviciute-Ljungar, I. (2021). Self-scored impairments in functioning and disability in post-COVID syndrome following mild COVID-19 infection. Journal of Rehabilitation Medicine, 53(11 (November), jrm00239.



Original Report