50
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Abs ac
Aim: This s udy aimed o in es iga e he heal h expe iences o pa ien s wi h long COVID.
Me hods:
A sys ema ic e iew was ca ied ou be ween June and July 2022 using PubMed, CINAHL, PsycINFO, Scopus and
Web o Science da abases. A quali y assessmen o he selec ed a icles was pe o med
.
Resul s: A o al o 29 a icles we e included in his e iew. On he one hand, he pe sis ence o symp oms o COVID-19 a ec ed
he physical capaci y o ca y ou ac i i ies o daily li ing, and a ec ed as well men al heal h, mainly due o anxie y, dep ession and
pos - auma ic illness de i ed om ea o con agion, dea h o hopelessness o symp oms ha do no disappea . On he o he
one, social, and occupa ional de e io a ion was also ound, and pa ien s el a depe sonalized a en ion and li le c edibili y by heal h
p o essionals and heal h se ices.
Conclusion: Long COVID symp oms can ad e sely a ec indi iduals physically, men ally, psychologically, and socially. Manage s
could plan p og ams o a end no only symp oms, bu also basic and ins umen al needs o he daily li e o people a e COVID-19,
gua an eeing he s eng hening o heal h and quali y o li e.
Key wo ds: Heal h condi ions, Long COVID, Pos -acu e COVID-19 synd ome, Public heal h.
Resumen
Obje i o: Es e es udio u o como obje i o in es iga las expe iencias de salud de los pacien es con COVID pe sis en e.
Mé odos:
Se ealizó una e isión sis emá ica en e junio y julio de 2022 u ilizando las bases de da os PubMed, CINAHL,
PsycINFO, Scopus y Web o Science. Se ealizó una e aluación de calidad de los a ículos seleccionados.
Resul ados: Un o al de 29 a ículos ue on incluidos en es a e isión.
Po un lado, la pe sis encia de los sín omas de COVID-19
a ec ó la capacidad ísica pa a ealiza las ac i idades de la ida dia ia y ambién a ec ó la salud men al, p incipalmen e po
ansiedad, dep esión y en e medades pos aumá icas de i adas del miedo al con agio, mue e o desespe anza po sín omas
que no desapa ecen. Po o o lado, ambién se encon ó de e io o social y labo al,y los pacien es sin ie on una a ención
despe sonalizada y poca c edibilidad po pa e de los p o esionales y se icios de salud.
Conclusión: Los sín omas p olongados de COVID pueden a ec a nega i amen e a las pe sonas ísica, men al, psicológica y
socialmen e. Los ges o es pod ían plani ica p og amas pa a a ende no sólo los sín omas, sino ambién las necesidades básicas
e ins umen ales de la ida dia ia de las pe sonas después del COVID-19, ga an izando el o alecimien o de la salud y la calidad
de ida.
Palab as cla e: Condiciones de salud, COVID pe sis en e, Síndo me pos -agudo de COVID-19, Salud pública.
Recei ed: 15 - XI - 2024
Accep ed: 13 - XII - 2024
doi: 10.3306/AJHS.2025.40.02.50
Co esponding au ho
Bá ba a Badan a
E-mail: [email p o ec ed]
eISSN 2255-0569
ORIGINAL
Beyond he acu e phase o COVID-19: heal h expe iences
om pa ien s wi h long COVID. A Sys ema ic Re iew
Más allá de la ase aguda de COVID-19: expe iencias de salud
de pacien es con COVID pe sis en e. Una e isión sis emá ica
Ma ía Rocío Mesegue -Fe nández1,2 , Bá ba a Badan a1,2
1. Depa men o Nu sing; Facul y o Nu sing, Physio he apy, and Podia y, Uni e sidad de Se illa, Spain
2. Resea ch G oup unde he Andalusian Resea ch CTS 1149 “Salud in eg al y sos enible: en oque Bio-psico-social,
Cul u al y Espi i ual pa a el Desa ollo Humano”
Ci e as: Mesegue -Fe nández MR, Badan a B. Beyond he acu e phase o COVID-19: heal h expe iences om pa ien s wi h long
COVID. A Sys ema ic Re iew. Academic Jou nal o Heal h Sciences 2025;40 (2): 50-64 doi: 10.3306/AJHS.2025.40.02.50
51
2025/40 (2): 50-64
Beyond he acu e phase o COVID-19: heal h expe iences om pa ien s wi h long COVID. A Sys ema ic Re iew
In oduc ion
The COVID-19 pandemic has led o he dea h o o e
6 million people wo ldwide1,2. Heal h sys ems ha e
aced many challenges, such as he need o con ol he
ansmission o co ona i us, he need o in as uc u es
o ca e o he popula ion a ec ed by his i us, and he
need o main ain heal h co e age o pa ien s wi h o he
pa hologies, such as ch onic diseases3.
Al hough mos indi iduals who su e COVID-19 e u n
o hei p e-COVID-19 baseline s a e wi hin se e al
weeks, i is es ima ed ha abou 10-20% o people ha e
pe sis en symp oma ology o weeks o e en mon hs
a e eco e y wi h cogni i e, soma ic, beha iou al, and
psychological symp oms, which can be disabling4,5.
When people who ha e been in ec ed and eco e ed
p esen symp oms, gene ally wi hin h ee mon hs om
he onse o COVID-19, o a e eco e y and main ained
in he long e m (a leas wo mon hs), his is ecognized
as “long COVID”6. Knowing his p olonga ion o heal h
de e io a ion is impo an since i mus be no ed ha he
long COVID is associa ed wi h epe cussions no only
in a physical way, bu also in a psychological, social,
and economic le el. In addi ion, he ac ha abou 10-
20% o people ha e pe sis en symp oma ology5, has
led he long COVID o be included in he In e na ional
Classi ica ion o Diseases Sys em (ICD), highligh ing
he need o es ablish collabo a i e mul idisciplina y ca e
be ween p ima y ca e and hospi al uni s1,4.
P e ious e iews show he p edominan cha ac e is ics o
he long COVID a e hospi al discha ge7,8. They poin o
he isk o long- e m sequela wi h cu aneous, espi a o y,
ca dio ascula , musculoskele al, men al heal h,
neu ologic, and enal in ol emen in hose who su i e
he acu e phase o he illness. Fu he mo e, some pa ien s
a e unable o cope wi h daily li e, especially i hey also
su e signi ican social isola ion and/o s igma iza ion, so i
impac s on he quali y o li e1,9. Howe e , he con o e sies
in i s de ini ion impai p ope ecogni ion and managemen .
The Wo ld Heal h O ganiza ion has called coun ies o inc ease
hei e o s o sys ema ically collec pos -COVID-19 da a
and o p io i ize he apeu ic and ehabili a ion de elopmen
o hose wi h long COVID10. F om his poin o iew, i is
necessa y o know he needs and demands o pa ien s
a ec ed by COVID-19 and hei amilies, as well as he use
and access o public esou ces o p omo e hei quali y o
li e, make adequa e decisions and implemen in eg a i e
ca e p og ams o people wi h physical and psychological
sequelae and social and economic epe cussions a e he
COVID-19 in ec ion11. The e o e, he aim o his s udy is o
analyse he heal h needs and condi ions and heal h ca e
p o ided o pa ien s wi h pe sis en symp oms a e in ec ion
wi h COVID-19. This includes expe iences abou heal h
needs due o physical o psychological epe cussions and
also ela ed o heal h ca e.
Me hods
Design
A sys ema ic e iew was ca ied ou be ween June
and July 2022, ollowing he P e e ed Repo ing I ems
o Sys ema ic Re iews and Me a-Analyses guidelines
(PRISMA).
Da abases and sea ch s a egy
Scien i ic da abases (PubMed, CINAHL, Psycin o, Scopus
and Web o Science) we e consul ed o his e iew. The
sea ch s a egy was ("pos co id*" OR "long co id" OR
"synd ome pos co id" OR "co id su i o s") AND ("heal h
needs" OR "men al heal h" OR "heal h esou ces" OR
"heal h se ices"). In addi ion, a sea ch in g ey li e a u e was
also pe o med in he Sys em o In o ma ion G ey Li e a u e
Eu ope (Open G ey) and he G ey Li e a u e Repo .
Inclusion and Exclusion C i e ia
o Selec ed A icles
To be included, a icles should be o iginal pape s published
du ing he i s wo yea s o he pandemic (2020-July
2022), wi h he ollowing subjec ma e : pa ien s wi h
long COVID, s udies ocused on epe cussions de i ed
om he pe sis ence, o ha hey analyse heal h needs
o ca e p o ided by he heal h se ices o his popula ion.
Because he co ona i us pandemic had global and
ecen epe cussions, he e we e no es ic ions on
language no yea o publica ion. A icles we e excluded i
hey we e con e ence abs ac s, case epo s, edi o ials,
le e s o he edi o , book chap e s and o he e iews.
S udies ocusing on pa ien s wi h no COVID-19 disease
(i.e., pa ien s wi h ch onic diseases du ing he pandemic)
and pa ien s in he acu e phase o co id-19 we e
excluded, and hose whose objec i e was o e alua e he
e ec i eness o pha macological ea men s.
S udy selec ion and da a ex ac ion
Two esea che s we e esponsible o ex ac ing he
da a independen ly. The ini ial selec ion o a icles was
conduc ed by eading i les and abs ac s. In his phase,
a icles po en ially ele an based on he inclusion and
exclusion c i e ia we e selec ed, and duplica e publica ions
we e manually emo ed as well. In he second phase, he
included a icles we e submi ed o a ull- ex eading.
Finally, he da a ex ac ed o each s udy included au ho s,
yea , coun y, pu pose o he s udy, esea ch design,
sample cha ac e is ics, and majo indings (Table I).
Assessmen o me hodological quali y
Me hodological quali y was assessed using ools ha ensu e
he high quali y o obse a ional s udies (e.g., S eng hening
he Repo ing o Obse a ional s udies in Epidemiology,
STROBE), and quali a i e s udies (e.g., S anda ds o
Repo ing Quali a i e Resea ch, SRQR guidelines) o
de e mine a sound me hodology in he selec ed s udies.
S udies wi h a low sco e on he assessmen s pe o med by
he in es iga o s o his s udy we e excluded.
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Ma ía Rocío Mesegue -Fe nández e al.
Resul s
The sea ch p ocess iden i ied 2099 publica ions
ma ching he sea ch c i e ia (Figu e 1).
A o al o 127 a icles unde wen ull- ex analysis. A e
eading he ull ex o he a icles, he inal sample
included 29 s udies.
Cha ac e is ics o he included s udies
Twen y-nine a icles in which he au ho s analysed he
pe sis en symp oms o long COVID and he heal h ca e
needs o hese pa ien s o a en ion p o ided o hem
we e included. These s udies we e p edominan ly om
he Eu opean con inen (82.7%; n= 24), No h Ame ica
(10.3%; n=3) and Asia (6.9%; n=2).
Mo e han hal o he s udies included in his e iew
(58.6%; n=17) aimed o know he sequelae ollowing
COVID-19 in ec ion a ec ing bo h physical and men al
heal h, and 27.6% (n=8) o know he quali y o li e o
pa ien s wi h long COVID and hei in o mal ca egi e s,
hei expe iences, and limi a ions in hei daily li e. Finally,
he aim o 13.8% (n=4) o he s udies was o e alua e he
di e en se ice models o ca ing o pa ien s wi h long
COVID o ehabili a ion.
Rega ding he sample, women we e majo i y in
77.7% (n=21) o he s udies. In gene al, he s udies
included pa ien s wi h long COVID (65.5%; n = 15). In
addi ion o hese pa icipan s, o he s udies included
heal hca e p o essionals and amily ca egi e s o
pa ien s wi h long COVID. S udies wi h ollow-up o
pa ien s in ec ed wi h co id-19 ha e anged om 3
mon hs o ollow-up o 12 mon hs, bo h in hospi alized
and home pa ien s.
Quali y assessmen
In assessing adhe ence o epo ing guidelines, all
included a icles a e o high o medium quali y (in
e ms o adhe ence), anging om 14.1 o 20.6 ou
o 22 in he Equa o Guide o Obse a ional S udies
(S eng hening he Repo ing o Obse a ional S udies
in Epidemiology).
A e e alua ion using he Guidelines on S anda ds o
Repo ing Quali a i e Resea ch, o he 8 s udies selec ed
all me quali y cha ac e is ics, all ul illing mos o he
i ems. The mos equen de iciencies de ec ed we e
poo desc ip ion o he in e iew sc ip s.
Theme 1. Ex a de e io a ion in he quali y o li e
The s udies analysed e lec he de e io a ion o
physical heal h in people a ec ed by COVID-19,
beyond he acu e phase o he disease. In ac , in a
s udy conduc ed in Swi ze land, 26% o he pa icipan s
Figu e 1: Flowcha o he selec ion o a icles o he e iew.
F om: Page MJ, McKenzie JE, Bossuy PM, Bou on I, Ho mann TC, Mul ow CD, e al. The PRISMA 2020 s a emen : an upda ed guideline o epo ing sys ema ic
e iews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. Fo mo e in o ma ion, isi www.p isma-s a emen .o g.
Reco ds iden i ied h ough da abases
and g ey li e a u e (n = 2099)
Pubmed (n = 708)
Scopus (n = 746)
Web o Science (n = 405)
CINAHL (n = 107)
Psycin o (n=130)
G ey Li e a u e (n = 3)
Full- ex a icles excluded (n =98),
due o:
• Ch onic diseases du ing he
pandemic.
• E ec i eness o d ugs in pa ien s
wi h COVID-19.
• Syn hesis o li e a u e.
• No access o ull ex a ailable.
Reco ds a e duplica es emo ed
(n =1993)
Selec e e ences a e eading i le and abs ac
(n = 127)
Full- ex e e ences assessed o eligibili y
(n = 127)
Reco ds excluded
(n = 106)
S udies included
(n=29
Iden i ica ion
Sc eening
Included Eligibili y
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Beyond he acu e phase o COVID-19: heal h expe iences om pa ien s wi h long COVID. A Sys ema ic Re iew
epo ed ha hey had no ully eco e ed be ween six
and eigh mon hs a e COVID-19 in ec ion12. In o he
s udy conduc ed in I aly13, he physical pe cei ed heal h
sco e was lowe han expec ed in hose o he gene al
popula ion a e 3 mon hs ollowing COVID in ec ion.
Mi azeli e al.14 conduc ed a s udy in I an, and hey
also showed ha 90% o pa ien s had a leas one
symp om o long COVID in hei ollow-up. This explains
a heal h- ela ed quali y o li e signi ican ly mo e impai ed
in people wi h long COVID compa ed o gene al
popula ion6,15. Fu he mo e, pa ien s wi h medical
como bidi ies p io o COVID in ec ion, as i could be
as hma, hype ension, sleep apnea, hypo hy oidism,
mig aines, diabe es and/o hype lipidaemia p esen
an ex a de e io a ion in he quali y o li e since hese
consequences o COVID can gene a e complica ions
in hei p e ious pa hologies16.
Respi a o y p oblems and a igue a e ound among he
mos pe sis en symp oms due o COVID-196,13,17-21.
Se e e pulmona y lesions, low oxygen sa u a ion and
dyspnea in pa ien s who ha e su e ed om COVID-19
ha e s ood ou , especially among hose pa ien s who
ha e had o be hospi alized o COVID-1922 o due o
o he pa hologies23. Fo ced i al capaci y and di using
capaci y o ca bon monoxide (DLCO) we e signi ican ly
wo se in pa ien s wi h g ea e de e io a ion in pe cei ed
physical heal h, h ee mon hs a e acu e in ec ion24.
Rega ding he a igue, in a s udy conduc ed in B azil,
au ho s epo ed ha al hough he e we e no s a is ically
signi ican di e ences, i was sligh ly mo e common as a
new-onse symp om han as a pe sis en symp om25, and
Mi azeli e al.14 ound no s a is ically signi ican ela ionship
be ween he se e i y o COVID-19 in he acu e phase
and u u e ch onic a igue synd ome as a symp om
o long COVID. In a s udy conduc ed in Tu key26, he
pa icipan s highligh ed ha he eeling o his a igue hey
we e expe iencing had no been expe ienced be o e; i
was a a igue ha did no pass by es ing o sleeping and
i was no ela ed o physical wo k. I was a e y s ange
eeling which limi ed hem o he pe o mance o daily li e
ac i i ies, he e o e, i dec eased hei independence. Fo
example, an al e a ion in physical ac i i y, he capaci y
o mobili y and a educ ion o he dis ance a elled was
obse ed24. Howe e , many people esigned hemsel es
and became accus omed o li ing wi h i 26.
O he pe sis en physical symp oms made pa ien s
o e u n o a heal h cen e (e.g., e e , de ma ological
p oblems, a hy hmias, and ches pain)27. Neu ological
diso de s also pe sis ed e en 3 mon hs a e in ec ion
ollowed by new onse ones, esul ing in al e ed sensa ion
and loss o smell (pe cep ion o unpleasan odou s
o ol ac o y hallucina ions), concen a ion p oblems,
myalgia6,14,16,25,28 and pe sis en headache, he la e
being mo e equen in women27.
Rega ding sex, Jiménez e al.19 poin ed o he emale as
mo e a ou able o he pe sis ence o symp oma ology
in a s udy conduc ed in Spain. Ri e a e al.23, wi h
a sample o 906 pa ien s wi h long COVID in Spain,
cla i ied ha a highe equency o pe sis en espi a o y
and sys emic symp oms was e idenced in men and a
highe p e alence o pe sis en men al heal h symp oms
(especially anxie y and dep ession) in women.
Theme 2. Beyond he physical impac : men al
heal h expe iences de i ed om long COVID
The COVID-19 in ec ion has gene a ed a si ua ion o
unce ain y, ange , ea , us a ion, and hopelessness.
Fu he mo e, when someone has been in ec ed by
COVID-19 and has had o be hospi alized wi hou
main aining con ac wi h his/he amily, he si ua ion is
mo e complica ed due o he inc easing le els o anxie y
and dep ession22,29.
I is no ewo hy ha he isk o de eloping men al diso de s
was wo imes highe in pa ien s who con inued wi h
pe sis en symp oms a e he in ec ion31, e en a e 6
mon hs o ollow-up16,19,23,31,32. In ac , a s udy conduc ed
in Spain epo ed ha pa ien s expe ienced a de e io a ion
o hei psychological s a e and cogni i e unc ion, wi h a
sligh imp o emen a 6 - 7 mon hs o ollow-up, excep
o anxie y and dep ession, which inc eased18. Ano he
s udy conduc ed in The Ne he lands32 showed ha
3 mon hs a e he onse o COVID symp oms, 40%
o he pa icipan s we e a isk o su e ing om pos -
auma ic s ess diso de , howe e , a 6-mon h ollow-up
i dec eased o almos 26%. Among he pa ien s who
we e a isk o pos - auma ic s ess diso de a he 3-
and 6-mon h ollow-ups, wo- hi ds had clinically ele an
symp oms o anxie y and dep ession18,32.
I is also e y common o pa ien s who ha e passed
COVID-19 o p esen some cogni i e impai men ,
memo y p oblems, sleep diso de s and loss o
concen a ion16,20,32. Rass e al.28 showed ha cogni i e
impai men was s ill e iden a 3-mon h ollow-up, and
al hough a 1-yea ollow-up his impai men imp o ed, i
did no disappea de ini i ely.
As consequences o his men al impac , some pa ien s
desc ibed how physical de e io a ion o a p olonged
change in as e and smell p e en ed hem om enjoying
ood, which limi ed he social ac i i ies o hese people,
such as going ou o ea wi h iends o amily, which may
lead o cause emo ional a ec a ions33. In o he cases,
making social li e was limi ed by inc eased dependence
o ac i i ies o daily li ing, due o ch onic a igue26. Fo
hese easons, al hough some pa ien s e u ned g adually
o wo k, o he s we e on long- e m sick lea e, which had
nega i e social and men al epe cussions15,34.
As pa o he whole p ocess, social suppo is conside ed
essen ial, since he in isibili y o his pa hology o he lack
o c edibili y o he symp oms by amily and iends could
de e io a e ela ionships wi h he social en i onmen 35.
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Ma ía Rocío Mesegue -Fe nández e al.
Theme 3.
Expe iences sea ching o heal h esou ces
Many pa ien s, a e COVID in ec ion, e u ned o he
heal h se ices looking o ea men o pe sis en
symp oms, so s a is ically signi ican inc eases in ac i i y
we e iden i ied in isi s o he p ima y ca e doc o and
nu se in pa ien s wi h long COVID35. They also made
use o eme gency se ices and men al heal h ca e
consul a ions, and some o hem needed o be e-
hospi alized12. To cu b he collapse due o inc eased
demand o heal h ca e, emo e consul a ion began o be
used. Howe e , while some pa ien s hough ha egula
ollow-up by heal hca e s a h ough elephone calls and
a i ual suppo g oup would be help ul20, o he ones wi h
mo e se e e symp oms we e conce ned abou he lack
o a comp ehensi e assessmen by heal h p o essionals
using hese me hods29.
In gene al, pa ien s ound di icul o access o
heal hca e se ices and no iced a a ia ion in he
quali y o he he apeu ic ela ionship. They epo ed
la e, non-exis en , o inadequa e esponses due o he
p essu e su e ed by he heal h se ice. Many young
people wi hou p e ious pa hologies el hey we e no
ea ed quickly, as i was conside ed ha COVID-19
and i s symp oms we e no so equen o so se e e
in pa ien s wi h his p o ile37. In his si ua ion, pa ien s
u ned o he In e ne as a suppo elemen o sol e
many o hei doub s ega ding hei heal h, o sha e
simila expe iences wi h o he online use s and o y
die s, supplemen s and medica ions ecommended by
o he people in he same si ua ion35,37. Howe e , in he
esul s o Taylo e al.38, pa icipan s exp essed ea o
soma ising o he people's symp oms when eso ing
o In e ne suppo g oups o sha e hei expe iences,
which hey desc ibed as an in e nal deba e in which
hey did no know i he o igin o hei symp oms was
hei own o psychological.
Ano he aspec ound in he analysed s udies is he
lack o c edibili y o he symp oms. Some pa ien s in
UK exp essed hei ea ha ce ain symp oms would
be pe cei ed nega i ely by hei p ima y ca e physician,
he e o e, hey o e ed limi ed in o ma ion abou hei
symp oms o heal h pe sonnel ou o ea o hei
eac ion38. All o his gene a ed complica ions and c i ical
e en s, unce ain p ognosis, and physical and emo ional
discom o because o o ganizing hei own eco e y
plan29,37. In sho , pa ien s el disen anchised, o e loaded
wi h ha ing o endu e and manage pe sis en symp oms
o long COVID, in addi ion o li ing wi h unce ain y and
ea o whe he ull eco e y is possible35,37.
Mo e de ails abou he esul s a e shown below, in able I.
REFERENCE
Bilgin e al.,
2021/ Tu key
Bu on e al.,
2022/ Uni ed
Kingdom (UK)
To de e mine he
pe cep ion o a igue
among pa ien s who
ha e eco e ed om
COVID-19.
To analyse ac o s
a ec ing men al
heal h and well-being
om he pe spec i e
o people wi h long
COVID.
Fa igue a ec ed all pa ien s who ha e pas-
sed COVID-19 inc easing dependence in ac-
i i ies o daily li ing and hinde ing sociabili y.
Some pa ien s associa ed a igue wi h he
ongoing s uggle wi h pe sis en COVID-19
symp oms, wi h no consuming enough ood
due o loss o appe i e and o he ch onic pa-
hologies. O he pa ien s associa ed he main
sou ce o a igue wi h unce ain y, he hough
o ge ing he disease again, ea o dea h and
nega i e news om he en i onmen .
Some s a egies hey employed o comba
a igue we e including a die ich in p o ein,
i amin supplemen s, in usions and i amin
C, ac i i ies o educe psychological s ess,
such as going shopping o aking a walk.
Pa ien s emphasized ha , as hei a igue
did no disappea comple ely, hey ied o
li e wi h i . They go used o i and esigned
hemsel es o i .
Long COVID caused dis u bances in pa ici-
pan s' daily li e. The lack o se ice and ea -
men op ions led o wo y, exace ba ion o
symp oms, con inued unce ain y abou he
disease and lack o unde s anding o o he s,
and consequen ly a ec ed he abili y o pa -
icipa e in enjoyable ac i i ies ha migh no -
mally p o ec pa icipan s' well-being.
Quali a i e (in e iews)
Quali a i e
(semi-s uc u ed
in e iews).
N = 14 pos -COVID-
19 pa icipan s.
Gende = 57.14%
emales.
Age = 24-67 yea s.
N = 21 pa icipan s
who sel - epo ed
long COVID.
Gende = 67%
emales.
Age = 26–70 yea s
(M = 47).
SRQR
SRQR
OBJECTIVE METHODS* SAMPLE MAJOR FINDINGS METHODOLOGICAL
QUALITY
Table I: Desc ip ion o main esul s.
55
2025/40 (2): 50-64
Beyond he acu e phase o COVID-19: heal h expe iences om pa ien s wi h long COVID. A Sys ema ic Re iew
REFERENCE
Chá ez Sosa
e al., 2022/
Pe u
Del Co al
e al., 2022/
Spain
To de e mine he
ela ionship be ween
quali y o li e and
dep ession in
ca egi e s o pos -
co id-19 pa ien s
in wo egions o
Pe u du ing he
second wa e o he
pandemic.
To in es iga e he
heal h- ela ed
quali y o li e
(HRQoL), symp oms,
psychological and
cogni i e s a e and
pulmona y and
physical unc ion
o non-hospi alized
COVID-19 pa ien s a
long- e m.
Among ca egi e s, 80.1% epo ed a poo qua-
li y o li e when ca ing o hei ela i es, espe-
cially in psychological and spi i ual well-being
dimensions. Gende , age, place o o igin, ma-
i al s a us, educa ional le el, ype o job, heal h
insu ance, COVID-19 accina ion, child en, e-
la ionship wi h he pa ien , and dep ession we e
ela ed o ca egi e s' quali y o li e. While being
a male ca egi e was associa ed wi h good
quali y o li e, ca egi e s who had child en, we e
accina ed agains COVID-19, we e immedia e
amily membe s, and had ele a ed dep ession
we e associa ed wi h poo quali y o li e.
An impai ed heal h- ela ed quali y o li e bo h
a baseline and a e ollow-up was mani es ed
by 60% o pa icipan s, mainly linked o
mobili y and pain/discom o p oblems.
Dyspnoea and muscle a igue we e he mos
equen physical symp oms, howe e , a 6-7
mon hs’ ollow-up pa icipan s exp essed a
sligh imp o emen .
A ound 40-56% o he pa ien s expe ienced a
de e io a ion o hei psychological s a e and
cogni i e unc ion, wi h a sligh imp o emen
a 6-7 mon hs, wi h he excep ion o anxie y/
dep ession, which inc eased.
Quan i a i e (ques-
ionnai es Modi ied
Be y Fe ell Quali y
o Li e and he Beck
Dep ession In en o y)
Quan i a i e (coho
s udy):
Eu opean Quali y o
Li e - 5 Dimensions
(Eu oQol); Pos au-
ma ic s ess diso de
checklis (PCL-C
sel -assessmen );
Hospi al Anxie y and
Dep ession Scale
(HADS); he Mon eal
Cogni i e Assess-
men (MoCA).
N = 730 ca egi e s
Gende = 76.3%
emales.
Age= 18-59 yea s
N = 102 non hos-
pi alized COVID-19
pa ien s
Gende =62.74%
emales.
Mean age= 46.6
yea s
STROBE
(19.6/22)
STROBE
(19.6/22)
OBJECTIVE METHODS* SAMPLE MAJOR FINDINGS METHODOLOGICAL
QUALITY
Duncan e al.,
2021/
Sco land
To desc ibe
he communi y
ehabili a ion p o ision
o people wi h long
COVID in Sco land.
Almos all Heal h Boa ds (13/14) o e ehabili a-
ion o people wi h long COVID wi hin p e-exis-
ing se ices and h ough a combina ion o
ace- o- ace and digi al con ac . The main
p oblems o which pa ien s need ehabili a ion
a e a igue (11/14), espi a o y diso de s (9/14),
musculoskele al condi ions (6/14), men al heal-
h (5/14) and neu ological diso de s (4/14).
The main means o access o ehabili a ion is
h ough he hospi al o p ima y ca e physician
(13/14), sel - e e al (11/14) o in e disciplina y
e e als (3/14). The p o ision o communi y e-
habili a ion se ices o people wi h long COVID
is mul idisciplina y. Almos all se ices (13/14)
include occupa ional he apy and physical he-
apy. Many include die e ics (11/14) and speech
he apy (9/14). Hal include psychology suppo
(7/14). In addi ion, h ee se ices epo ed ha
hey could e e o, o ha e inpu om, di e en
esou ces, such as pos -in ensi e ea men
nu sing eams, he apeu ic assis an s, ou -
pa ien se ices o people wi h neu ological
condi ions, spi i ual ca e eams, and medical
consul an se ices specializing in ehabili a ion.
Mixed me hods:
A na ional elec onic
su ey was de elo-
ped, and he espon-
ses we e analysed
desc ip i ely.
N = 14 Allied Heal h
P o essions Di ec o s
SRQR
STROBE
(14.9/22)
Fe ando
e al.,
2022/ USA
To desc ibe
neu opsychological,
medical, psychia ic,
and unc ional
co ela es o
cogni i e complain s
expe ienced a e
eco e y om acu e
COVID-19 in ec ion.
The mos equen acu e symp oms we e
a igue (92%), espi a o y symp oms (90%),
neu ological symp oms (87%), anosmia (67%)
and memo y/cogni i e p oblems (57%). In
addi ion, 27% had low sco es on a leas 1
neu opsychological es , and 53.33% wi h
cogni i e complain s sco ed lowe han
he gene al popula ion wi h he same age
ange on es s o a en ion, p ocessing
speed, memo y, and execu i e unc ion.
Finally, 53.33% also epo ed highe le els o
dep ession, anxie y, a igue, pos - auma ic
s ess diso de , and unc ional di icul ies, as
well as lowe quali y o li e.
Quan i a i e
The Law on-B ody Ins-
umen al Ac i i ies o
Daily Li ing Scale
Ins umen al Ac i i ies
o Daily Li ing Scale
(IADL); Chalde Fa igue
Scale; Pa ien Heal h
Ques ionnai e-9 (PHQ-
9); Endico Sa is ac-
ion and Enjoymen o
Quali y-o -Li e Scale
(Endico QLESQ);
The Pos -T auma ic
S ess Diso de Chec-
klis (PTSD); Gene ali-
zed Anxie y Diso de -7
ques ionnai e; The
P emo bid Func ion
Tes ; Pa ien Assess-
men o Own Func ion
(PAOF); Neu opsycho-
logical S a us Assess-
men (RBANS).
N = 60 pa icipan s
Gende = 67%
emales
Mean age= 41 yea s
STROBE
(21/22)
56
2025/40 (2): 50-64
Ma ía Rocío Mesegue -Fe nández e al.
REFERENCE
Giu gi-Oncu
e al., 2021/
Romania
To analyse he
se e i y o he
acu e COVID-19 and
heal h impai men s
in subjec s who a e
cu en ly su e ing
om pos -acu e
COVID-19; and, o
explo e he in luence
o hospi al admis-
sions on he men al
heal h and wellbeing
o hese pa ien s.
The e we e s a is ically signi ican co ela ions
be ween numbe o pe sis en symp oms and
numbe o weeks since COVID-19 diagnosis,
se e i y o lung inju y, CRP le els du ing acu e
in ec ion, and he numbe o hospi al days. All
inpa ien s had mild/mode a e lung inju y du-
ing acu e COVID-19, in con as o 37.97%
o ou pa ien s. Clinical dep ession and anxie-
y we e p esen in 46.87% and 34.37% o
inpa ien s and 27.84% and 40.5% o ou pa-
ien s. The di e ences we e only s a is ically
signi ican o dep ession.
Pa ien s who we e examined be o e 6 weeks
since COVID-19 in ec ion had mo e impai-
ed ac i i y le els, mo e pain/discom o wi h
wo se VAS sco es and epo ed highe le els
o anxie y and dep ession.
Quan i a i e s udy
using ans ho acic
echoca diog aphy
(TTE); men al heal h
examina ion; a quali-
y-o -li e ques ionnai e
(QoL); a pos -CO-
VID-19 unc ional
s a us scale (PCFS);
a Hospi al Anxie y
and Dep ession scale
(HADS) and VAS.
N = 143 pa icipan s
wi h pos -acu e CO-
VID-19 (64 inpa ien s
and 79 ou pa ien s)
Gende =54.54%
emales
Age= 18 – 55 yea s
(M = 44.06).
STROBE
(20.3/22)
OBJECTIVE METHODS* SAMPLE MAJOR FINDINGS METHODOLOGICAL
QUALITY
Ha enwall e
al., 2021/ UK
To e alua e a
7-week i ual
ehabili a ion cou se
(“Reco e ing om
COVID” cou se) om
a biopsychosocial
app oach o
unde s anding
COVID-19 and pos -
i al a igue (PVF).
"Reco e ing om COVID" included elaxa ion,
sel -moni o ing, ac ion planning and
p oblem sol ing, b ea hing and mind ulness
echniques o ac i a e he pa asympa he ic
ne ous sys em, and i ocused on sleep
op imiza ion, nu i ion, ac i i y managemen ,
ene gy conse a ion, s ess managemen ,
and b ea hing op imiza ion. E alua ion o
pa icipan eedback showed ha 96%
o people el mo e knowledgeable abou
hei symp oms, 100% el he exe cises
h oughou he cou se we e help ul.
Analyses e ealed a s a is ically signi ican
e ec o long COVID synd ome upon VAS
sco es (10%) a he pos cou se assessmen ,
bu s a is ically signi ican e ec s we e
no obse ed be ween pa icipan s who
comple ed he ollow up and hose ha did
no . A he pos -cou se assessmen 53.9%
epo ed an imp o ed heal h s a e, 7.9% had
no change, 10.5% epo ed a wo se heal h
s a e, and 22.4% epo ed a mixed change
in heal h s a e. Only 3% o pa icipan s
e u ning o ull heal h. Imp o emen s o
pa ien s we e no signi ican ly p edic ed by
age o symp om du a ion.
Pilo s udy
EQ-5D-5L o assess
heal h- ela ed quali y
o li e (HRQoL), VAS.
Du a ion: 1h / session
Themes:
-Unde s anding
COVID-19 and Vi al
Fa igue.
-Sleep and how o
imp o e i
-Die and he oice
-Ac i i y managemen
-Mo emen and
ene gy conse a ion
-S ess managemen
-Planning o he
u u e
N = 149 pa icipan s
(social, heal h, and
ca e s a who a e
expe iencing long
COVID).
Gende = 75%
emales.
Mean age=47.25
yea s.
STROBE
(21/22)
Houben-
Wilke e al.,
2022/
The
Ne he lands
To explo e symp oms
o pos auma ic
s ess diso de
(PTSD), anxie y and
dep ession up o
6 mon hs a e he
onse o COVID-19 –
ela ed symp oms
Sel - epo ed heal h s a us signi ican ly
wo sened 3 mon hs a e in ec ion and
du ing he 6-mon h ollow-up.
A 3 mon hs a e symp om onse , 37.2%
o pa ien s we e a isk o PTSD, which
dec eased o 26.8% a he 6-mon h ollow-
up. A 3 mon hs a e symp om onse ,
pa ien s e e ed di icul y concen a ing
(84.5%), di icul y alling asleep o s aying
asleep (71.1%), and dis u bing hough s o
memo ies abou he e en ha ha e come
o hei mind agains hei will (56.5%).
A 3-mon h ollow-up o he pa ien s,
clinically ele an symp oms o anxie y and
dep ession we e de ec ed in 35.6% and
46.9%, espec i ely. The p e alence o
anxie y and dep essi e symp oms emained
high a he 6-mon h ollow-up (34.7% o
anxie y symp oms and 40.6% o dep essi e
symp oms).
Quan i a i e N = 239 pa ien s
wi h con i med
COVID-19
Gende = 82.8%
emales.
Age = 39-56 yea s
(M = 50).
STROBE (19/22)
57
2025/40 (2): 50-64
Beyond he acu e phase o COVID-19: heal h expe iences om pa ien s wi h long COVID. A Sys ema ic Re iew
REFERENCE
Jiménez-
Rod íguez
e al., 2022/
Spain
Ke s en e al.,
2022/ India
To analyze he
associa ions
be ween pos -
COVID-19
cha ac e is ics wi h
up o 6-mon hs
o ollow-up in
hospi alized and
non-hospi alized
pa ien s.
To analyse he
co ela ion be ween
he physical and
men al bu den o
symp oms o long
COVID pa ien s and
he indings o a
soma ic e alua ion.
Quan i a i e (coho
s udy): clinical da a.
Fi s ollow-up
consul a ion (FFuC):
wo mon hs a e
COVID-19 diagnosis.
Second ollow-up
consul a ion (SFuC):
six mon hs a e ini ial
diagnosis.
Quan i a i e (coho
s udy using SF-36
ques ionnai e:
physical unc ion,
physical ole, bodily
pain, gene al heal h,
i ali y, social unc ion,
emo ional ole, men al
heal h and heal h
ansi ion and clinical
da a.
N = 217 pa ien s
Gende = 53.5%
males.
Age= 49-68 yea s
(M= 59).
N = 367 pa ien s.
Gende = 57.5%
emales
Mean age= 47.3
yea s.
STROBE
(17.3/22)
STROBE
(20.1/22)
OBJECTIVE METHODS* SAMPLE MAJOR FINDINGS METHODOLOGICAL
QUALITY
In he FFuC, he mos p e alen symp oms we e
dyspnoea (53.6%), a igue (53.5%), emo ional
in ol emen (53.9%) and dep ession (57.1%).
Abno mal adiological indings con inued o be
p esen in 30.3% o pa ien s du ing he s udy.
In he SFuC, 73.3% o pa ien s con inued
o p esen symp oms o claimed o de elop
new symp oma ology a e he acu e p ocess
ha was no ela ed o al e na i e diagnoses.
Dyspnoea (42.5%), a igue (47.8%), hai loss
(22.7%), emo ional in ol emen (44%) and
dep ession (21.7%) we e he mos equen
symp oms. O he al e a ions such as memo y,
concen a ion and language de ici s began o
appea e lec ing a cogni i e de ici in 27.1%
o he cases, as well as e ec ile dys unc ion o
dec eased sexual appe i e (1.4%).
In gene al, emale sex is a o able o he
pe sis ence o he symp oma ology. The mos
equen a ec ed pa ame e is he al e a ion
o he pulmona y di usion capaci y in bo h
hospi alized and non-hospi alized pa ien s.
The mos common symp oms in long
COVID uni we e a igue (51.1%) and
dyspnea (42.5%). A posi i e co ela ion
be ween ini ial disease se e i y (need o
hospi aliza ion, in ensi e ca e medicine)
and esul ing symp om bu den a ollow-
up (a leas 3 mon hs o ollow-up) could
be demons a ed. The e was a signi ican
co ela ion be ween symp om se e i y and
educed exe cise ole ance in he 6-Minu e
walk es and di usion capaci y o ca bon
monoxide among pa ien s wi h long COVID.
Pa ien s wi h impai ed subjec i e physical
and men al s a us we e signi ican ly mo e
likely o be women.
I eson e al.,
2022/ UK
To explo e he
physical and
epis emic challenges
o li ing wi h long
COVID.
Mos o he pa icipan s e lec ed ha on se e al
occasions hey ha e no been aken se iously
du ing heal hca e be o e long COVID was
o icially ecognized (mainly i hey we e young
and heal hy people), making hem ulne able
o he physical, men al, and emo ional impac
o ha ing o cope on hei own. The e o e, i
had impo an consequences o la e s ages
o hei disease ajec o y and ca e.
In e ne was an elemen o suppo o pa ien s
who had el le down by heal h se ices. I was
common o people wi h pe sis en symp oms
o y die s, medica ions, and supplemen s o
imp o e hei s a e o heal h.
Quali a i e ( hema ic
analysis o pa ien
s o ies)
N = 66 pa ien s’
s o ies
SRQR
Kings one
e al
2020/ UK
To explo e
expe iences
o people wi h
pe sis ing symp oms
ollowing COVID-19
in ec ion, and hei
iews on p ima y
ca e suppo
ecei ed.
Quali a i e (semi-
s uc u ed in e iews
by elephone o ideo
call).
N = 24 people
wi h sel - epo ed
expe iences o long
COVID
Gende = 79%
emales.
Age= 20 – 68 yea s
(M = 43.20).
SRQRNone o he pa icipan s we e hospi alized
du ing hei ini ial (suspec ed o con i med)
COVID-19 in ec ion. Resul s show he
pa ien s' o e load o ha ing o endu e and
manage he pe sis en symp oms o long
COVID, as well as li ing wi h unce ain y and
ea as o whe he ull eco e y is possible.
Due o he ch onic a igue, some o he
pa icipan s consumed i amins C, D, B12
o Zinc o alle ia e hei symp oms, wi hou
he ecommenda ion o a doc o . They also
exp essed he di icul y o inding answe s o
hei symp oms, so some people eso ed o
online suppo g oups; while o some o hem
i was somewha a ou able, o o he s, i
inc eased hei anxie y and conce n.
Some pa icipan s no ed ha hei expe iences
made hem eel ha hey we e no en i led
o heal h ca e, and hey e e ed o he
impo ance o inding a P ima y Ca e physician
wi h empa hy and unde s anding.
58
2025/40 (2): 50-64
Ma ía Rocío Mesegue -Fe nández e al.
REFERENCE
Ladds e al.,
2020/ UK
Ma sumo o
e al.,
2022/
Japan and
Sweden
Menges
e al.,
2021/
Swi ze land
Mi azeli e al.,
2022/ I an
To unde s and
he pe cep ions o
heal hca e wo ke s
wi h long COVID in
o de o p opose
he c ea ion o a
model o ca e o he
managemen o his
disease.
To in es iga e pos -
COVID condi ions
and hei e ec s on
he men al heal h
o pa icipan s om
Japan and Sweden.
To assess he
impai ed heal h (bo h
physical and men al)
among indi iduals
a e SARS-CoV-2
in ec ion and
cha ac e ize he
heal hca e u iliza ion.
To in es iga e he
associa ion be ween
clinical mani es a ion
o he COVID-19
and he expe ience
o u u e long COVID
symp oms.
Quali a i e: Online
ocus g oups,
indi idual na a i e
in e iews o
symp om dia ies and
s a emen s.
Quan i a i e s udy.
COVID-19 Fea
Scale-19 (FCV-19S);
he Pa ien Heal h
Ques ionnai e-9
(PHQ-9); he Gene al
Anxie y Diso de -7
(GAD-7) i em and
he Impac o E en s
Scale-Re ised
(IES-R).
Quan i a i e (coho
s udy).
Fa igue Assessmen
Scale (FAS); he
modi ied Medical
Resea ch Council
(mMRC) dyspnoea
scale; dep ession,
anxie y and s ess
scale (DASS-21) and
heal h- ela ed quali y
o li e using he EQ-
5D-5L ins umen and
Visual Analogue Scale
(VAS).
Quan i a i e (clinical
in o ma ion by
elephone in e iews,
including he Pe sian
e sion o he
Mon eal Cogni i e
Assessmen (MoCA-
BLIND 7.1).
N = 43 heal hca e
p o essionals wi h
long COVID.
Mean age= 40 yea s.
Gende = 81.39%
emales.
N = 763 adul s (387
Japanese and 376
Swedish)
Gende = 63.8%
males.
Mean age: 36.7
yea s.
N = 431 adul s.
Gende =50%
emales
Age= 33-58 yea s
(M = 47)
N = 95 ou pa ien s
and
Inpa ien s)
Gende = 58% males.
Age= 28-86 yea s (M
= 50)
SRQR
STROBE (21/22)
STROBE (20.3/22)
STROBE (18.4/22)
OBJECTIVE METHODS* SAMPLE MAJOR FINDINGS METHODOLOGICAL
QUALITY
On he one hand, he absence o guidelines
inc eases he unce ain y ega ding long
COVID. On he o he hand, simila ly, he
pa icipan s posi i ely men ion he suppo
and ollow-up ecei ed h ough he apeu ic
ela ionships. E en so, he need o
imp o emen in medical se ices is highligh ed.
Heal h p o essionals emphasize e lexi i y and
imp o emen , he sha ing o knowledge and
expe ience, and he p omo ion o esea ch
and he subsequen imp o emen o e idence-
based se ices. Howe e , pa icipan s we e
scep ical o hese p oposals due o inancial
cons ain s, s a sho ages and he na u e o
change wi hin he Na ional Heal h Sys em.
The isk o de eloping men al diso de s in
pa icipan s who had passed COVID-19
in ec ion and who con inued wi h pe sis en
symp oms (among Japanese we e dysgeusia,
a igue, i edness, ol ac o y dys unc ion,
ches pain, cough and palpi a ions; among
Swedes, we e a igue, i edness, ol ac o y
dys unc ion and e e ) was a leas 2 imes
highe han in pa icipan s wi hou his
condi ion. In he COVID-19 expe ience g oup
he pe cen age o people who exceeded he
cu -o was 39.3% o dep ession, 24.4%
o gene alized anxie y, and 50.4% o pos -
auma ic s ess diso de (PTSD).
Be ween six and eigh mon hs, 40%
epo ed a leas one pos -SARS-CoVID-19
ela ed GP isi and 10% o indi iduals
we e e-hospi alized, 26% epo ed no ully
eco e ed, and one- hi d o hem did no seek
u he heal h ca e. The p esence o se e e
symp oms du ing he acu e phase was
ela ed o como bidi ies and no comple e
eco e y. The highe he pe cen age o emale
pa icipan s and ini ially hospi alized, hey
epo ed no ha ing eco e ed comple ely
compa ed o non-hospi alized men.
Rega ding symp oms, 55% epo ed a igue,
25% dyspnoea, and 26% dep ession.
Dep essi e symp oms we e mo e equen in
olde women, and younge pa icipan s and
women mo e equen ly exp essed s ess
symp oms compa ed o olde indi iduals
and men.
Dyspnoea, a igue, and dep essi e symp oms
we e associa ed wi h mo e heal h con ac s
a e acu e COVID-19 in ec ion.
Cons i u ional neu opsychia ic symp oms
in he acu e phase (e.g., headache,
dec eased limb s eng h, anosmia,
hypogeusia, e e and weakness) p edic ed
ch onic a igue synd ome a ollow-up, and
speci ic neu opsychia ic symp oms (e.g.,
pho ophobia, change o men al s a us,
hallucina ion, ision and speech p oblems,
seizu es and balance dis u bances, dia hea,
nausea, cough, and dyspnoea) we e
associa ed wi h gas oin es inal symp oms in
he long COVID.
Respi a o y symp oms in he acu e phase
p edic ed u u e symp oms o anosmia and
dysgeusia a ollow-up.
