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Background Many coronavirus disease 2019 (COVID‐19) survivors experience persistent symptoms, such as fatigue, dyspnea, and musculoskeletal pain. However, less is known about the impact of COVID‐19 on longer term functional outcomes. Objective To evaluate patient‐reported activity of daily living (ADL) function and fatigue symptoms 30 days after hospitalization for COVID‐19. Design Cross‐sectional study. Setting Tertiary care university hospital. Participants Adults 18 years or older hospitalized for COVID‐19 and survived to 30 days after discharge. Methods A standardized telephone questionnaire was administered 30 days after hospital discharge. Main Outcome Measures Ability to perform basic and instrumental ADLs and fatigue symptoms severity (Patient‐Reported Outcome Measurement Information System [PROMIS] Fatigue Short Form 7a) were assessed by self‐report. Results Participants (n = 55) were 22‐95 years old. Compared to pre‐COVID hospitalization, 52% developed new difficulty and 6% new dependence with performing basic ADLs (bADLs), 48% developed new difficulty and 11% new dependence with instrumental ADLs (iADLs), and 69% experienced a clinically significant worsening in their fatigue symptom severity. The average fatigue symptom severity T‐score before hospitalization was 44.2 ± 7.4 and after hospitalization was 54.5 ± 9.8. In exploratory multivariate analyses, each additional COVID symptom at presentation was associated with a predicted increase of 1.43 units (95% confidence interval [CI], 0.45–2.42) in the 30‐day fatigue symptom severity T‐score, each additional day of hospitalization was associated with an 1.2 times increased odds of worsening fatigue (95% CI, 0.98–1.5; p = .08), and each unit increase in baseline body mass index was associated with 0.8 times decreased odds of new bADL or iADL dependence at 30 days (95% CI, 0.65–0.99). Conclusions New functional impairments are common at 30 days after discharge among survivors of hospitalization for COVID‐19. Early rehabilitation, advance care planning, and referrals to appropriate therapies should be considered in postacute COVID‐19 care to maximize patients' functional outcomes. However, ongoing research is still needed regarding management of these patients.

Background Half of all physical disability, including activity of daily living (ADL) disability, among older adults occurs in the setting of hospitalization. This study examines whether appendicular lean mass (ALM) and grip strength, which are commonly included in various definitions of sarcopenia, are associated with the development of hospital-associated ADL disability in older adults in the Health ABC Study. Methods Individuals hospitalized during the first 5 years of follow-up (n = 1 724) were analyzed. ALM to body mass index (BMI) ratio (ALMBMI), by dual-energy x-ray absorptiometry (DXA), and grip strength, by hand-held dynamometery, were assessed annually. Development of new ADL disability was assessed at the time of the next annual assessment after hospitalization. Separate regression analyses modeled the association of prehospitalization ALMBMI or grip strength with death before the next scheduled annual assessment. Next, among those who survived to the next annual assessment, separate regression analyses modeled the association of ALMBMI or grip strength with development of ADL disability. Results Each standard deviation decrement in prehospitalization grip strength was associated with an adjusted 1.80 odds of new ADL disability at follow-up (95% CI: 1.18, 2.74). Low, compared with not low, grip strength (per FNIH definition) was associated with an adjusted 2.36 odds of ADL disability at follow-up (95% CI: 1.12, 4.97). ALM measures were not associated with the development of hospital-associated ADL disability. ALM and grip strength measures were not associated with death. Conclusions Prehospitalization lower grip strength may be an important risk factor for ADL disability among older adult survivors of hospitalization.

Introduction: As of December 19th 2020, Coronavirus Disease 2019 (COVID-19) has resulted in approximately 17.6 million cases and 315,000 deaths in the United States. The hospitalization rate for COVID-19 in the US continues to rise and is currently around 295.8 hospitalizations per 100,000 population. Despite the increasing number of individuals who are contracting and recovering from this disease, little is known about their functional recovery. Understanding functional outcomes in these patients is critical to address their rehabilitation needs. The purpose of this study is to characterize the 30-day patient-reported functional outcomes of older and younger adults following acute hospitalization for COVID-19. Methods: A single-center prospective cohort study was performed from April to October 2020 of adult survivors of hospitalization for COVID-19 (n=28). A standardized telephone questionnaire was administered 30-days after hospital discharge to participants addressing their ability to perform basic activities of daily living (ADLs), instrumental ADLs, mobility, fatigue symptoms (Patient-Reported Outcomes Measurement Information Systems-PROMIS) and general disability (Health Assessment Questionnaire Disability Index - HAQ-DI). Results: Participants' were 23-95 years old. Twenty-one (75%) were less than 65 years old. Fifteen (54%) were female and 19 (68%) were white. Mean hospital length of stay was 11.3 days and 10 (36%) participants required ICU admission. Among adults aged 65 years developed new impairments and 29% new dependence. The most common new impairments in both age groups were transferring for basic ADLs and preparing meals and grocery shopping for instrumental ADLs. Seventy-one percent of older and 76% of younger adults experienced a decline in at least one mobility task (getting up from a chair, walking up 10 stairs, or walking mile). Seventy-six percent of younger adults and 43% of older adults experienced a clinically significant worsening (> 5 points) in their PROMIS fatigue scores. Sixty-two percent of younger adults and 43% of older adults experienced a clinically significant worsening (> 0.22 points) in their HAQ-DI scores. Conclusions: Among adults hospitalized with COVID-19, the majority experienced a decline in ≥1 functional task 30 days after discharge compared to pre-hospitalization. Younger adults had similar to worse impairment in physical functional outcomes than older adults. These results indicate all adults, regardless of age, are at risk for prolonged, clinically significant functional impairment following hospitalization for COVID-19.

Author(s): Andrews, James S; Gold, Laura S; Nevitt, Michael; Heagerty, Patrick J; Cawthon, Peggy M | Abstract: ObjectiveThe association of sarcopenia with development of knee osteoarthritis (OA) or knee pain in older adults is uncertain. We examined the relationship of grip strength and appendicular lean mass (ALM) with the likelihood of developing knee OA and knee pain in older adults in the Health ABC (Health, Aging, and Body Composition) Study.MethodsALM and grip strength were assessed at baseline by dual-energy x-ray absorptiometry and handheld dynamometry, respectively. Incident clinically diagnosed, symptomatic knee OA, defined as new participant report of physician-diagnosed knee OA and concurrent frequent knee pain, and incident frequent knee pain over 5 years of follow-up were examined. Separate regression analyses, stratified by sex, modeled associations of baseline ALM and grip strength with the likelihood of incident clinically diagnosed, symptomatic knee OA and incident knee pain over follow-up, adjusting for covariates.ResultsAmong the 2779 subjects without OA at baseline, 95 men (6.9%) and 158 women (11.3%) developed clinically diagnosed, symptomatic knee OA, and, among the 2182 subjects without knee pain at baseline, 315 men (28.3%) and 385 women (36.1%) developed knee pain over follow-up. Among men only, each SD decrement of ALM was associated with decreasing likelihood of incident knee OA (odds ratio [OR] per SD decrement: 0.68; 95% confidence interval [CI]: 0.47-0.97), and each SD decrement of grip strength was associated with increasing likelihood of incident knee pain (OR per SD decrement: 1.20; 95% CI: 1.01-1.42).ConclusionIn older men, ALM and grip strength may be associated with the development of knee OA and knee pain, respectively.

Reduced physical function and health-related quality of life are common in rheumatoid arthritis (RA), and further studies are needed that examine novel determinates of reduced physical function in RA. This study examines whether frailty, a state of increased vulnerability to stressors, is associated with differences in self-reported physical function among adults with RA. Adults from a longitudinal RA cohort (n=124) participated in the study. Using an established definition of frailty, individuals with three or more of the following physical deficits were classified as frail: (1) body mass index ≤18.5, (2) low grip strength (adjusted for sex and body mass index (BMI), measured by handheld dynamometer), (3) severe fatigue (measured by the Multidimensional Assessment of Fatigue), (4) slow 4-m walking speed (adjusted for sex and height), and (5) low physical activity (measured by the International Physical Activity Questionnaire). Individuals with one or two deficits were classified as "pre-frail" and those with no deficits as "robust." Self-reported physical function was assessed by the Health Assessment Questionnaire (HAQ) and the Valued Life Activities Difficulty scale. Regression analyses modeled associations of frailty category with HAQ and Valued Life Activities (VLA) Difficulty scores with and without controlling for age, sex, disease duration, C-reactive protein, use of oral steroids, and pain. Among adults with RA, being frail compared to being robust was associated with a 0.44 worse VLA score (p&nbsp

Objective Limited data exist describing relationships between muscle strength, muscle mass, and physical disability among individuals with systemic lupus erythematosus (SLE). The present study examines the relationship of muscle strength and muscle mass with physical disability among adult women with SLE.

ObjectivesTo determine whether pain predicts future activity of daily living (ADL) disability or death in individuals aged 60 and older.DesignProspective cohort study.SettingThe 1998 to 2008 Health and Retirement Study (HRS), a nationally representative study of older community-living individuals.ParticipantsTwelve thousand six hundred thirty-one participants in the 1998 HRS aged 60 and older who did not need help in any ADL.MeasurementsParticipants reporting that they had moderate or severe pain most of the time were defined as having significant pain. The primary outcome was time to development of ADL disability or death over 10yrs, assessed at five successive 2-year intervals. ADL disability was defined as needing help performing any ADL: bathing, dressing, transferring, toileting, eating, or walking across a room. A discrete hazards survival model was used to examine the relationship between pain and incident disability over each 2-year interval using only participants who started the interval with no ADL disability. Several potential confounders were adjusted for at the start of each interval: demographic factors, seven chronic health conditions, and functional limitations (ADL difficulty and difficulty with five measures of mobility).ResultsAt baseline, 2,283 (18%) participants had significant pain. Participants with pain were more likely (all P&nbsp

Background Frailty is defined as “excess vulnerability to stressors, with reduced ability to maintain or regain homeostasis after a destabilizing event” 1 . Frailty is closely related to body composition and physical functioning, and is associated with increased risk of poor health outcomes including death. Serum inflammation is associated with differences in body composition and physical functioning in the general population and individuals with chronic disease. The ability of serum markers of inflammation to identify increased frailty among individuals with rheumatoid arthritis (RA) is unknown. Objectives We tested whether serum erythrocyte sedimentation rate (ESR) and C-Reactive Protein (CRP) are associated with increased risk of frailty among men and women with RA. Methods Participants were individuals in a longitudinal RA cohort. ESR and high sensitivity CRP were assessed from blood samples using standard clinical assays. Individuals with 3 or more of the following physical deficits were classified as frail 1 : 1) body mass index ≤18.5, 2) low grip strength (adjusted for sex and BMI, measured by handheld dynamometer), 3) severe fatigue (measured by the Fatigue Severity Inventory), 4) slow 4-meter walking speed (adjusted for sex and height), 5) low physical activity (measured by the International Physical Activity Questionnaire). Individuals with 1 or 2 deficits were classified as pre-frail, and those with no deficits as robust. 1 Multinomial logistic regression analyses controlling for age, sex, smoking status, RA disease duration, prednisone use, tumor necrosis factor inhibitor use, appendicular lean mass, and pain modeled the effects of ESR and CRP on severity of frailty. Results Of the 141 participants, 60% were female; mean age was 58 (±11) years, duration of RA was 19 (±11) years, ESR was 19 (±19) mm/h, and hsCRP was 5 (± 8) mg/L. Sixteen participants (11%) were frail, 86 (61%) pre-frail, 22 (16%) robust, and 17 (12%) were missing grip strength data. In adjusted models, higher ESR was associated with significantly increased risk of frailty (Table 1). Similar trends were observed between CRP and risk of frailty, but did not reach statistical significance in adjusted models. Conclusions Frailty and pre-frailty were common in our cohort of individuals with RA, with a greater prevalence than that of geriatric populations. ESR levels were associated with approximately twice the risk of being frail or pre-frail compared to being robust. CRP demonstrated similar effects on risk of frailty, though trends did not reach statistical significance. These findings underscore the burden of frailty among individuals with RA, and they may suggest a clinical role for serum ESR and CRP to identify individuals with RA at greatest risk of frailty. References Fried J Am Geriatr Soc 2001;56:M146 Disclosure of Interest None declared