Article Text

Prevalence of swallow, communication, voice and cognitive compromise following hospitalisation for COVID-19: the PHOSP-COVID analysis
  1. Camilla Dawson1,2,
  2. Gemma Clunie3,
  3. Felicity Evison4,
  4. Sallyanne Duncan5,
  5. Julie Whitney6,
  6. Linzy Houchen-Wolloff7,
  7. Charlotte E Bolton8,
  8. Olivia C Leavy9,
  9. Matthew Richardson10,
  10. Elneima Omer11,
  11. Hamish McAuley12,
  12. Aarti Shikotra13,
  13. Amisha Singapuri11,
  14. Marco Sereno11,
  15. Ruth M Saunders14,
  16. Victoria C Harris11,
  17. Neil J Greening15,16,
  18. Claire Marie Nolan17,
  19. Dan Gower Wootton18,
  20. Enya Daynes19,
  21. Gavin Donaldson20,
  22. Jack Sargent21,
  23. Janet Scott22,
  24. John Pimm23,
  25. Lettie Bishop24,
  26. Melitta McNarry25,
  27. Nicholas Hart26,
  28. Rachael A Evans12,
  29. Sally Singh27,
  30. Tom Yates12,
  31. Trudie Chalder28,
  32. William Man20,
  33. Ewen Harrison29,
  34. Annemarie Docherty29,
  35. Nazir I Lone29,
  36. Jennifer K Quint20,30,
  37. James Chalmers31,
  38. Ling-Pei Ho32,33,
  39. Alex Robert Horsley34,
  40. Michael Marks35,
  41. Krisnah Poinasamy36,
  42. Betty Raman37,38,
  43. Louise V Wain39,40,
  44. Chris Brightling41,
  45. PHOSP-COVID collaborative Group,
  46. Neil Sharma42,43,
  47. Margaret Coffey20,
  48. Amit Kulkarni44 and
  49. Sarah Wallace45
  1. 1Department of Speech and Language Therapy, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  2. 2Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  3. 3Department of Surgery and Cancer, Imperial College London, London, UK
  4. 4Department of Informatics, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  5. 5Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
  6. 6King's College London Faculty of Life Sciences and Medicine, London, UK
  7. 7Department of Pulmonary Rehabilitation, University Hospitals of Leicester, Leicester, UK
  8. 8Respiratory Medicine, NIHR Nottingham Biomedical Research Centre Respiratory Theme, University of Nottingham, Nottingham, UK
  9. 9Department of Health Sciences, University of Leicester, Leicester, UK
  10. 10Leicester Respiratory Biomedical Research Unit, National Institute for Health Research, Leicester, UK
  11. 11Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
  12. 12University of Leicester, Leicester, UK
  13. 13NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
  14. 14Department of Infection, Immunity and Inflammation, Institute for Lung Health, NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
  15. 15Respiratory Sciences, University of Leicester, Leicester, UK
  16. 16Respiratory Medicine, Institute for Lung Health, UK
  17. 17Royal Brompton and Harefield Hospitals, London, UK
  18. 18Respiratory Research, University Hospital Aintree, Liverpool, UK
  19. 19CERS, NIHR Leicester Biomedical Research Centre, Leicester, UK
  20. 20Imperial College London, London, UK
  21. 21University Hospitals of Leicester NHS Trust, Leicester, UK
  22. 22University of Glasgow, Glasgow, UK
  23. 23Healthy Minds, The Buckinghamshire IAPT Service, Oxford Health NHS Foundation Trust, Oxford, UK
  24. 24Loughborough University, Loughborough, UK
  25. 25College of Engineering, Swansea University, Swansea, UK
  26. 26Lane Fox Respiratory Service, Guy's & St Thomas' NHS Foundation Trust, London, UK
  27. 27Cardiac/Pulmonary Rehabilitation, University Hospitals of Leicester NHS Trust, Leicester, UK
  28. 28King's College London, London, UK
  29. 29Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
  30. 30NHLI, Imperial College London, London, UK
  31. 31Tayside Respiratory Research Group, University of Dundee, Dundee, UK
  32. 32MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, Oxford, UK
  33. 33Oxford Centre for Respiratory Medicine, Churchill Hospital, Oxford, UK
  34. 34Respiratory Medicine, Manchester Adult Cystic Fibrosis Centre, Manchester, UK
  35. 35London School of Hygiene & Tropical Medicine, London, UK
  36. 36Head of Research and Innovation Advocacy, Asthma UK, London, UK
  37. 37Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxfordshire, UK
  38. 38University of Oxford, Oxford, UK
  39. 39Biomedical Research Centre—Respiratory, National Institute for Health Research, Leicester, UK
  40. 40Genetic Epidemiology Group, Department of Health Sciences, University of Leicester, Leicester, UK
  41. 41Institute of Lung Health, University of Leicester, Leicester, UK
  42. 42Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
  43. 43Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  44. 44Royal College of Speech and Language Therapists, London, UK
  45. 45Wythenshawe Hospital, Manchester, UK
  1. Correspondence to Dr Camilla Dawson; camilla.dawson{at}nhs.net

Abstract

Objective Identify prevalence of self-reported swallow, communication, voice and cognitive compromise following hospitalisation for COVID-19.

Design Multicentre prospective observational cohort study using questionnaire data at visit 1 (2–7 months post discharge) and visit 2 (10–14 months post discharge) from hospitalised patients in the UK. Lasso logistic regression analysis was undertaken to identify associations.

Setting 64 UK acute hospital Trusts.

Participants Adults aged >18 years, discharged from an admissions unit or ward at a UK hospital with COVID-19.

Main outcome measures Self-reported swallow, communication, voice and cognitive compromise.

Results Compromised swallowing post intensive care unit (post-ICU) admission was reported in 20% (188/955); 60% with swallow problems received invasive mechanical ventilation and were more likely to have undergone proning (p=0.039). Voice problems were reported in 34% (319/946) post-ICU admission who were more likely to have received invasive (p<0.001) or non-invasive ventilation (p=0.001) and to have been proned (p<0.001). Communication compromise was reported in 23% (527/2275) univariable analysis identified associations with younger age (p<0.001), female sex (p<0.001), social deprivation (p<0.001) and being a healthcare worker (p=0.010). Cognitive issues were reported by 70% (1598/2275), consistent at both visits, at visit 1 respondents were more likely to have higher baseline comorbidities and at visit 2 were associated with greater social deprivation (p<0.001).

Conclusion Swallow, communication, voice and cognitive problems were prevalent post hospitalisation for COVID-19, alongside whole system compromise including reduced mobility and overall health scores. Research and testing of rehabilitation interventions are required at pace to explore these issues.

  • ARDS
  • COVID-19
  • critical care
  • pneumonia

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Footnotes

  • Twitter @camillacdawson, @alexrhorsley

  • Contributors CD wrote the manuscript in collaboration with GC, FE, SW, AK, NS and SD. MC and AK conceptualised and formalised the data access. FE undertook the statistical analysis. DGW, CB, WM, SS, ED, JSa, MMcN, TC, MR, CEB, NJG, LVW, OCL, ARH, RMS, JKQ, L-PH, MM, JW, NH, NIL, RAE and HMcA all reviewed and provided updates and iterations to the drafting of the manuscript. CD is responsible for overall content as guarantor.The guarantor accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. The PHOSP collaboration all supported data collection.

  • Funding PHOSP-COVID is jointly funded by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19 (grant references: MR/V027859/1 and COV0319).

  • Disclaimer The views expressed in the publication are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care. The Royal College of Speech and Language Therapists provided funding for the statistician support.

  • Competing interests CEB has a UKRI PHOSP grant through NIHR Nottingham Biomedical Research Centre for support to conduct the PHOSP study, and Nottingham Hospital Trust Charity donations to support her research. JC has grants/contracts with AstraZeneca, Boehringer Ingelheim, Insmed, Gilead Sciences, Grifols and has received consulting fees from AstraZeneca, Boehringer Ingelheim, Insmed, Gilead Sciences, Grifols, Pfizer, Zambon, Antabio, Janssen. LVW holds a UK Research and Innovation GSK/Asthma + Lung UK National Institute of Health Research Grant and Orion Pharma GSK Genentech AstraZeneca research funding and has received consulting fees from Galapagos Boehringer Ingelheim and travel fees from Greentech, is on the advisory board for Galapagos and is the Associate Editor for European Respiratory Journal. MR has received consulting fees from Galapagos Boehringer Ingelheim. ASi received joint funding UKRI & NIHR grant references: MR/V027859/1 and COV031. CB has received UKRI/DHSC PHOSP-COVID grant via NIHR Leicester BRC, grants from GSK, AZ, Sanofi, BI, Chiesi, Novartis, Roche, Genentech, Mologic, 4DPharma, consultancy paid to institution from GSK, AZ, Sanofi, BI, Chiesi, Novartis, Roche, Genentech, Mologic, 4DPharma, TEVA. RAE has received NIHR/UKRI/Wolfson Foundation grants, consulting fees from AstraZeneca for long COVID, honoraria payment from Boeringher, support from Chiesi to attend BTS, and is ERS Group 01.02 Pulmonary Rehabilitation Secretary. JKQ is on the Thorax editorial board.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the 'Methods' section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.