Postural balance and functional muscle strength in the hands and legs one year after hospitalisation due to COVID-19

Authors

  • Lena Rafsten Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
  • Alexandra Larsson Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
  • Annie Palstam Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; School of Health and Welfare, Dalarna University, Falun. Sweden
  • Hanna Persson Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden

DOI:

https://doi.org/10.2340/jrm.v57.42763

Keywords:

COVID-19, postural balance, muscle strength, hand, leg

Abstract

Objective: The aim of the study was to investigate postural balance and functional muscle strength over 1 year following hospital discharge due to COVID-19 and identify possible differences depending on age, sex, and level of hospital care.

Design: A prospective longitudinal study.

Subjects: A total of 164 participants were included.

Methods: Postural balance, functional leg strength, and functional hand strength were evaluated. Change over time and differences between groups were investigated.

Results: At the 1-year follow-up postural balance was improved (p = 0.001), as well as strength in the hands (p = 0.001), and legs (p = 0.001). Participants treated at an intensive care unit (ICU) had impaired functional muscle strength in the hands but not in the legs 1 year after discharge. Functional muscle strength in dominant hand on discharge, age, and previous level of physical activity were associated with having more impaired functional muscle strength in the dominant hand 1 year after discharge.

Conclusion: Functional muscle strength and postural balance after COVID-19 improved significantly from discharge to the 1-year follow-up although nearly half of the patients still had impaired functional muscle strength 1 year after COVID-19 hospitalization.

Trial registration: FoU i Sverige (Research & Development in Sweden, Registration number: 274476, registered 2020-05-28).

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References

A minimal common outcome measure set for COVID-19 clinical research. Lancet Infect Dis 2020; 20: e192–e197.

https://doi.org/10.1016/s1473-3099(20)30483-7 DOI: https://doi.org/10.1016/S1473-3099(20)30483-7

Sveriges kommuner och regioner. Hälso- och sjukvårdsrapporten 2021. 2021 [cited 2023]. Available from: https://skr.se/skr/tjanster/rapporterochskrifter/publikationer/halsoochsjukvardsrapporten2021.65001.html

World Health Organization. WHO Coronavirus (COVID-19) Dashboard. 2023 [cited 2024 Feb 22]. Available from: https://covid19.who.int

D’Amico F, Marmiere M, Righetti B, Scquizzato T, Zangrillo A, Puglisi R, et al. COVID-19 seasonality in temperate countries. Environ Res 2022; 206: 112614.

https://doi.org/10.1016/j.envres.2021.112614 DOI: https://doi.org/10.1016/j.envres.2021.112614

Marshall M. The lasting misery of coronavirus long-haulers. Nature 2020; 585: 339–341.

https://doi.org/10.1038/d41586-020-02598-6 DOI: https://doi.org/10.1038/d41586-020-02598-6

Manta A, Michelakis I, Dafni M, Spanoudaki A, Krontira S, Tsoutsouras T, et al. Long-term outcomes, residual symptoms and quality of life in COVID-19 hospitalized patients: a 12-month longitudinal study. J Investig Med 2024; 72: 193–201.

https://doi.org/10.1177/10815589231212899 DOI: https://doi.org/10.1177/10815589231212899

Seeßle J, Waterboer T, Hippchen T, Simon J, Kirchner M, Lim A, et al. Persistent symptoms in adult patients 1 year after coronavirus disease 2019 (COVID-19): a prospective cohort study. Clin Infect Dis 2022; 74: 1191–1198.

https://doi.org/10.1093/cid/ciab611 DOI: https://doi.org/10.1093/cid/ciab611

Duggal P, Penson T, Manley HN, Vergara C, Munday RM, Duchen D, et al. Post-sequelae symptoms and comorbidities after COVID-19. J Med Virol 2022; 94: 2060–2066.

https://doi.org/10.1002/jmv.27586 DOI: https://doi.org/10.1002/jmv.27586

Heidemann C, Sarganas G, Du Y, Gaertner B, Poethko-Müller C, Cohrdes C, et al. Long-term health consequences among individuals with SARS-CoV-2 infection compared to individuals without infection: results of the population-based cohort study CoMoLo Follow-up. BMC Public Health 2023; 23: 1587.

https://doi.org/10.1186/s12889-023-16524-8 DOI: https://doi.org/10.1186/s12889-023-16524-8

Nasserie T, Hittle M, Goodman SN. Assessment of the frequency and variety of persistent symptoms among patients with COVID-19: a systematic review. JAMA Netw Open 2021; 4: e2111417.

https://doi.org/10.1001/jamanetworkopen.2021.11417 DOI: https://doi.org/10.1001/jamanetworkopen.2021.11417

Gesser AF, Campos ML, Artismo RS, Karloh M, Matte DL. Impact of COVID-19 critical illness on functional status, fatigue symptoms, and health-related quality of life one-year after hospital discharge: a systematic review and meta-analysis. Disabil Rehabil 2024; 46: 4086–4097.

https://doi.org/10.1080/09638288.2023.2266365 DOI: https://doi.org/10.1080/09638288.2023.2266365

Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: a cross-sectional evaluation. J Med Virol 2021; 93: 1013–1022.

https://doi.org/10.1002/jmv.26368 DOI: https://doi.org/10.1002/jmv.26368

Centers for Disease Control and Prevention (CDC). Covid-19. 2019 [cited 2023 28 Feb]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/index.html

World Health Organization (WHO). Post COVID-19 condition (Long COVID). 2023 [cited 2023]. Available from: https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition

Patrucco F, Zeppegno P, Baricich A, Gramaglia CM, Balbo PE, Falaschi Z, et al. Long-lasting consequences of coronavirus disease 19 pneumonia: a systematic review. Minerva Med 2022; 113: 158–171.

https://doi.org/10.23736/s0026-4806.21.07594-7 DOI: https://doi.org/10.23736/S0026-4806.21.07594-7

Gil S, Jacob Filho W, Shinjo SK, Ferriolli E, Busse AL, Avelino-Silva TJ, et al. Muscle strength and muscle mass as predictors of hospital length of stay in patients with moderate to severe COVID-19: a prospective observational study. J Cachexia Sarcopenia Muscle 2021; 12: 1871–1878.

https://doi.org/10.1002/jcsm.12789 DOI: https://doi.org/10.1002/jcsm.12789

Gil S, de Oliveira Júnior GN, Sarti FM, Filho WJ, Longobardi I, Turri JAO, et al. Acute muscle mass loss predicts long-term fatigue, myalgia, and health care costs in COVID-19 survivors. J Am Med Dir Assoc 2023; 24: 10–16.

https://doi.org/10.1016/j.jamda.2022.11.013 DOI: https://doi.org/10.1016/j.jamda.2022.11.013

National Library of Medicine. 2009 [cited 2024 October]. Available from: https://www.ncbi.nlm.nih.gov/mesh?Db=mesh&Cmd=DetailsSearch&Term=%22Postural+Balance%22%5BMeSH+Terms%5D

Kocaman H, Soslu R, Gökşen A, Uysal A. COVID-19 and postural sway: a comparison of individuals with a SARS-CoV-2 history and healthy sedentary women. Somatosens Mot Res 2023; 40: 90–96.

https://doi.org/10.1080/08990220.2023.2175810 DOI: https://doi.org/10.1080/08990220.2023.2175810

Yeh PC, Syu DK, Ho CC, Lee TS. Associations of lower-limb muscle strength performance with static and dynamic balance control among older adults in Taiwan. Front Public Health 2024; 12: 1226239.

https://doi.org/10.3389/fpubh.2024.1226239 DOI: https://doi.org/10.3389/fpubh.2024.1226239

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 2008; 61: 344–349.

https://doi.org/10.1016/j.jclinepi.2007.11.008 DOI: https://doi.org/10.1016/j.jclinepi.2007.11.008

Bohannon RW, Andrews AW, Thomas MW. Walking speed: reference values and correlates for older adults. J Orthop Sports Phys Ther 1996; 24: 86–90.

https://doi.org/10.2519/jospt.1996.24.2.86 DOI: https://doi.org/10.2519/jospt.1996.24.2.86

Bohannon RW. Comfortable and maximum walking speed of adults aged 20–79 years: reference values and determinants. Age Ageing 1997; 26: 15–19.

https://doi.org/10.1093/ageing/26.1.15 DOI: https://doi.org/10.1093/ageing/26.1.15

Watson MJ. Refining the ten-metre walking test for use with neurologically impaired people. Physiotherapy 2002; 88: 386–397.

https://doi.org/10.1016/S0031-9406(05)61264-3 DOI: https://doi.org/10.1016/S0031-9406(05)61264-3

Bohannon RW. Single limb stance times: a descriptive meta-analysis of data from individuals at least 60 years of age. Top Geriatr Rehabil 2006; 22: 70–77.

https://doi.org/10.1097/00013614-200601000-00010 DOI: https://doi.org/10.1097/00013614-200601000-00010

Fu C-J, Chen W-C, Lu M-L, Niu C-C, Lee Y-H, Cheng C-H. Equipment-free fall-risk assessments for the functionally independent elderly: a systematic review and meta-analysis. Int J Gerontol 2021; 15: 301–308.

Persson CU, Hansson PO, Sunnerhagen KS. Clinical tests performed in acute stroke identify the risk of falling during the first year: postural stroke study in Gothenburg (POSTGOT). J Rehabil Med 2011; 43: 348–353.

https://doi.org/10.2340/16501977-0677 DOI: https://doi.org/10.2340/16501977-0677

Berg K, Wood-Dauphine S, Williams J, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can 1989; 41: 304–311.

https://doi.org/10.3138/ptc.41.6.304 DOI: https://doi.org/10.3138/ptc.41.6.304

Berg KO, Wood-Dauphinee SL, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Can J Public Health 1992; 83: S7–11.

Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil 1985; 66: 69–74.

Boissy P, Bourbonnais D, Carlotti MM, Gravel D, Arsenault BA. Maximal grip force in chronic stroke subjects and its relationship to global upper extremity function. Clin Rehabil 1999; 13: 354–362.

https://doi.org/10.1191/026921599676433080 DOI: https://doi.org/10.1191/026921599676433080

Bertrand AM, Mercier C, Bourbonnais D, Desrosiers J, Gravel D. Reliability of maximal static strength measurements of the arms in subjects with hemiparesis. Clin Rehabil 2007; 21: 248–257.

https://doi.org/10.1177/0269215506070792 DOI: https://doi.org/10.1177/0269215506070792

Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am 1984; 9: 222–226.

https://doi.org/10.1016/s0363-5023(84)80146-x DOI: https://doi.org/10.1016/S0363-5023(84)80146-X

Gill S, McBurney H. Reliability of performance-based measures in people awaiting joint replacement surgery of the hip or knee. Physiother Res Int 2008; 13: 141–152.

https://doi.org/10.1002/pri.411 DOI: https://doi.org/10.1002/pri.411

Jones CJ, Rikli RE, Beam WC. A 30-s chair–stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport 1999; 70: 113–119.

https://doi.org/10.1080/02701367.1999.10608028 DOI: https://doi.org/10.1080/02701367.1999.10608028

Lein DH Jr, Alotaibi M, Almutairi M, Singh H. Normative reference values and validity for the 30-second chair–stand test in healthy young adults. Int J Sports Phys Ther 2022; 17: 907–914.

https://doi.org/10.26603/001c.36432 DOI: https://doi.org/10.26603/001c.36432

Macfarlane DJ, Chou KL, Cheng YH, Chi I. Validity and normative data for thirty-second chair stand test in elderly community-dwelling Hong Kong Chinese. Am J Hum Biol 2006; 18: 418–421.

https://doi.org/10.1002/ajhb.20503 DOI: https://doi.org/10.1002/ajhb.20503

Mehrholz J, Wagner K, Rutte K, Meissner D, Pohl M. Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil 2007; 88: 1314–1319.

https://doi.org/10.1016/j.apmr.2007.06.764 DOI: https://doi.org/10.1016/j.apmr.2007.06.764

Holden MK, Gill KM, Magliozzi MR, Nathan J, Piehl-Baker L. Clinical gait assessment in the neurologically impaired: reliability and meaningfulness. Phys Ther 1984; 64: 35–40.

https://doi.org/10.1093/ptj/64.1.35 DOI: https://doi.org/10.1093/ptj/64.1.35

Grimby G, Börjesson M, Jonsdottir IH, Schnohr P, Thelle DS, Saltin B. The “Saltin–Grimby Physical Activity Level Scale” and its application to health research. Scand J Med Sci Sports 2015; 25 Suppl 4: 119–125.

https://doi.org/10.1111/sms.12611 DOI: https://doi.org/10.1111/sms.12611

Saltin B, Grimby G. Physiological analysis of middle-aged and old former athletes: comparison with still active athletes of the same ages. Circulation 1968; 38: 1104–1115.

https://doi.org/10.1161/01.cir.38.6.1104 DOI: https://doi.org/10.1161/01.CIR.38.6.1104

Klok FA, Boon GJAM, Barco S, Endres M, Geelhoed JJM, Knauss S, et al. The Post-COVID-19 Functional Status scale: a tool to measure functional status over time after COVID-19. Eur Resp J 2020; 56: 2001494.

https://doi.org/10.1183/13993003.01494-2020 DOI: https://doi.org/10.1183/13993003.01494-2020

Rikli RE, Jones CJ. Functional fitness normative scores for community-residing older adults, ages 60-94. J Aging Phys Activity 1999; 7: 162–181.

https://doi.org/10.1123/japa.7.2.162 DOI: https://doi.org/10.1123/japa.7.2.162

Bellan M, Soddu D, Balbo PE, Baricich A, Zeppegno P, Avanzi GC, et al. Respiratory and psychophysical sequelae among patients with Covid-19 four months after hospital discharge. JAMA Netw Open 2021; 4: e2036142.

https://doi.org/10.1001/jamanetworkopen.2020.36142 DOI: https://doi.org/10.1001/jamanetworkopen.2020.36142

Tanriverdi A, Savci S, Kahraman BO, Ozpelit E. Extrapulmonary features of post-COVID-19 patients: muscle function, physical activity, mood, and sleep quality. Ir J Med Sci 2022; 191: 969–975.

https://doi.org/10.1007/s11845-021-02667-3 DOI: https://doi.org/10.1007/s11845-021-02667-3

Heesakkers H, van der Hoeven JG, Corsten S, Janssen I, Ewalds E, Simons KS, et al. Clinical outcomes among patients with 1-year survival following intensive care unit treatment for COVID-19. JAMA 2022; 327: 559–565.

https://doi.org/10.1001/jama.2022.0040 DOI: https://doi.org/10.1001/jama.2022.0040

Kiriella JB, Araujo T, Vergara M, Lopez-Hernandez L, Cameron JI, Herridge M, et al. Quantitative evaluation of muscle function, gait, and postural control in people experiencing critical illness after discharge from the intensive care unit. Phys Ther 2018; 98: 8–15.

https://doi.org/10.1093/ptj/pzx102 DOI: https://doi.org/10.1093/ptj/pzx102

Faulkner JA, Larkin LM, Claflin DR, Brooks SV. Age-related changes in the structure and function of skeletal muscles. Clin Exp Pharmacol Physiol 2007; 34: 1091–1096.

https://doi.org/10.1111/j.1440-1681.2007.04752.x DOI: https://doi.org/10.1111/j.1440-1681.2007.04752.x

Ryall JG, Schertzer JD, Lynch GS. Cellular and molecular mechanisms underlying age-related skeletal muscle wasting and weakness. Biogerontology 2008; 9: 213–228.

https://doi.org/10.1007/s10522-008-9131-0 DOI: https://doi.org/10.1007/s10522-008-9131-0

Larsson AC, Engwall M, Palstam A, Persson HC. Self-assessed aspects of health 3 months after COVID-19 hospitalization: a Swedish cross-sectional study. Int J Environ Res Public Health 2022; 19: 8020.

https://doi.org/10.3390/ijerph19138020 DOI: https://doi.org/10.3390/ijerph19138020

Yılmaz O, Mutlu B, Yaman H, Bayazıt D, Demirhan H, Bayazıt YA. Assessment of balance after recovery from Covid-19 disease. Auris Nasus Larynx 2022; 49: 291–298.

https://doi.org/10.1016/j.anl.2021.08.011 DOI: https://doi.org/10.1016/j.anl.2021.08.011

Friello P, Silver N, Sangi-Haghpeykar H, Cohen HS. Screening for balance in children and adults in a community science education setting: normative data, influence of age, sex, and body mass index, and feasibility. PLoS One 2022; 17: e0268030.

https://doi.org/10.1371/journal.pone.0268030 DOI: https://doi.org/10.1371/journal.pone.0268030

Published

2025-06-15

How to Cite

Rafsten, L., Larsson, A., Palstam, A., & Persson, H. (2025). Postural balance and functional muscle strength in the hands and legs one year after hospitalisation due to COVID-19. Journal of Rehabilitation Medicine, 57, jrm42763. https://doi.org/10.2340/jrm.v57.42763

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