The first question in this study sought to evaluate the changes of life quality over time and discovering variables that effects in post COVID-19 patients. Recent trends in COVID-19 have led to a proliferation of research on post-COVID-19 effects [15–17]. The importance and originality of this study are that it explores quality of life changes after COVID-19.
The most striking result to emerge from our study is that, all quality of life parameters evaluated by SF-36 were decreased in post acute 1st and 2nd admission to COVID-19 Follow-up Centre. Our study includes patients who had COVID-19 disease of different severity and were followed up at home or in the hospital as suggested by guidelines published by the Turkish Ministry of Health's Scientific Committee . However, much of the current literature on outcomes and quality of life changes had focused on critical illness such as ARDS and sepsis [19–23].
In reviewing the literature, a data was found on the quality of life was impaired in %44.1 of discharged patients according to EuroQoL visual analogue scale . A study was conducted in China compared COVID-19 patients and normal population with SF-36 parameters that shows that patients had higher body pain and vitality scores, but lower physiological function, social function, and role-physical scores . In our study, the general health parameter of patients hospitalized in the intensive care unit increased in the 2 admission. It is encouraging to compare this figure with that found by Wong (2020) who found that a third of patients with COVID-19 reporting at least moderate impairment in major dimensions of quality of life 3 months after symptom onset . A Dutch study reported that quality of life was evaluated six weeks after COVID-19 pneumonia, and reported to be lower than Dutch population .
The next section of our study was concerned with identifying connections between age and treatment places. Comparing the COVID-19 treatment areas and the ages of the patients, it was seen that the patients in the hospital and intensive care unit were older than the patients treated at home. Contrary to expectations, our study did not find a significant difference in age groups (adult or elder) with SF-36 subgroups.
In the current study, comparing gender with SF-36 subgroups showed that the only significant difference in General Health worse in Female patients. A research showed that female sex was a predictor of mental component summary lower than 50 in SF-36 and suggesting that female sex is a risk factor for the mental health quality of life in Chinese COVID-19 patients . In a study in which the SF-36 scale was applied, it was shown that Physical Function and Pain in women in Diabetic Foot Disease had worse outcomes . A possible explanation for these results may be the lack of adequate sample size.
In many studies, cough and dyspnea was reported as persistent symptoms after COVID-19 infection [24, 29–32]. Our study found that; cough, dyspnea and chest pain was found to be agrevated after two months follow up. In first and second admission to our COVID-19 Follow-up Centre, cough is the cardinal symptom that persists. This study confirms that cough is associated with not only common in patients admitted to intermediate care/intensive care units but also the most continuing sypmtom after COVID-19 .
A Chinese study, compared pulmonary rehabilitation and control group for quality of life after six weeks in post COVID-19 elderly patients and no change was reported in any subgroup of SF-36 in control group . The methodology of that study is different from ours, however it shows similarity with our study as it is also a follow-up study on quality of life. Different from the above study, in our study quality of life was negatively affected after two months follow-up. Ethnic, age differences and also longer follow-up time than Chinese study may explain these different results.
Prior studies that have noted the importance implacations of gender and age on quality of life was enlightened [35–39]. In a study conducted in China with post COVID-19 patients were evaluated in terms of SF-36 values change at 3 months after disharge from hospital and the values were reported to be lower when compared with Chinese people normal values of SF-36 . Besides in female patients, most of the SF-36 subgroups were reported lower scores than male. Further analysis showed in this study showed that elderly patients were found to have lower general health and physical function scores than adult patients . In another Chinese study investigating association between age and gender with quality of Life, Chen (2020) reported that, most of subgroups were found to be lower from general Chinese population and physical function and physical role was reported to be negatively associated with age, also physical function and emotional role were reported to be negatively associated with female gender when post COVID-19 patients were interviewed with SF-36 after 1 month discharge . Cross-sectional studies such as these do not necessarily show subtle changes over time. This cohort study seeks to obtain data gives 6-month follow up which will help to address these research gaps in the post COVID-19 period. We also evaluated SF-36 change according to gender, age and treatment places. At the first admission, the ongoing treatment and rehabilitation process of the patients were recorded. When the patients came for the second control, those who found worsening in their complaints and general health evaluation were referred to the relevant units (Chest Diseases, Cardiology, Psychiatry, Physical Therapy and Rehabilitation, etc.). Being able to detect and document this situation has set an example for the multidisciplinary approach of the COVID-19 follow-up center, and it has been concluded that the spread of such centers will enable the detection of patients and their follow-up with a holistic approach.
The scope of this study was limited in terms of the lack of sample size that study was conducted as a retrospective single design. The results of this research support the idea of almost 1 year following up COVID-19 patients in single COVID-19 Follow-up Centre. Since the study was limited to 6 months follow-up after diagnosed with COVID-19, it was not possible to fully understand the effects of long term COVID-19. On the other hand, we believe the present study lays the groundwork for future research into the long term effects of COVID-19 and further studies regarding the role of COVID-19 Follow-up Centres all around the world.