Return to work and health-related quality of life up to 1 year in patients hospitalized for COVID-19: the CO-FLOW study

Abstract

Background: Currently, evidence about the long-term consequences of COVID-19 on return to work and health-related quality of life (HRQoL) is limited. We evaluated return to work and its associations with baseline characteristics and physical and mental recovery over time in patients up to 1 year after hospitalization for COVID-19. Secondly, we aimed to evaluate the association between return to work and health-related quality of life (HRQoL).

Methods: CO-FLOW, a multicenter prospective cohort study, enrolled adult participants hospitalized for COVID-19, aged ≥ 18 years within 6 months after hospital discharge. Return to work and HRQoL were collected at 3, 6, and 12 months after hospital discharge using the iMTA Productivity Cost Questionnaire and the 36-Item Short Form Health Survey, respectively. Data were collected between July 1, 2020, and September 1, 2022. Generalized estimating equations with repeated measurements were used to assess outcomes over time.

Results: In the CO-FLOW study, 371 participants were employed pre-hospitalization. At 3, 6, and 12 months post-discharge, 50% (170/342), 29% (92/317), and 15% (44/295) of participants had not returned to work, and 21% (71/342), 21% (65/317), and 16% (48/295) only partially, respectively. ICU admission (adjusted odds ratio (95% confidence interval): 0.17 (0.10 to 0.30), p < 0.001), persistent fatigue (0.93 (0.90 to 0.97), p < 0.001), female sex (0.57 (0.36 to 0.90), p = 0.017), and older age (0.96 (0.93 to 0.98), p < 0.001) were independently associated with no return to work. ICU patients required a longer time to return to work than non-ICU patients. Patients who did not return or partially returned to work reported lower scores on all domains of HRQoL than those who fully returned.

Conclusions: One year after hospitalization for COVID-19, only 69% of patients fully returned to work, whereas 15% did not return and 16% partially returned to work. No or partial return to work was associated with reduced HRQoL. This study suggests that long-term vocational support might be needed to facilitate return to work.

Trial registration: World Health Organization International Clinical Trials Registry Platform NL8710.

Keywords: COVID-19; Fatigue; Intensive care; Mental health; Quality of life; Rehabilitation; Return to work.

Fig. 1

Flowchart of inclusion procedure for the study sample. Of the 650 patients, 371 were employed prior to hospitalization for COVID-19 and were included in the study sample. The final generalized estimating equations analyses with full model specification included 354 (95.4%) patients

Fig. 2

Alluvial plot showing changes in employment status (retired, no return to work, partial return to work, full return to work, or temporary unemployed) over the follow-up time of patients employed prior to hospitalization for COVID-19

Fig. 3

Plots presenting the percentage of non-ICU patients compared to ICU patients who did not return, partially returned, or fully returned to work at 3, 6, and 12 months after hospitalization for COVID-19. ICU, intensive care unit; OR, odds ratio; CI, confidence intervals. ^a Odds ratios are obtained from univariable Generalized Estimating Equations analysis with return to work (partial or full) as dependent variable

Fig. 4

Forest plot showing adjusted odds ratios from multivariable analysis of A return to work (no versus partial/full) and B full return to work (no/partial versus full) up to 1 year after hospitalization for COVID-19. ICU, intensive care unit; M, months; STS, sit-to-stand; %pred, percentage of normative values; HGS, handgrip strength

Fig. 5

Radar plots representing HRQoL on the 8 domains of the SF-36 in the study population compared with the Dutch norm (gray line). A HRQoL on SF-36 domains for the total cohort at 3, 6, and 12 months. B–D HRQoL on SF-36 domains for participants with no (red line), partial (orange line), or full (green) return to work. In B, the results are shown for 3-months follow-up; in C, for 6-months follow-up; and in D, for 12-months follow-up. * Significant improvement over time (p < 0.007).  = significant difference in HRQoL between no return to work and partial/full return to work (p < 0.05).   = significant difference between no/partial return to work and full return to work (p < 0.03). PF, physical functioning; RP, role limitations due to physical health; RE, role limitations due to emotional problems; VT, vitality; MH, mental health; SF, social functioning; BP, bodily pain; GH, general health

Fig. 6

Forest plot showing adjusted odds ratios from multivariable analysis of A Physical Component Summary and B Mental Component Summary up to 1 year after hospitalization for COVID-19. ICU, intensive care unit; STS, sit-to-stand; %pred, percentage of normative values; HGS, handgrip strength