Evaluation of Muscle Strength, Functional Independence, Myalgia, Fatigue and Dyspnea in COVID-19 Infection
Condition: Covid19
MeSH terms: COVID-19; Myalgia; Dyspnea; Fatigue
Study type: Observational

Summary: 
      Coronavirus disease 2019 (COVID-19) is a serious, acute infectious disease caused by Serious
      Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). COVID-19 can manifest itself in a wide
      variety of clinical scenarios. Asymptomatic disease, mild flu findings, pneumonia accompanied
      by acute respiratory failure, acute respiratory distress syndrome (ARDS) requiring
      hospitalization in the intensive care unit, and death are possible clinical consequences.

      Myalgia, fatigue, and muscle weakness are reported regardless of the severity of the clinical
      presentation of COVID-19. Data on the prevalence and severity of muscle disorders and
      weakness during hospitalization and discharge due to COVID-19 disease are limited.

      The aim of this study is to evaluate muscle strength, functional independence, myalgia
      severity, physical fatigue and dyspnea in hospitalized COVID-19 patients.
    

Detailed description: 
      Coronavirus disease 2019 (COVID-19) is a serious, acute infectious disease caused by Serious
      Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). On March 11, 2020, the World Health
      Organization declared a pandemic due to COVID-19 disease transmitted from person to person.
      Positive COVID-19 patients are classified as asymptomatic, mild, moderate, severe and
      critical. Asymptomatic patients have no clinical symptoms, mild cases present with acute
      symptoms of respiratory tract infection and gastrointestinal complaints. Moderate patients
      experience pneumonia, they don't have clinically aberrant hypoxemia but they have positive
      findings on chest computerized tomography (CT) scans. Severe patients present with pneumonia
      ,they have hypoxemia and CT lesions while critical patients present with acute respiratory
      distress syndrome (ARDS), and shock, encephalopathy, myocardial injury, coagulation
      dysfunction, heart failure, acute kidney injury may accompany ARDS.

      Myalgia, fatigue, and muscle weakness are reported regardless of the severity of the clinical
      presentation of COVID-19 disease. Data on the prevalence and severity of muscle disorders and
      weakness during hospitalization and discharge due to COVID-19 disease are limited.

      Changes associated with critical disease myopathy triggered by the virus are reported in
      COVID-19 survivors.

      In addition, immune-induced focal myofibril atrophy and necrosis have been documented in
      post-mortem examinations of patients with severe acute respiratory syndrome (SARS). An
      increase in the risk of acute sarcopenia and muscle weakness has been reported in survivors
      of COVID-19. Possible mechanisms of sarcopenia in COVID-19 disease are: suppression of muscle
      protein synthesis due to systemic inflammation and increased cytokine response, prolonged bed
      rest especially in intensive care patients, prolonged use of muscle relaxants to maintain the
      prone position, increased need for nutrients due to the catabolic state, inadequate nutrition
      due to decreased appetite and induction of muscle loss by dexamethasone used in COVID-19
      treatment.

      The aim of this study is to evaluate muscle strength, functional independence, myalgia
      severity, physical fatigue and dyspnea in hospitalized COVID-19 patients and to investigate
      whether these variables differ between the mild, moderate and severe groups according to the
      severity of the disease. The secondary aim of the study is to investigate the relationship
      between muscle strength and prognostic markers of COVID-19 disease (lymphocyte count,
      D-dimer, c-reactive protein, ferritin).
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        The study cohort will consist of patients receiving inpatient treatment for mild, moderate
        and severe COVID-19 infection in a university hospital. Every subject meeting the criteria
        of inclusion is going to be included into the study via consecutive participant sampling
        method.
      
Keywords: covid19; muscle weakness; functional independence; myalgia; fatigue; dyspnea