Functional Status

BackgroundAn increasing number of subjects are recovering from COVID-19, raising the need for tools to adequately assess the course of the disease and its impact on functional status. We aimed to assess the construct validity of the Post-COVID-19 Functional Status (PCFS) Scale among adult subjects with confirmed and presumed COVID-19.MethodsAdult subjects with confirmed and presumed COVID-19, who were members of an online panel and two Facebook groups for subjects with COVID-19 with persistent symptoms, completed an online survey after the onset of infection-related symptoms. The number and intensity of symptoms were evaluated with the Utrecht Symptom Diary, health-related quality of life (HrQoL) with the 5-level EQ-5D questionnaire, impairment in work and activities with the Work Productivity and Activity Impairment questionnaire and functional status with the PCFS Scale.Results1939 subjects were included in the analyses (85% women, 95% non-hospitalized during infection) about 3 months after the onset of infection-related symptoms. Subjects classified as experiencing 'slight', 'moderate' and 'severe' functional limitations presented a gradual increase in the number/intensity of symptoms, reduction of HrQoL and impairment in work and usual activities. No differences were found regarding the number and intensity of symptoms, HrQoL and impairment in work and usual activities between subjects classified as experiencing 'negligible' and 'no' functional limitations. We found weak-to-strong statistical associations between functional status and all domains of HrQoL (r: 0.233-0.661). Notably, the strongest association found was with the 'usual activities' domain of the 5-level EQ-5D questionnaire.ConclusionWe demonstrated the construct validity of the PCFS Scale in highly-symptomatic adult subjects with confirmed and presumed COVID-19, 3 months after the onset of symptoms.

BackgroundPatients with Heart Failure (HF) show impaired functional capacities which have been related to their prognosis. Moreover, physical functional performance in functional tests has also been related to the prognosis in patients with HF. Thus, it would be useful to investigate how physical functional performance in functional tests could determine the prognosis in patients with HF, because HF is the leading cause of hospital admissions for people older than 65 years old. This systematic review and meta-analysis aims to summarise and synthesise the evidence published about the relationship between physical functional performance and prognosis in patients with HF, as well as assess the risk of bias of included studies and the level of evidence per outcome.MethodsMajor electronic databases, such as PubMed, AMED, CINAHL, EMBASE, PEDro, Web of Science, were searched from inception to March 2020 for observational longitudinal cohort studies (prospective or retrospective) examining the relationship between physical functional performance and prognosis in patients with HF.Results44 observational longitudinal cohort studies with a total of 22,598 patients with HF were included. 26 included studies reported a low risk of bias, and 17 included studies showed a moderate risk of bias. Patients with poor physical functional performance in the Six Minute Walking Test (6MWT), in the Short Physical Performance Battery (SPPB) and in the Gait Speed Test showed worse prognosis in terms of larger risk of hospitalisation or mortality than patients with good physical functional performance. However, there was a lack of homogeneity regarding which cut-off points should be used to stratify patients with poor physical functional performance from patients with good physical functional performance.ConclusionThe review includes a large number of studies which show a strong relationship between physical functional performance and prognosis in patients with HF. Most of the included studies reported a low risk of bias, and GRADE criteria showed a low and a moderate level of evidence per outcome.

ImportanceLittle is known about the association of poverty with functional status (FS) in patients with rheumatoid arthritis (RA) who use rheumatology care.ObjectivesTo examine the association between socioeconomic status (SES) and FS among patients with RA and to evaluate the association between SES and functional declines over time in patients who received at least some rheumatology care.Design, setting, and participantsThis cohort study used data from the American College of Rheumatology's Rheumatology Informatics System for Effectiveness (RISE) registry between January 1, 2016, and December 31, 2018. Analyses included all adult patients with a confirmed RA diagnosis (ie, had ≥2 encounters associated with RA International Classification of Diseases codes ≥30 days apart) and at least 1 FS score documented between 2016 and 2018 seen at participating rheumatology practices. Data analysis was conducted from April to December 2020.ExposuresThe Area Deprivation Index (ADI), a zip code-based indicator of neighborhood poverty, was used as a proxy for SES. ADI scores were categorized into quintiles.Main outcomes and measuresFS measures included Multidimensional Health Assessment Questionnaire (MDHAQ), Health Assessment Questionnaire Disability index, and Health Assessment Questionnaire-II. Cross-sectionally, mean FS scores were compared across ADI quintiles. Longitudinally, among patients with at least 2 FS scores, multilevel multivariate regression computed the probability of functional decline, defined as a change greater than the minimum clinically important difference, across ADI quintiles. In a subgroup analysis, whether disease activity mediated the association between SES and functional decline was examined.ResultsOf the 83 965 patients included in the study, 66 649 (77%) were women, and 60 037 (72%) were non-Hispanic White. Mean (SD) age was 63.4 (13.7) years. MDHAQ was the most reported FS measure (56 928 patients [67.8%]). For all measures, mean (SD) FS score was worse at lower SES levels (eg, for MDHAQ quintile 1: 1.79 [1.87]; quintile 5: 2.43 [2.17]). In longitudinal analyses, the probability of functional decline was 14.1% (95% CI, 12.5%-15.7%) in the highest SES quintile and 18.9% (95% CI, 17.1%-20.7%) in the lowest SES quintile. The association between SES and functional decline was partially mediated (7%; 95% CI, 4%-22%) by disease activity.Conclusions and relevanceIn this cohort study of patients with RA, worse FS and faster declines in functioning over time were observed in patients with lower SES. These findings provide a framework for monitoring disparities in RA and for generating evidence to spur action toward achieving health equity.

BackgroundFatigue is one of the most common and disabling symptoms experienced by patients with multiple sclerosis (MS). This study aimed to assess the association between fatigue and functional status among patients with multiple sclerosis.MethodsA descriptive correlational cross-sectional study was conducted in September 2025 to January 2026, on 78 patients diagnosed with MS using a purposive sampling method, at Nasser Institute Hospital, Egypt. Data were collected using a structured interview questionnaire, the Fatigue Severity Scale, Lawton and Brody's Instrumental Activities of Daily Living Scale (IADL), the MS Walking Scale, and the Social Functioning Questionnaire. Data were analyzed using SPSS version 25. Statistical significance was considered at p ResultsAfter assessment using the Fatigue Severity Scale, 46.1% of participants were classified as having severe fatigue, 52.6% had moderate fatigue, and 1.3% had mild fatigue. Female participants reported higher fatigue scores than males. More than half of the participants demonstrated impaired social functioning, and a considerable proportion exhibited dependence in instrumental activities of daily living and moderate-to-severe walking impairment. Significant positive correlations were observed between fatigue severity and dependence in instrumental activities of daily living, walking impairment, and social dysfunction (all p R 2 = 0.545, adjusted R 2 = 0.500, F = 11.984, p β = 0.371, p = 0.010) and poorer instrumental activities of daily living (IADL; β = 0.311, p = 0.033) remained independently associated with higher fatigue severity, whereas social functioning was not independently associated with fatigue severity after adjustment (β = 0.200, p = 0.095).ConclusionFatigue is highly prevalent among patients with MS and is significantly associated with poorer functional status, particularly reduced instrumental activities of daily living and greater walking impairment. Routine assessment of fatigue and the development of comprehensive fatigue-management strategies may help identify patients at risk of functional limitations and support the delivery of individualized care aimed at maintaining independence, mobility, and quality of life among individuals with MS.