300 Section - Four-Year Functional Outcomes in COVID-19 Survivors

Wednesday, May 20, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

Marta Imamura, MD, PhD (she/her/hers)

Associate Professor
Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, BR.
Sao Paulo / Sao Paulo, Sao Paulo, Brazil

Corresponding Author/Autor a quien dirigir la corr(s)

LD

Lucas R. De Pretto, PhD

Data Scientist
Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, BR.
Santos, Sao Paulo, Brazil

Co-Author/Coautor(s)

SU

Sabrina S. T. Uchiyama, MD

Physician
Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, BR.
Sao Paulo, Sao Paulo, Brazil
Ed

Elizabeth M. da Silva, MD

Physiotherapist
Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, BR.
Sao Paulo, Sao Paulo, Brazil
CC

Carlos R. R. Carvalho, MD, PhD

Full Professor
Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, BR.
Sao Paulo, Sao Paulo, Brazil
LB

Linamara R. Battistella, MD, PhD

Full Professor
Departamento de Medicina Legal, Bioética, Medicina do Trabalho e Medicina Física e Reabilitação, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, BR.
São Paulo, Sao Paulo, Brazil

Objectives : COVID-19 survivors are subject to long-term functional limitations. This prospective observational study assessed 425 adult patients (mean age: 54.9 ± 13.6 years; 52.0% male) hospitalized in a Brazilian tertiary hospital for at least 24 hours. They completed an initial post-discharge evaluation and a second assessment approximately 4 years later, aiming to evaluate their long-term functional status.

Design: Demographic information and functional measurements were collected: handgrip strength, Medical Research Council (MRC) score, Visual Analogue Scale (VAS) for pain, Functional Independence Measure (FIM), and ultrasound measures of rectus femoris and vastus medialis thickness. Participants were categorized into three groups according to respiratory support during hospital stay: no oxygen support (NOX), oxygen support without intubation (OX), and with intubation (INT). Analyses focused on longitudinal comparisons and group differences using paired t-tests and multivariable linear regression adjusted for age, sex, hospital length of stay, and oxygenation group, with Holm–Bonferroni correction.

Results: Longitudinal analysis revealed significant improvements in multiple measurements. Overall, handgrip strength increased and MRC scores also improved (p< 0.01). Pain decreased (p< 0.01), but still averages 3.6 at follow-up. FIM scores showed only modest change, and muscle ultrasound measures remained largely stable. Per-group analyses indicated significant (p< 0.05) improvements across all groups for handgrip and VAS, though the magnitude of improvement varied, being higher for NOX and OX groups, as the INT group had better baseline values. MRC and FIM also improved across groups, but without statistical significance. Regression models confirmed that oxygenation group influenced the magnitude of recovery for strength and VAS, though this effect was attenuated when baseline value was included.

Conclusion:

These findings demonstrate that although COVID-19 survivors show meaningful long-term improvements in strength and pain, some level of pain persists even four years after infection. Recovery patterns are associated with oxygen support level, but largely reflect different baseline values between groups.