Date Presented 03/21/24
Long COVID is a novel and evolving cause of disability. This cohort study of data from the All of Us research program found that OT is currently used but may be underutilized. OT’s potential on care teams is discussed.
Primary Author and Speaker: Kristen E. Kehl-Floberg
Contributing Authors: Ronald Gangnon, Dorothy Edwards
PURPOSE: Between 9.5% and 30% of U.S. adults with history of COVID-19 experience persistent symptoms and problems after infection (termed ‘long COVID’) (NCHS, 2023). The World Health Organization has named impact on function as a long COVID diagnostic criterion (Soriano, 2022). Although Occupational Therapy (OT) is recommended for long COVID functional impairment (Chuang, 2023), its utilization is not known.
DESIGN: This retrospective cohort study analyzed data from the All of Us Research Program, a population-based longitudinal study of over 600k U.S. adults who have shared survey, genomic, and EHR data (Ramirez, 2022). We included participants ≥18 years with history of COVID-19 illness. Long COVID cases had at least one long COVID symptom ≥28 days after illness; controls had none.
METHOD: We queried demographics, surveys, lab results, conditions, and CPT procedure codes for participants who met inclusion criteria. We computed descriptive statistics, odds ratios of receiving OT, and mean OT units (CPT).
RESULTS: 83,791 people with complete demographic data and were analyzed. 52,263(62%) had at least one long COVID symptom, 53,293(64%) were female, and 62,857(75%) white. Mean age was 58(16.5). Among those with long COVID symptoms, 8,224(16%) had an indication of OT, compared to 1,186(4%) among those without (OR 4.8, 98% CI 4.43-5.14). About 10% of our sample had indications of both long COVID and OT, which is 7% lower than the estimated prevalence at the time these data were gathered. The mean lifetime total CPT units was 5.75 (29) for long COVID vs. 2.46 (13.6) without.
CONCLUSION: People with long COVID symptoms were nearly 5 times more likely to receive OT than those without, however OT may still be under-utilized.
IMPACT: OT practitioners can collaborate with referring providers to increase recognition and referral for people with long COVID-related disability. We demonstrate how researchers can use All of Us to explore OT service utilization.
References
National Center for Health Statistics. U.S. Census Bureau, Household Pulse Survey, 2022–2023. Long COVID. Generated interactively: from https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm. Accessed Nov. 13, 2023.
Soriano, J. B., Murthy, S., Marshall, J. C., Relan, P., & Diaz, J. V. (2022). A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis, 22(4), e102–e107. https://doi.org/10.1016/s1473-3099(21)00703-9
Chuang et al., 2023Crook, H., Raza, S., Nowell, J., Young, M., & Edison, P. (2021). Long covid-mechanisms, risk factors, and management. Bmj, 374, n1648. https://doi.org/10.1136/bmj.n1648
Ramirez, A. H., Sulieman, L., Schlueter, D. J., Halvorson, A., Qian, J., Ratsimbazafy, F., . . . Roden, D. M. (2022). The All of Us Research Program: Data quality, utility, and diversity. Patterns (N Y), 3(8), 100570. https://doi.org/10.1016/j.patter.2022.100570
