Beyond the acute phase of COVID-19: health experiences from patients with long COVID. A Systematic Review

50 2025/40 (2): 50-64 Abstract Aim: This study aimed to investigate the health experiences of patients with long COVID. Methods: A systematic review was carried out between June and July 2022 using PubMed, CINAHL, PsycINFO, Scopus and Web of Science databases. A quality assessment of the selected articles was performed . Results: A total of 29 articles were included in this review. On the one hand, the persistence of symptoms of COVID-19 affected the physical capacity to carry out activities of daily living, and affected as well mental health, mainly due to anxiety, depression and post-traumatic illness derived from fear of contagion, death or hopelessness for symptoms that do not disappear. On the other one, social, and occupational deterioration was also found, and patients felt a depersonalized attention and little credibility by health professionals and health services. Conclusion: Long COVID symptoms can adversely affect individuals physically, mentally, psychologically, and socially. Managers could plan programs to attend not only symptoms, but also basic and instrumental needs of the daily life of people after COVID-19, guaranteeing the strengthening of health and quality of life. Key words: Health conditions, Long COVID, Post-acute COVID-19 syndrome, Public health. Resumen Objetivo: Este estudio tuvo como objetivo investigar las experiencias de salud de los pacientes con COVID persistente. Métodos: Se realizó una revisión sistemática entre junio y julio de 2022 utilizando las bases de datos PubMed, CINAHL, PsycINFO, Scopus y Web of Science. Se realizó una evaluación de calidad de los artículos seleccionados. Resultados: Un total de 29 artículos fueron incluidos en esta revisión. Por un lado, la persistencia de los síntomas de COVID-19 afectó la capacidad física para realizar las actividades de la vida diaria y también afectó la salud mental, principalmente por ansiedad, depresión y enfermedades postraumáticas derivadas del miedo al contagio, muerte o desesperanza por síntomas que no desaparecen. Por otro lado, también se encontró deterioro social y laboral,y los pacientes sintieron una atención despersonalizada y poca credibilidad por parte de los profesionales y servicios de salud. Conclusión: Los síntomas prolongados de COVID pueden afectar negativamente a las personas física, mental, psicológica y socialmente. Los gestores podrían planificar programas para atender no sólo los síntomas, sino también las necesidades básicas e instrumentales de la vida diaria de las personas después del COVID-19, garantizando el fortalecimiento de la salud y la calidad de vida. Palabras clave: Condiciones de salud, COVID persistente, Síndorme post-agudo de COVID-19, Salud pública. Received: 15 - XI - 2024 Accepted: 13 - XII - 2024 doi: 10.3306/AJHS.2025.40.02.50 Corresponding author Bárbara Badanta E-mail: [email protected] eISSN 2255-0569 ORIGINAL Beyond the acute phase of COVID-19: health experiences from patients with long COVID. A Systematic Review Más allá de la fase aguda de COVID-19: experiencias de salud de pacientes con COVID persistente. Una revisión sistemática María Rocío Meseguer-Fernández1,2 , Bárbara Badanta1,2 1. Department of Nursing; Faculty of Nursing, Physiotherapy, and Podiatry, Universidad de Sevilla, Spain 2. Research Group under the Andalusian Research CTS 1149 “Salud integral y sostenible: enfoque Bio-psico-social, Cultural y Espiritual para el Desarrollo Humano” Cite as: Meseguer-Fernández MR, Badanta B. Beyond the acute phase of COVID-19: health experiences from patients with long COVID. A Systematic Review. Academic Journal of Health Sciences 2025;40 (2): 50-64 doi: 10.3306/AJHS.2025.40.02.50 51 2025/40 (2): 50-64 Beyond the acute phase of COVID-19: health experiences from patients with long COVID. A Systematic Review Introduction The COVID-19 pandemic has led to the death of over 6 million people worldwide1,2. Health systems have faced many challenges, such as the need to control the transmission of coronavirus, the need for infrastructures to care for the population affected by this virus, and the need to maintain health coverage for patients with other pathologies, such as chronic diseases3. Although most individuals who suffer COVID-19 return to their pre-COVID-19 baseline state within several weeks, it is estimated that about 10-20% of people have persistent symptomatology for weeks or even months after recovery with cognitive, somatic, behavioural, and psychological symptoms, which can be disabling4,5. When people who have been infected and recovered present symptoms, generally within three months from the onset of COVID-19, or after recovery and maintained in the long term (at least two months), this is recognized as “long COVID”6. Knowing this prolongation of health deterioration is important since it must be noted that the long COVID is associated with repercussions not only in a physical way, but also in a psychological, social, and economic level. In addition, the fact that about 1020% of people have persistent symptomatology5, has led the long COVID to be included in the International Classification of Diseases System (ICD), highlighting the need to establish collaborative multidisciplinary care between primary care and hospital units1,4. Previous reviews show the predominant characteristics of the long COVID after hospital discharge7,8. They point to the risk of long-term sequela with cutaneous, respiratory, cardiovascular, musculoskeletal, mental health, neurologic, and renal involvement in those who survive the acute phase of the illness. Furthermore, some patients are unable to cope with daily life, especially if they also suffer significant social isolation and/or stigmatization, so it impacts on the quality of life1,9. However, the controversies in its definition impair proper recognition and management. The World Health Organization has called countries to increase their efforts to systematically collect post-COVID-19 data and to prioritize therapeutic and rehabilitation development for those with long COVID10. From this point of view, it is necessary to know the needs and demands of patients affected by COVID-19 and their families, as well as the use and access to public resources to promote their quality of life, make adequate decisions and implement integrative care programs for people with physical and psychological sequelae and social and economic repercussions after the COVID-19 infection11. Therefore, the aim of this study is to analyse the health needs and conditions and health care provided to patients with persistent symptoms after infection with COVID-19. This includes experiences about health needs due to physical or psychological repercussions and also related to health care. Methods Design A systematic review was carried out between June and July 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Databases and search strategy Scientific databases (PubMed, CINAHL, Psycinfo, Scopus and Web of Science) were consulted for this review. The search strategy was ("post covid*" OR "long covid" OR "syndrome post covid" OR "covid survivors") AND ("health needs" OR "mental health" OR "health resources" OR "health services"). In addition, a search in grey literature was also performed in the System for Information Grey Literature Europe (Open Grey) and the Grey Literature Report. Inclusion and Exclusion Criteria for Selected Articles To be included, articles should be original papers published during the first two years of the pandemic (2020-July 2022), with the following subject matter: patients with long COVID, studies focused on repercussions derived from the persistence, or that they analyse health needs or care provided by the health services to this population. Because the coronavirus pandemic had global and recent repercussions, there were no restrictions on language nor year of publication. Articles were excluded if they were conference abstracts, case reports, editorials, letters to the editor, book chapters and other reviews. Studies focusing on patients with no COVID-19 disease (i.e., patients with chronic diseases during the pandemic) and patients in the acute phase of covid-19 were excluded, and those whose objective was to evaluate the effectiveness of pharmacological treatments. Study selection and data extraction Two researchers were responsible for extracting the data independently. The initial selection of articles was conducted by reading titles and abstracts. In this phase, articles potentially relevant based on the inclusion and exclusion criteria were selected, and duplicate publications were manually removed as well. In the second phase, the included articles were submitted to a full-text reading. Finally, the data extracted for each study included authors, year, country, purpose of the study, research design, sample characteristics, and major findings (Table I). Assessment of methodological quality Methodological quality was assessed using tools that ensure the high quality of observational studies (e.g., Strengthening the Reporting of Observational studies in Epidemiology, STROBE), and qualitative studies (e.g., Standards for Reporting Qualitative Research, SRQR guidelines) to determine a sound methodology in the selected studies. Studies with a low score on the assessments performed by the investigators of this study were excluded. 52 2025/40 (2): 50-64 María Rocío Meseguer-Fernández et al. Results The search process identified 2099 publications matching the search criteria (Figure 1). A total of 127 articles underwent full-text analysis. After reading the full text of the articles, the final sample included 29 studies. Characteristics of the included studies Twenty-nine articles in which the authors analysed the persistent symptoms of long COVID and the health care needs for these patients or attention provided to them were included. These studies were predominantly from the European continent (82.7%; n= 24), North America (10.3%; n=3) and Asia (6.9%; n=2). More than half of the studies included in this review (58.6%; n=17) aimed to know the sequelae following COVID-19 infection affecting both physical and mental health, and 27.6% (n=8) to know the quality of life of patients with long COVID and their informal caregivers, their experiences, and limitations in their daily life. Finally, the aim of 13.8% (n=4) of the studies was to evaluate the different service models of caring for patients with long COVID for rehabilitation. Regarding the sample, women were majority in 77.7% (n=21) of the studies. In general, the studies included patients with long COVID (65.5%; n = 15). In addition to these participants, other studies included healthcare professionals and family caregivers of patients with long COVID. Studies with follow-up of patients infected with covid-19 have ranged from 3 months of follow-up to 12 months, both in hospitalized and home patients. Quality assessment In assessing adherence to reporting guidelines, all included articles are of high or medium quality (in terms of adherence), ranging from 14.1 to 20.6 out of 22 in the Equator Guide for Observational Studies (Strengthening the Reporting of Observational Studies in Epidemiology). After evaluation using the Guidelines on Standards for Reporting Qualitative Research, of the 8 studies selected all met quality characteristics, all fulfilling most of the items. The most frequent deficiencies detected were poor description of the interview scripts. Theme 1. Extra deterioration in the quality of life The studies analysed reflect the deterioration of physical health in people affected by COVID-19, beyond the acute phase of the disease. In fact, in a study conducted in Switzerland, 26% of the participants Figure 1: Flowchart for the selection of articles for the review. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit www.prisma-statement.org. Records identified through databases and grey literature (n = 2099) Pubmed (n = 708) Scopus (n = 746) Web of Science (n = 405) CINAHL (n = 107) Psycinfo (n=130) Grey Literature (n = 3) Full-text articles excluded (n =98), due to: • Chronic diseases during the pandemic. • Effectiveness of drugs in patients with COVID-19. • Synthesis of literature. • No access to full text available. Records after duplicates removed (n =1993) Select references after reading title and abstract (n = 127) Full-text references assessed for eligibility (n = 127) Records excluded (n = 106) Studies included (n=29 Identification Screening Included Eligibility 53 2025/40 (2): 50-64 Beyond the acute phase of COVID-19: health experiences from patients with long COVID. A Systematic Review reported that they had not fully recovered between six and eight months after COVID-19 infection12. In other study conducted in Italy13, the physical perceived health score was lower than expected in those of the general population after 3 months following COVID infection. Mirfazeli et al.14 conducted a study in Iran, and they also showed that 90% of patients had at least one symptom of long COVID in their follow-up. This explains a health-related quality of life significantly more impaired in people with long COVID compared to general population6,15. Furthermore, patients with medical comorbidities prior to COVID infection, as it could be asthma, hypertension, sleep apnea, hypothyroidism, migraines, diabetes and/or hyperlipidaemia present an extra deterioration in the quality of life since these consequences of COVID can generate complications in their previous pathologies16. Respiratory problems and fatigue are found among the most persistent symptoms due to COVID-196,13,17-21. Severe pulmonary lesions, low oxygen saturation and dyspnea in patients who have suffered from COVID-19 have stood out, especially among those patients who have had to be hospitalized for COVID-1922 or due to other pathologies23. Forced vital capacity and diffusing capacity for carbon monoxide (DLCO) were significantly worse in patients with greater deterioration in perceived physical health, three months after acute infection24. Regarding the fatigue, in a study conducted in Brazil, authors reported that although there were no statistically significant differences, it was slightly more common as a new-onset symptom than as a persistent symptom25, and Mirfazeli et al.14 found no statistically significant relationship between the severity of COVID-19 in the acute phase and future chronic fatigue syndrome as a symptom of long COVID. In a study conducted in Turkey26, the participants highlighted that the feeling of this fatigue they were experiencing had not been experienced before; it was a fatigue that did not pass by resting or sleeping and it was not related to physical work. It was a very strange feeling which limited them for the performance of daily life activities, therefore, it decreased their independence. For example, an alteration in physical activity, the capacity of mobility and a reduction of the distance travelled was observed24. However, many people resigned themselves and became accustomed to living with it26. Other persistent physical symptoms made patients to return to a health center (e.g., fever, dermatological problems, arrhythmias, and chest pain)27. Neurological disorders also persisted even 3 months after infection followed by new onset ones, resulting in altered sensation and loss of smell (perception of unpleasant odours or olfactory hallucinations), concentration problems, myalgia6,14,16,25,28 and persistent headache, the latter being more frequent in women27. Regarding sex, Jiménez et al.19 pointed to the female as more favourable for the persistence of symptomatology in a study conducted in Spain. Rivera et al.23, with a sample of 906 patients with long COVID in Spain, clarified that a higher frequency of persistent respiratory and systemic symptoms was evidenced in men and a higher prevalence of persistent mental health symptoms (especially anxiety and depression) in women. Theme 2. Beyond the physical impact: mental health experiences derived from long COVID The COVID-19 infection has generated a situation of uncertainty, anger, fear, frustration, and hopelessness. Furthermore, when someone has been infected by COVID-19 and has had to be hospitalized without maintaining contact with his/her family, the situation is more complicated due to the increasing levels of anxiety and depression22,29. It is noteworthy that the risk of developing mental disorders was two times higher in patients who continued with persistent symptoms after the infection31, even after 6 months of follow-up16,19,23,31,32. In fact, a study conducted in Spain reported that patients experienced a deterioration of their psychological state and cognitive function, with a slight improvement at 6 - 7 months of follow-up, except for anxiety and depression, which increased18. Another study conducted in The Netherlands32 showed that 3 months after the onset of COVID symptoms, 40% of the participants were at risk of suffering from posttraumatic stress disorder, however, at 6-month follow-up it decreased to almost 26%. Among the patients who were at risk for post-traumatic stress disorder at the 3and 6-month follow-ups, two-thirds had clinically relevant symptoms of anxiety and depression18,32. It is also very common for patients who have passed COVID-19 to present some cognitive impairment, memory problems, sleep disorders and loss of concentration16,20,32. Rass et al.28 showed that cognitive impairment was still evident at 3-month follow-up, and although at 1-year follow-up this impairment improved, it did not disappear definitively. As consequences of this mental impact, some patients described how physical deterioration or a prolonged change in taste and smell prevented them from enjoying food, which limited the social activities of these people, such as going out to eat with friends or family, which may lead to cause emotional affectations33. In other cases, making social life was limited by increased dependence for activities of daily living, due to chronic fatigue26. For these reasons, although some patients returned gradually to work, others were on long-term sick leave, which had negative social and mental repercussions15,34. As part of the whole process, social support is considered essential, since the invisibility of this pathology or the lack of credibility of the symptoms by family and friends could deteriorate relationships with the social environment35. 54 2025/40 (2): 50-64 María Rocío Meseguer-Fernández et al. Theme 3. Experiences searching for health resources Many patients, after COVID infection, returned to the health services looking for treatment of persistent symptoms, so statistically significant increases in activity were identified in visits to the primary care doctor and nurse in patients with long COVID35. They also made use of emergency services and mental health care consultations, and some of them needed to be rehospitalized12. To curb the collapse due to increased demand for health care, remote consultation began to be used. However, while some patients thought that regular follow-up by healthcare staff through telephone calls and a virtual support group would be helpful20, other ones with more severe symptoms were concerned about the lack of a comprehensive assessment by health professionals using these methods29. In general, patients found difficult to access to healthcare services and noticed a variation in the quality of the therapeutic relationship. They reported late, non-existent, or inadequate responses due to the pressure suffered by the health service. Many young people without previous pathologies felt they were not treated quickly, as it was considered that COVID-19 and its symptoms were not so frequent or so severe in patients with this profile37. In this situation, patients turned to the Internet as a support element to solve many of their doubts regarding their health, to share similar experiences with other online users and to try diets, supplements and medications recommended by other people in the same situation35,37. However, in the results of Taylor et al.38, participants expressed fear of somatising other people's symptoms when resorting to Internet support groups to share their experiences, which they described as an internal debate in which they did not know if the origin of their symptoms was their own or psychological. Another aspect found in the analysed studies is the lack of credibility for the symptoms. Some patients in UK expressed their fear that certain symptoms would be perceived negatively by their primary care physician, therefore, they offered limited information about their symptoms to health personnel out of fear of their reaction38. All of this generated complications and critical events, uncertain prognosis, and physical and emotional discomfort because of organizing their own recovery plan29,37. In short, patients felt disenfranchised, overloaded with having to endure and manage persistent symptoms of long COVID, in addition to living with uncertainty and fear of whether full recovery is possible35,37. More details about the results are shown below, in table I. REFERENCE Bilgin et al., 2021/ Turkey Burton et al., 2022/ United Kingdom (UK) To determine the perception of fatigue among patients who have recovered from COVID-19. To analyse factors affecting mental health and well-being from the perspective of people with long COVID. Fatigue affected all patients who have passed COVID-19 increasing dependence in activities of daily living and hindering sociability. Some patients associated fatigue with the ongoing struggle with persistent COVID-19 symptoms, with not consuming enough food due to loss of appetite and other chronic pathologies. Other patients associated the main source of fatigue with uncertainty, the thought of getting the disease again, fear of death and negative news from the environment. Some strategies they employed to combat fatigue were including a diet rich in protein, vitamin supplements, infusions and vitamin C, activities to reduce psychological stress, such as going shopping or taking a walk. Patients emphasized that, as their fatigue did not disappear completely, they tried to live with it. They got used to it and resigned themselves to it. Long COVID caused disturbances in participants' daily life. The lack of service and treatment options led to worry, exacerbation of symptoms, continued uncertainty about the disease and lack of understanding of others, and consequently affected the ability to participate in enjoyable activities that might normally protect participants' well-being. Qualitative (interviews) Qualitative (semi-structured interviews). N = 14 post-COVID19 participants. Gender = 57.14% females. Age = 24-67 years. N = 21 participants who self-reported long COVID. Gender= 67% females. Age = 26–70 years (M = 47). SRQR SRQR OBJECTIVE METHODS* SAMPLE MAJOR FINDINGS METHODOLOGICAL QUALITY Table I: Description of main results. 55 2025/40 (2): 50-64 Beyond the acute phase of COVID-19: health experiences from patients with long COVID. A Systematic Review REFERENCE Chávez Sosa et al., 2022/ Peru Del Corral et al., 2022/ Spain To determine the relationship between quality of life and depression in caregivers of postcovid-19 patients in two regions of Peru during the second wave of the pandemic. To investigate the health-related quality of life (HRQoL), symptoms, psychological and cognitive state and pulmonary and physical function of non-hospitalized COVID-19 patients at long-term. Among caregivers, 80.1% reported a poor quality of life when caring for their relatives, especially in psychological and spiritual well-being dimensions. Gender, age, place of origin, marital status, educational level, type of job, health insurance, COVID-19 vaccination, children, relationship with the patient, and depression were related to caregivers' quality of life. While being a male caregiver was associated with good quality of life, caregivers who had children, were vaccinated against COVID-19, were immediate family members, and had elevated depression were associated with poor quality of life. An impaired health-related quality of life both at baseline and after follow-up was manifested by 60% of participants, mainly linked to mobility and pain/discomfort problems. Dyspnoea and muscle fatigue were the most frequent physical symptoms, however, at 6-7 months’ follow-up participants expressed a slight improvement. Around 40-56% of the patients experienced a deterioration of their psychological state and cognitive function, with a slight improvement at 6-7 months, with the exception of anxiety/ depression, which increased. Quantitative (questionnaires Modified Betty Ferell Quality of Life and the Beck Depression Inventory) Quantitative (cohort study): European Quality of Life - 5 Dimensions (EuroQol); Posttraumatic stress disorder checklist (PCL-C self-assessment); Hospital Anxiety and Depression Scale (HADS); the Montreal Cognitive Assessment (MoCA). N = 730 caregivers Gender= 76.3% females. Age= 18-59 years N = 102 non hospitalized COVID-19 patients Gender=62.74% females. Mean age= 46.6 years STROBE (19.6/22) STROBE (19.6/22) OBJECTIVE METHODS* SAMPLE MAJOR FINDINGS METHODOLOGICAL QUALITY Duncan et al., 2021/ Scotland To describe the community rehabilitation provision for people with long COVID in Scotland. Almost all Health Boards (13/14) offer rehabilitation for people with long COVID within pre-existing services and through a combination of face-to-face and digital contact. The main problems for which patients need rehabilitation are fatigue (11/14), respiratory disorders (9/14), musculoskeletal conditions (6/14), mental health (5/14) and neurological disorders (4/14). The main means of access to rehabilitation is through the hospital or primary care physician (13/14), self-referral (11/14) or interdisciplinary referrals (3/14). The provision of community rehabilitation services for people with long COVID is multidisciplinary. Almost all services (13/14) include occupational therapy and physical therapy. Many include dietetics (11/14) and speech therapy (9/14). Half include psychology support (7/14). In addition, three services reported that they could refer to, or have input from, different resources, such as post-intensive treatment nursing teams, therapeutic assistants, outpatient services for people with neurological conditions, spiritual care teams, and medical consultant services specializing in rehabilitation. Mixed methods: A national electronic survey was developed, and the responses were analysed descriptively. N = 14 Allied Health Professions Directors SRQR STROBE (14.9/22) Ferrando et al., 2022/ USA To describe neuropsychological, medical, psychiatric, and functional correlates of cognitive complaints experienced after recovery from acute COVID-19 infection. The most frequent acute symptoms were fatigue (92%), respiratory symptoms (90%), neurological symptoms (87%), anosmia (67%) and memory/cognitive problems (57%). In addition, 27% had low scores on at least 1 neuropsychological test, and 53.33% with cognitive complaints scored lower than the general population with the same age range on tests of attention, processing speed, memory, and executive function. Finally, 53.33% also reported higher levels of depression, anxiety, fatigue, post-traumatic stress disorder, and functional difficulties, as well as lower quality of life. Quantitative The Lawton-Brody Instrumental Activities of Daily Living Scale Instrumental Activities of Daily Living Scale (IADL); Chalder Fatigue Scale; Patient Health Questionnaire-9 (PHQ9); Endicott Satisfaction and Enjoyment of Quality-of-Life Scale (Endicott QLESQ); The Post-Traumatic Stress Disorder Checklist (PTSD); Generalized Anxiety Disorder-7 questionnaire; The Premorbid Function Test; Patient Assessment of Own Function (PAOF); Neuropsychological Status Assessment (RBANS). N = 60 participants Gender= 67% females Mean age= 41 years STROBE (21/22) 56 2025/40 (2): 50-64 María Rocío Meseguer-Fernández et al. REFERENCE Giurgi-Oncu et al., 2021/ Romania To analyse the severity of the acute COVID-19 and health impairments in subjects who are currently suffering from post-acute COVID-19; and, to explore the influence of hospital admissions on the mental health and wellbeing of these patients. There were statistically significant correlations between number of persistent symptoms and number of weeks since COVID-19 diagnosis, severity of lung injury, CRP levels during acute infection, and the number of hospital days. All inpatients had mild/moderate lung injury during acute COVID-19, in contrast to 37.97% of outpatients. Clinical depression and anxiety were present in 46.87% and 34.37% of inpatients and 27.84% and 40.5% of outpatients. The differences were only statistically significant for depression. Patients who were examined before 6 weeks since COVID-19 infection had more impaired activity levels, more pain/discomfort with worse VAS scores and reported higher levels of anxiety and depression. Quantitative study using transthoracic echocardiography (TTE); mental health examination; a quality-of-life questionnaire (QoL); a post-COVID-19 functional status scale (PCFS); a Hospital Anxiety and Depression scale (HADS) and VAS. N = 143 participants with post-acute COVID-19 (64 inpatients and 79 outpatients) Gender=54.54% females Age= 18 – 55 years (M = 44.06). STROBE (20.3/22) OBJECTIVE METHODS* SAMPLE MAJOR FINDINGS METHODOLOGICAL QUALITY Harenwall et al., 2021/ UK To evaluate a 7-week virtual rehabilitation course (“Recovering from COVID” course) from a biopsychosocial approach to understanding COVID-19 and postviral fatigue (PVF). "Recovering from COVID" included relaxation, self-monitoring, action planning and problem solving, breathing and mindfulness techniques to activate the parasympathetic nervous system, and it focused on sleep optimization, nutrition, activity management, energy conservation, stress management, and breathing optimization. Evaluation of participant feedback showed that 96% of people felt more knowledgeable about their symptoms, 100% felt the exercises throughout the course were helpful. Analyses revealed a statistically significant effect of long COVID syndrome upon VAS scores (10%) at the post course assessment, but statistically significant effects were no observed between participants who completed the follow up and those that did not. At the post-course assessment 53.9% reported an improved health state, 7.9% had no change, 10.5% reported a worse health state, and 22.4% reported a mixed change in health state. Only 3% of participants returning to full health. Improvements of patients were not significantly predicted by age or symptom duration. Pilot study EQ-5D-5L to assess health-related quality of life (HRQoL), VAS. Duration: 1h / session Themes: -Understanding COVID-19 and Viral Fatigue. -Sleep and how to improve it -Diet and the voice -Activity management -Movement and energy conservation -Stress management -Planning for the future N = 149 participants (social, health, and care staff who are experiencing long COVID). Gender= 75% females. Mean age=47.25 years. STROBE (21/22) HoubenWilke et al., 2022/ The Netherlands To explore symptoms of posttraumatic stress disorder (PTSD), anxiety and depression up to 6 months after the onset of COVID-19 – related symptoms Self-reported health status significantly worsened 3 months after infection and during the 6-month follow-up. At 3 months after symptom onset, 37.2% of patients were at risk for PTSD, which decreased to 26.8% at the 6-month followup. At 3 months after symptom onset, patients referred difficulty concentrating (84.5%), difficulty falling asleep or staying asleep (71.1%), and disturbing thoughts or memories about the event that have come to their mind against their will (56.5%). At 3-month follow-up of the patients, clinically relevant symptoms of anxiety and depression were detected in 35.6% and 46.9%, respectively. The prevalence of anxiety and depressive symptoms remained high at the 6-month follow-up (34.7% for anxiety symptoms and 40.6% for depressive symptoms). Quantitative N = 239 patients with confirmed COVID-19 Gender= 82.8% females. Age = 39-56 years (M = 50). STROBE (19/22) 57 2025/40 (2): 50-64 Beyond the acute phase of COVID-19: health experiences from patients with long COVID. A Systematic Review REFERENCE JiménezRodríguez et al., 2022/ Spain Kersten et al., 2022/ India To analyze the associations between postCOVID-19 characteristics with up to 6-months of follow-up in hospitalized and non-hospitalized patients. To analyse the correlation between the physical and mental burden of symptoms of long COVID patients and the findings of a somatic evaluation. Quantitative (cohort study): clinical data. First follow-up consultation (FFuC): two months after COVID-19 diagnosis. Second follow-up consultation (SFuC): six months after initial diagnosis. Quantitative (cohort study using SF-36 questionnaire: physical function, physical role, bodily pain, general health, vitality, social function, emotional role, mental health and health transition and clinical data. N = 217 patients Gender= 53.5% males. Age= 49-68 years (M= 59). N = 367 patients. Gender= 57.5% females Mean age= 47.3 years. STROBE (17.3/22) STROBE (20.1/22) OBJECTIVE METHODS* SAMPLE MAJOR FINDINGS METHODOLOGICAL QUALITY In the FFuC, the most prevalent symptoms were dyspnoea (53.6%), fatigue (53.5%), emotional involvement (53.9%) and depression (57.1%). Abnormal radiological findings continued to be present in 30.3% of patients during the study. In the SFuC, 73.3% of patients continued to present symptoms or claimed to develop new symptomatology after the acute process that was not related to alternative diagnoses. Dyspnoea (42.5%), fatigue (47.8%), hair loss (22.7%), emotional involvement (44%) and depression (21.7%) were the most frequent symptoms. Other alterations such as memory, concentration and language deficits began to appear reflecting a cognitive deficit in 27.1% of the cases, as well as erectile dysfunction or decreased sexual appetite (1.4%). In general, female sex is favorable for the persistence of the symptomatology. The most frequent affected parameter is the alteration of the pulmonary diffusion capacity in both hospitalized and non-hospitalized patients. The most common symptoms in long COVID unit were fatigue (51.1%) and dyspnea (42.5%). A positive correlation between initial disease severity (need for hospitalization, intensive care medicine) and resulting symptom burden at followup (at least 3 months of follow-up) could be demonstrated. There was a significant correlation between symptom severity and reduced exercise tolerance in the 6-Minute walk test and diffusion capacity for carbon monoxide among patients with long COVID. Patients with impaired subjective physical and mental status were significantly more likely to be women. Ireson et al., 2022/ UK To explore the physical and epistemic challenges of living with long COVID. Most of the participants reflected that on several occasions they have not been taken seriously during healthcare before long COVID was officially recognized (mainly if they were young and healthy people), making them vulnerable to the physical, mental, and emotional impact of having to cope on their own. Therefore, it had important consequences for later stages of their disease trajectory and care. Internet was an element of support for patients who had felt let down by health services. It was common for people with persistent symptoms to try diets, medications, and supplements to improve their state of health. Qualitative (thematic analysis of patient stories) N = 66 patients’ stories SRQR Kingstone et al 2020/ UK To explore experiences of people with persisting symptoms following COVID-19 infection, and their views on primary care support received. Qualitative (semistructured interviews by telephone or video call). N = 24 people with self-reported experiences of long COVID Gender= 79% females. Age= 20 – 68 years (M = 43.20). SRQRNone of the participants were hospitalized during their initial (suspected or confirmed) COVID-19 infection. Results show the patients' overload of having to endure and manage the persistent symptoms of long COVID, as well as living with uncertainty and fear as to whether full recovery is possible. Due to the chronic fatigue, some of the participants consumed vitamins C, D, B12 or Zinc to alleviate their symptoms, without the recommendation of a doctor. They also expressed the difficulty of finding answers to their symptoms, so some people resorted to online support groups; while for some of them it was somewhat favourable, for others, it increased their anxiety and concern. Some participants noted that their experiences made them feel that they were not entitled to health care, and they referred to the importance of finding a Primary Care physician with empathy and understanding. 58 2025/40 (2): 50-64 María Rocío Meseguer-Fernández et al. REFERENCE Ladds et al., 2020/ UK Matsumoto et al., 2022/ Japan and Sweden Menges et al., 2021/ Switzerland Mirfazeli et al., 2022/ Iran To understand the perceptions of healthcare workers with long COVID in order to propose the creation of a model of care for the management of this disease. To investigate postCOVID conditions and their effects on the mental health of participants from Japan and Sweden. To assess the impaired health (both physical and mental) among individuals after SARS-CoV-2 infection and characterize the healthcare utilization. To investigate the association between clinical manifestation of the COVID-19 and the experience of future long COVID symptoms. Qualitative: Online focus groups, individual narrative interviews or symptom diaries and statements. Quantitative study. COVID-19 Fear Scale-19 (FCV-19S); the Patient Health Questionnaire-9 (PHQ-9); the General Anxiety Disorder-7 (GAD-7) item and the Impact of Events Scale-Revised (IES-R). Quantitative (cohort study). Fatigue Assessment Scale (FAS); the modified Medical Research Council (mMRC) dyspnoea scale; depression, anxiety and stress scale (DASS-21) and healthrelated quality of life using the EQ5D-5L instrument and Visual Analogue Scale (VAS). Quantitative (clinical information by telephone interviews, including the Persian version of the Montreal Cognitive Assessment (MoCABLIND 7.1). N = 43 healthcare professionals with long COVID. Mean age= 40 years. Gender= 81.39% females. N = 763 adults (387 Japanese and 376 Swedish) Gender= 63.8% males. Mean age: 36.7 years. N = 431 adults. Gender=50% females Age= 33-58 years (M = 47) N = 95 outpatients and Inpatients) Gender= 58% males. Age= 28-86 years (M = 50) SRQR STROBE (21/22) STROBE (20.3/22) STROBE (18.4/22) OBJECTIVE METHODS* SAMPLE MAJOR FINDINGS METHODOLOGICAL QUALITY On the one hand, the absence of guidelines increases the uncertainty regarding long COVID. On the other hand, similarly, the participants positively mention the support and follow-up received through therapeutic relationships. Even so, the need for improvement in medical services is highlighted. Health professionals emphasize reflexivity and improvement, the sharing of knowledge and experience, and the promotion of research and the subsequent improvement of evidencebased services. However, participants were sceptical of these proposals due to financial constraints, staff shortages and the nature of change within the National Health System. The risk of developing mental disorders in participants who had passed COVID-19 infection and who continued with persistent symptoms (among Japanese were dysgeusia, fatigue, tiredness, olfactory dysfunction, chest pain, cough and palpitations; among Swedes, were fatigue, tiredness, olfactory dysfunction and fever) was at least 2 times higher than in participants without this condition. In the COVID-19 experience group the percentage of people who exceeded the cut-off was 39.3% for depression, 24.4% for generalized anxiety, and 50.4% for posttraumatic stress disorder (PTSD). Between six and eight months, 40% reported at least one post-SARS-CoVID-19 related GP visit and 10% of individuals were re-hospitalized, 26% reported not fully recovered, and one-third of them did not seek further health care. The presence of severe symptoms during the acute phase was related to comorbidities and not complete recovery. The higher the percentage of female participants and initially hospitalized, they reported not having recovered completely compared to non-hospitalized men. Regarding symptoms, 55% reported fatigue, 25% dyspnoea, and 26% depression. Depressive symptoms were more frequent in older women, and younger participants and women more frequently expressed stress symptoms compared to older individuals and men. Dyspnoea, fatigue, and depressive symptoms were associated with more health contacts after acute COVID-19 infection. Constitutional neuropsychiatric symptoms in the acute phase (e.g., headache, decreased limb strength, anosmia, hypogeusia, fever and weakness) predicted chronic fatigue syndrome at follow-up, and specific neuropsychiatric symptoms (e.g., photophobia, change of mental status, hallucination, vision and speech problems, seizures and balance disturbances, diarrhea, nausea, cough, and dyspnoea) were associated with gastrointestinal symptoms in the long COVID. Respiratory symptoms in the acute phase predicted future symptoms of anosmia and dysgeusia at follow-up.