Long-term complaints and quality of life among COVID-19 survivors in the Hail region; KSA

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Post-COVID-19 sequelae with particular systemic long-term complaints were defined and ultimately led to an impairment in health-related quality of life for a long time after recovery. Aim: This study aimed to determine the long-term complaints of COVID-19 survivors and their impact on their quality of life in the Hail region, KSA. Methods: A retrospective cross-sectional study was carried out with a random sample of 295 COVID-19 survivors to determine the long-term complaints of COVID-19 and its impact on quality of life in the Hail region. Long-term complaint data related to COVID-19 were collected viaa self-report questionnaire, while quality of life was measured via the EQ-5D scale. Results: More than half of the participants complained of fatigue (60%), followed by frequent headache (59%), loss of appetite (54.9%), arthralgia/myalgia (51%), cough (46%) and difficult breathing (36.9%). The overall quality of life was poor among survivors (M±SD 11.911± 3.760), while anxiety and depression were the most common. Thehealth-related quality of life was significantly related to activity, smoking status, fever, cough, fatigue, headache, duration of disease, level of help, and oxygen therapy (p< 0.05). Multiple linear regression revealed that marital status ( p = 0.001), regular and irregular physical activity ( p = 0.008 and 0.011), duration of hospitalization ( p <0.011), and oxygen therapy ( p <0.027) were the independent factors affecting quality of life post-COVID-19. Conclusion: Approximately two-thirds of the COVID-19 survivors experienced long-term complaints, while more than half of them experienced impaired quality of life. Therefore, health care facilities must establish prolonged care plans to improve health status and promote quality of life among COVID-19 survivors. COVID-19 long-term complaints post-COVID-19 symptoms health-related quality of life ED-Q5 Figures Figure 1 Figure 2 Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 [COVID-19]) has been rapidly disseminated worldwide; hundreds of millions of people have acute coronavirus infections with a variety of clinical presentations ( 1 ). In the midst of the COVID-19 pandemic, healthcare providers in various regions and countries have noted that many recovered patients still experience a variety of complaints for a long duration after the acute phase. Hence, long-term complaints or post-COVID-19 illness have been used for describing persistent symptoms in people who have either recovered from COVID-19 or have had the usual symptoms for far longer than would be expected ( 2 ). The up-to-date statistics from the World Health Organization dashboard indicate that 767,364,883 cases of COVID-19 and 6,938,353 deaths have been reported globally; on the other hand, 13,375,580,553 vaccine doses have been administered up to May 2023 ( 3 ). In Saudi Arabia, where strict measures of protection and prevention were applied across the country, complete lockdown and quarantine, in addition to providing out boundaries, help other surrounding and remote countries. According to SEHHATY, the official health application in the KSA, the Ministry of Health reported that 817.127 cumulative cases were confirmed, including 9361 deaths at the beginning of this study ( 4 ). Although the incidence curve has declined compared to that in the same period of the previous two years, the prolonged complications and late consequences are still unclear and cause an increased unplanned return of patients to emergency departments and related healthcare facilities ( 5 ). Local health agencies have made exceptional efforts in health prevention, public precautions, and immunization, which play major roles in breaking down the chain of infection and dissemination of the coronavirus. Unfortunately, there is increasing evidence about the prolonged effect of post-COVID-19 syndrome on various body systems ( 6 – 8 ). Many studies have reported particular systemic long-term effects of COVID-19; a study of 3-month postdischarge critical COVID‐19 patients in the ICU showed that 55% of patients had impaired lung function, exhibiting restrictive patterns, and 65% of patients reported inability to walk a 6-minute distance ( 9 ). Another study investigated acute clinical cardiovascular manifestations and revealed that ventricular dysfunction, cardiogenic shock, myocardial ischemia/infarction, and acute heart failure are the most common manifestations among hospitalized patients with COVID‐19 ( 10 ). Likewise, a retrospective study indicated that COVID‐19 infection was associated with acute kidney injury and a decrease in the estimated glomerular filtration rate (eGFR) in discharged COVID-19 patients compared to non-COVID-19 patients ( 11 ). COVID-19 more typically causes myalgia and arthralgia without true inflammatory arthritis, and a major complication of severe COVID-19 is catabolic muscle wasting as a result of systemic inflammation, prolonged bed rest, and malnutrition ( 12 ). Studies of long-term consequences and prolonged symptoms have attracted increased interest from many researchers and health agencies that have reported a wide array of post-COVID-19 complaints. In general, more than two-thirds of COVID-19 patients reported at least one long-term symptom for 6 months after the initial acute symptoms ( 7 , 8 , 13 ). A meta-analysis of the long-term effects of COVID-19 revealed more than 50 late sequelae and complaints, of which fatigue was the most common, followed by headache, attention disorders, hair loss, and dyspnea ( 14 ). Moreover, impaired quality of life is an important health outcome indicator that is measured as a primary variable ( 9 ). Health-related quality of life (HRQoL) refers to a person’s level of well-being as a result of evaluating various aspects of life based on overall health conditions. The concept of decreasing HRQoL was revealed with previous similar infections of severe acute respiratory syndrome [SARS-CoV-1] and Middle East respiratory syndrome infection ( 15 , 16 ). The relationship between COVID-19 and decreasing HRQoL has not been widely studied, and relatively little is known about this association. Therefore, evaluating the natural course of COVID-19 infection and assessing the HRQoL are crucial to defining long-term complaints post-COVID-19 syndrome ( 17 ). Awareness of health care providers about prolonged symptoms, signs, and complaints that are present in patients previously affected by COVID-19 promotes quick assessment, allows long COVID-19 progression, minimizes the risk of chronic effects and helps re-establish pre-COVID-19 health ( 14 ). Thus, this study aimed to determine the long-term complaints of COVID-19 and their impact on quality of life among COVID-19 survivors in the Hail region. Materials and methods Study design and participants A cross-sectional retrospective design was utilized to determine the long-term incidence of COVID-19 and to investigate the effect of COVID-19 on quality of life among COVID-19 survivors in the Hail region, the largest city in the northern district of Saudi Arabia. The study population comprised all confirmed cases of COVID-19 infection according to the SEHHTY application, the official application of the Ministry of Health, at the time of data collection. The application dashboard showed that 10800 cases of COVID-19 were confirmed through September 2022 in the Hail region. The sample size (295 participants) was determined with the use of the epi-info calculator in the descriptive study at the 95% CI and 0.5 level of significance. Clients who had confirmed evidence of COVID-19 infection were invited to participate in the study based on the eligibility criteria, which included a confirmed history of COVID-19 infection at least 6 months ago, while participants who complained of cognitive disabilities or were aged less than 18 years were excluded. Tools of the study: A structured questionnaire was developed after reviewing the related literature [6,8–10]. This questionnaire comprises three parts. The first part sought to assess the sociodemographic and clinical data, history of acute infection, level of intervention, and length of hospital stay. The second part of the structured questionnaire for COVID-19 survivors was adapted from a study conducted by Huang. C et al 2021 ( 18 ) assessed long-term complaints, which included headache, arthralgia/myalgia, persistent cough, dyspnea, weight loss, loss of appetite, chest pain, palpitation, dementia, depression, loss of acquired skill, sexual dysfunctions, smell and taste impairment, skin pigmentation, and repeated health seeking. The third part aimed to evaluate the level of quality of life among COVID-19 survivors using the European Quality of Life Scale-5 dimensions [EQ-5D], which is a valid and reliable scale developed by the EURO group [1987]. The Arabic version of the EQ-5D scale was developed and tested for validity and reliability by Aburuz.s et al. 2009 and Bekairi A. et al. 2018 ( 19 , 20 ). The scale contains 5 dimensions of health-related quality of life: mobility, self-care, family activity, pain and discomfort, and anxiety/depression. Each dimension is scored on a five-point Likert scale ranging from extreme loss = 1 to competence = 5. The tool validity was assessed by five experts in the field of study to measure internal validity, incredibility, and comprehension, after which the comments and modifications were applied accordingly. Data collection Official permission was obtained from the health cluster in the Hail region. The database of COVID-19 cases in the health affairs office in Hail city was officially accessed to establish the sample for the study. A systematic random sample was subsequently established according to the lists of involved patients. The researchers phoned the candidates to give a clear explanation of the aim of the study, ethical concerns, and the required data. In addition to the participants’ role and their right to give up, the agreement to participate was obtained verbally from each participant. Then, self-reports and written consent forms were sent via WhatsApp to the participants via Google. Pilot study: A pilot study of 35 participants in the presumed sample was carried out to assess the applicability, feasibility, and reliability of the scale. The results indicated that the questionnaires were easy to understand and took 15–20 minutes. The internal consistency reliability was confirmed for the Self-report Questionnaire of COVID-19 Long-term Complaints and the European Quality of Life Scale-5, for which the Cronbach's alpha coefficient was 0.870 and 0.8.21, respectively, indicating good reliability. Ethical consideration: This study was reviewed and approved by the Research Ethics Committee at the University of Hail (Ethical approval No: H 2022 − 407) and the General Health Affairs Director, Hail Health Cluster (IRB; 2022-71). Anonymity, privacy, and confidentiality were ensured by the researchers. The participants also received a clear explanation of the data management and methods of data storage and saving. Statistical analysis The data were analyzed using IBM SPSS Statistics software, version 27 (IBM Corp., Armonk, NY, USA). The mean and standard deviation (SD) were used to represent normally distributed continuous variables, whereas frequencies and percentages were used to describe normally distributed categorical variables. The Kolmogorov‒Smirnov test was used to confirm the normality of the distribution. The findings showed that the data were not normally distributed, as evidenced by a p value of less than 0.05. Therefore, nonparametric statistics (such as the Mann‒Whitney test or Kruskal‒Wallis test) were employed in this investigation. Multiple linear regression was used to evaluate factors that were significantly linked to participants’ quality of life after COVID-19. p < 0.05 indicated statistical significance. Results Table 1 provides a summary of the sociodemographic characteristics of the study participants. The mean age of the participants was 38.09 ± 14.55 years, and the majority of them were male and lived in urban areas (67.1% and 61.7%). More than half (58.6%) were married, and less than half had secondary education or a governmental employer (48.5% and 41.7%, respectively). The table also shows that most of the participants (43.1%) had 3–5 family members, and more than one-third of them (39.7%) performed physical exercise and activities irregularly. Regarding smoking and diet, the table indicates that approximately one-third of the participants were nonsmokers, and more than half of them had no diet regimen or consumed complementary nutrients or vitamins. Table 1 Sociodemographic, habits and life style Characteristics of participants (N = 295) Variables Age Mean ± SD 38.09 ± 14.55 BMI Mean ± SD 25.14 ± 3.16 n % Sex Male Female 198 97 67.1 32.9 Marital status Married Single Divorced 173 92 30 58.6 31.2 10.2 Educational level Primary Secondary University 38 143 114 12.9 48.5 38.6 Occupation Governmental Private Unemployment 123 76 96 41.7 25.8 32.5 Number of family ˂ 3 3–5 ≥ 5 94 127 74 31.9 43.1 25.1 Exercises Regular exercises Irregular exercise No exercise activity 88 117 90 29.8 39.7 30.5 Nutrition Diet regime Diet consideration No diet regime 36 85 174 12.2 28.8 59.0 Smoking Smoker Past smoker Non-smoker 97 95 103 32.9 32.2 34.9 M: mean, SD: standard deviation, BMI: body mass index. The frequency of long term complaints among participants is illustrated in Figure (1), which indicates that more than half of the participants had complained of fatigue, headache, arthralgia, or prolonged loss of appetite as a long-term consequence for more than 6 months (60%, 59%, 51.1%, and 54.9%, respectively). For the following complaints, dyspnea, chronic cough, and chest pain were reported. In addition, palpitations, memory changes, depressive episodes, confusion, sexual dysfunction, and impaired smell and taste were reported in varying percentages of participants. The health related quality of life among the participants is displayed in Fig. 2 , which shows the means of participants’ responses across the dimensions of the EQ-5D. The results indicate that walking and movement had the highest mean scores, followed by “self-care activities” (3.3695 ± 1.63998 and 3.0441 ± 1.50558, respectively). In contrast, the lowest mean score was obtained for the pain and discomfort dimension (1.759 ± 1.436), while the mean total score on the EQ-5D was 11.9119 ± 3.76057. Table 2 represents the relationship between sociodemographic variables and the mean score on the EQ-5D. Marital status and family size were significantly related to the EQ-5D score (p = 0.030 and 0.036, respectively). On the other hand, no significant associations were revealed between age, sex, educational level, occupation, or address and the total scores on the EQ-5D (p ˃0.05). Lifestyle was significantly related to the total score on the EQ-5D and to lifestyle-related variables such as activity and smoking (p < 0.05). In addition, significant relationships between the total EQ-5D score and history of acute illness, such as fever, cough, fatigue, headache, duration of disease, level of help, and oxygen therapy (p < 0.05), were reported. However, there was no significant relationship between nutritional status or length of stay and the total score on the EQ-5D (p ˃0.05). Table 2 Relationship between Sociodemographic characteristics, history of acute illness and EQ-5D scores Variables n Mean Rank p-value Sex Male Female 198 97 150.59 142.71 0.454 Age in years 18–30 31–45 46–80 117 95 83 147.88 143.64 149.68 0.884 Educational level Primary Secondary University 38 143 114 147.26 154.01 140.71 0.458 Occupation Governmental Private Unemployment 123 76 96 137.20 153.41 157.56 0.090 Number of family ˂ 3 3–5 > 5 94 127 74 142.27 139.50 169.88 0.036 Activity Regular exercises Irregular exercise No exercise activity 88 117 90 127.09 140.27 178.49 < 0.001 Smoking Smoker Past smoker Non-smoker 97 95 103 144.24 132.01 166.30 0.015 Fever was the chief complaint No Yes 119 176 125.59 163.15 < 0.001 Cough is the chief complaint No Yes 107 188 127.32 159.77 0.002 Fatigue No Yes 125 170 134.92 157.62 0.023 Headache No Yes 131 164 136.21 157.42 0.033 Duration 3 days or less 4–7 days more than 7 days 75 67 153 169.61 114.51 152.07 0.001 Level of help ER-OPD IPD ICU 107 122 66 150.39 135.28 167.64 0.042 Hospitalization 3 days or less 4–7 days more than 7 days 118 73 104 153.66 134.86 150.80 0.303 ER-OPD: Emergency room – outpatients department, IPD: In-patient department, ICU: intensive care unit Table 3 Multiple linear regression analysis revealed that marital status ( P = 0.001), regular or irregular exercise ( P = 0.008 and 0.011), duration of hospitalization ( P < 0.011), and oxygen therapy ( P < 0.027) were the independent factors affecting quality of life post-COVID-19. Table (3) : Predictors of factors affecting quality of life after COVID-19 Factor Unstandardized Coefficients Standardized Coefficients t Sig. B Std Error Beta Marital status Married Single Divorced Ref 1.891 0.186 0.587 0.734 0.233 0.015 3.224 0.253 0.001 0.800 Activity Regular exercises -1.545- .0576 -0.188- -2.681- 0.008 Irregular exercise -1.301- 0.510 -0.170- -2.553- 0.011 No exercise activity Ref Smoking Smoker -0.674- 0.508 -0.084- -1.326- 0.186 Past smoker -0.662- 0.548 -0.082- -1.207- 0.228 Non-smoker Ref Fever Yes 0.850 0.477 0.111 1.783 0.076 No Ref Cough Yes -0.769- 0.432 -0.098- -1.780- 0.076 No Ref Fatigue Yes 0.498 0.465 0.066 1.071 0.285 No Ref Headache Yes 0.484 0.424 0.064 1.141 0.255 No Ref Duration ˂ 3 days -0.109- 0.586 -0.013- -0.187- 0.852 4–7 days -1.460- 0.574 -0.163- -2.544- 0.011 > 7 days Ref Level of help ER-OPD Ref IPD 0.340 0.554 0.045 0.614 0.539 ICU 0.644 0.834 0.071 0.772 0.441 Oxygen No oxygen supply O2 mask supply MV Others methods Ref -1.155- 1.030 0.438 0.519 0.882 0.666 -0.140- 0.089 0.042 -2.224- 1.168 0.657 0.027 0.244 0.511 R = 0.478; R 2 = 0.229; Adjusted R 2 = 0.178; O2 = oxygen; MV = mechanical ventilator Discussion At the time of this discussion, on 31 May 2023, the WHO website showed 767,364,883 cases of COVID-19 and 6,938,353 deaths globally. In addition, 13,375, 580,553 vaccine doses have been administered ( 3 ). COVID-19 has been reported as one of the most highly contagious pandemic infections and is the most common infection in the new era, causing a variety of changes in health systems, general public health and society ( 21 ). By reviewing an article carried out by Z. Mohammed et al. (2021), they reported that many recovered COVID-19 patients face a variety of long-term complications ( 22 ). Therefore, in-depth investigations of the long-term effects of COVID‐19 infection will help in the appropriate analysis, evaluation and management of persistent or emerging health consequences. Hence, the possible pathophysiological mechanisms of long-term complications should be considered. The main mechanism includes direct viral tissue damage; the presence of the receptor angiotensin-converting enzyme 2 (ACE2); and entry of the virus into target cells through activation of its spike protein in a variety of locations in the body. Therefore, direct tissue damage may be a primary mechanism involved in the pathogenesis of SARS-CoV-2 infection, which may also contribute to its longer-term complications ( 23 , 24 ). In the present study, the long-term consequences of COVID-19 among COVID-19 survivors in the Hail region, KSA, were assessed, and the results revealed that 60% of participants were experiencing intermittent or continuous fatigue for more than 6 months after COVID-19. In addition to fatigue, arthralgia, and myalgia, which are common long-term consequences, these three common symptoms may occur due to disability and impaired daily activities. Similarly, in various studies, musculoskeletal symptoms were defined as complaints of COVID-19, both at the acute and postacute phases. The presence of ACE 2 receptors in skeletal muscle and synovial tissue suggested that viral invasion causes these symptoms. Even though arthritis is common with many viral illnesses, COVID-19 more typically causes myalgia and arthralgia without true inflammatory arthritis ( 12 , 25 , 26 ). Similarly, moderate to severe levels of fatigue were reported among 61% of the participants in the study conducted by Halpin. et al. (2020) ( 27 ). Similarly, Jacobs et al. (2020) reported that fatigue is the most common symptom (56.8%) occurring one month postdischarge, followed by other symptoms, such as shortness of breath (51.4%), cough (40.4%), lack of taste (21.9%), muscular pain (20.2%), diarrhea (15.8%), lack of smell (15.3%), production of phlegm (13.7%), and headache (13.1%) ( 28 ). The second most common complaint in the present study was headache; 60% of participants complained of headache frequently, and 14% of them still complained of headache during the time of data collection. Similarly, headache is one of the most commonly reported symptoms among the neuropsychiatric long-term complications of COVID-19 ( 18 ). Headache may be an iceberg symptom of neurocognitive complications due to systemic inflammatory damage, although pathological studies of the brain and real-time PCR have failed to detect coronavirus in cerebrospinal fluid ( 29 ). On the other hand, some studies did not report headache as a long-term complaint ( 30 ). Regarding gastrointestinal alterations, the present study revealed that more than half of the participants complained of loss of appetite, and this persistent complaint may be related to the replication of the virus within the digestive tract ( 31 ). Researchers have reported dyspnea, shortness of breath or breathlessness as common long-term pulmonary complications after COVID-19 ( 1 ). Mandal et al. (2021) reported that 53%, 43%, and 69% of participants complained of dyspnea, cough, and fatigue, respectively ( 32 ). Similarly, Weerahndi et al. (2021) reported that 74% of overall postdischarge patients complained of shortness of breath for more than one month ( 33 ). In addition, Halpin et al. (2020) reported that two-thirds of postdischarge ICU patients complained of breathlessness, whereas two-fifths of ward patients complained about breathlessness ( 27 ). In this study, 45% of participants complained of frequent and continuous dyspnea episodes for more than 6 months after discharge. The respiratory system is the primary site of coronavirus infections; thus, long-term complaints such as cough and chest pain, which can accompany dyspnea, may be related to frequent exposure to viruses during subsequent waves of pandemics. The symptoms of confusion, memory loss, and depression are related mainly to neuropsychiatric status. High levels of stress, extreme anxiety, and apprehension may aggravate symptoms and long-term complaints, particularly when individuals have a low level of knowledge about the novel cause of COVID-19 and when there is controversy among health agencies and many governments. The present study revealed that 43.7%, 28.2%, and 28.1% of participants complained of frequent episodes of confusion, memory alterations, and depression, respectively. Many studies have reported similar findings; Lopaze et al. (2021), in a systemic review and meta-analysis study, reported that attention disorders, memory loss, and depression were 26%, 16%, and 12%, respectively, among COVID-19 survivors ( 34 ). Similarly, a cohort study was carried out to investigate the 6-month psychiatric outcomes among COVID-19 patients; 46.2% of the hospitalized patients had neuropsychiatric problems, whereas 33.6% of the overall participants had neuropsychiatric problems ( 30 ). The effect of COVID-19 on quality of life has been assessed in many studies worldwide. Garrigues, E. et al. (2020), in their study of postdischarge persistent symptoms and related quality of life, showed that five dimensions of quality of life were altered with slight significance among ICU patients, while the overall index of the EQ-5D was 0.86. They also found that approximately one-third of participants who were active workers had not returned to their work at the time of data collection ( 35 ). However, et al. (2020) indicated that persistent symptoms for 35 days after discharge were significantly related to impaired ability to perform activities of daily living and impaired mental, social, and physical functions ( 28 ). To the best of our knowledge, no study has evaluated how COVID-19 infection affects patients' quality of life in Saudi Arabia and the Arabian Peninsula. The mean quality of life score among participants in this study was 11.9 ± 3.71, while pain and discomfort, anxiety/depression, and daily activities were the most common. Furthermore, we found that anxiety and depression were the most common sequelae among patients who received ICU intervention, while pain and discomfort were the most persistent postdischarge sequelae among ward-admitted patients. These findings are in agreement with those of Malik et al. (2021) in a systematic review of post-acute COVID‐19 syndrome (PCS) and health‐related quality of life (HRQoL) data; they concluded that 58% of post‐COVID‐19 patients had poor quality of life. A total of 41.5% of the participants had pain/discomfort, 37.5% had anxiety/depression, 36% had problems with mobility, 28% had problems with usual activities, and only 8% had self‐care problems. These results indicate that the majority of COVID‐19 survivors have a poor quality of life, which ultimately results in challenges for patients, healthcare providers, and public health providers ( 36 ). Along the same line, Poudal. AK et al. [2021] summarize similar results from a structured review of five studies from different countries ( 37 ). Furthermore, the current study revealed that post-COVID-19 quality of life was significantly affected by infection; anxiety/depression and unexplained pain and discomfort were the most apparent deficits in the quality-of-life dimensions. This study revealed significant relationships between marital status and family size and quality of health; single participants experienced lower quality of life than married participants did. Moreover, an increased number of family members significantly improves quality of life. Family and social support in Arabian society are important, and most people live in homogenous close families and tribes; this may explain these significant relationships. Moreover, COVID-19 patients were more dependent on their relatives because of quarantine and preventive measures. Concurrently, Emrani et al. (2020) studied the effect of sociodemographic characteristics on quality of life in Iran. They found that increased age and marital status are associated with low quality of life ( 38 ); although their study was not focused on COVID-19, it coincides with our findings regarding the effect of sociodemographic factors on quality of life among COVID-19 survivors. This study investigated the factors that predict quality of life among COVID-19 survivors. The quality of life was significantly affected by the level of activity/exercise and smoking history. A lack of exercise activities (e.g., walking) has been related to poor quality of life after discharge, which may be related to muscular resilience after COVID-19. Smoking leads to poor quality of life as a result of the systemic effects of smoking, impaired oxygen supply, and accumulation of carbon monoxide. Other factors that affect quality of life were associated with the severity of symptoms and the level of medical intervention during the acute phase. These findings correspond with those of Garrigues, E. et al. (2020), who indicated that quality of life was influenced by the most common persistent symptoms, such as fever, cough, fatigue, length of stay, and type of oxygen supply. The authors suggested that patients who experienced one or more of these symptoms reported poor quality of life after recovery ( 35 ). Another recent systemic review of quality-of-life post-COVID-19 discharge concluded that quality-of-life post-COVID-19 was significantly impacted regardless of the duration of acute infection. It has been shown that advanced age, comorbidities, patients who need ICU treatment, prolonged length of study, and mechanical ventilation are associated with a greater risk of poor quality of life postdischarge ( 39 ). Conclusion COVID-19 survivors in the Hail region, KSA, complained of a variety of long-term complaints after recovery. Fatigue, headache, loss of appetite, and myalgia/arthralgia were the most commonly reported long-term complaints among participants in the present study. Furthermore, health-related quality of life was significantly impaired, the mean score on the EQ-5D was poor, and pain/discomfort and anxiety/depression were the most affected dimensions. The pooled prediction factors in the present study indicate that single participants and those who live with small families and who have a prolonged length of hospital stay experience a worse quality of life than their counterparts. Moreover, the level of activity/exercise, smoking history and length of stay significantly affect the quality of life of COVID-19 survivors [26]. Abbreviations KSA; kingdom of Saudi arabia EQ-5D; European quality of life – 5 dimension scale SARS-COV2; sever acute respiratory syndrome corona virus 2 HRQoL; health related quality of life CI; confidence interval ACE 2; angiotensin converting enzyme 2 Declarations Ethical approval This study was reviewed and approved by the Research Ethics Committee at the University of Hail (Ethical approval No: H 2022-407) on 5/12/2022; for data collection, approval by the General Health Affairs Director, Hail Health Cluster (IRB; 2022-71) also obtained. Data availability statement The original contributions presented in this study are included in the article/Supplementary material for further inquiries directed to the corresponding author. Data available on: https://drive.google.com/file/d/16o4Qs8X_8qfbKt183-8KdEuAcK_0xCNR/view?usp=drive_link Funding This study funded by the deanship of the scientific research; university of Hail, KSA; research project no (IFP-22-059) Author contributions All the authors contributed to the conceptualization, data collection, analysis, discussion, review and editing of the manuscript for submission. M.A.A; concept, data collection, review, methodology and discussion K.S ; data collection; references management S.A ; data analysis, results , and review Consent to participate : informed consent was obtained from the participants before the data collection (the participant could not proceed to the questionnaire section unless he/she agreed to participate), the form of consent is available on: https://drive.google.com/file/d/1sgLDpF8uZgoiNV0Dp9sRaM2XBOH5q4Zw/view?usp=drive_link Consent to publish : Not applicable Acknowledgments The authors are indebted to the deanship of scientific research and Hail University for their endless support and cooperation in this study. The authors would like to thank the Hail Health Cluster and Health Affairs Office for their cooperation and help in the data collection. Conflict of interest The authors declare that there are no conflicts of interest associated with this research. References Desai AD, Lavelle M, Boursiquot BC, Wan EY. 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Psychosocial effects of social distancing during coronavirus infections: integrative review. Acta Paulista de Enfermagem. 2021;34. Huang L, Zhao P, Tang D, Zhu T, Han R, Zhan C, et al. Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging. JACC Cardiovasc Imaging. 2020;13(11):2330–9. Ferreira LN, Pereira LN, da Fé Brás M, Ilchuk K. Quality of life under the COVID-19 quarantine. Qual Life Res. 2021;30(5):1389–405. Zenbaba D, Sahiledengle B, Beressa G, Desta F, Atlaw D, Bogale D, et al. Healthcare workers’ compliance with COVID-19 preventive measures, and associated factors, in Ethiopia: A systematic review and meta-analysis. BMJ open. 2022;12(8):e060681. Huang L, Zhao P, Tang D, Zhu T, Han R, Zhan C, et al. Cardiac involvement in patients recovered from COVID-2019 identified using magnetic resonance imaging. Cardiovasc Imaging. 2020;13(11):2330–9. Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. The Lancet. 2021;397(10270):220–32. Aburuz S, Bulatova N, Twalbeh M, Gazawi M. The validity and reliability of the Arabic version of the EQ-5D: a study from Jordan. Ann Saudi Med. 2009;29(4):304–8. Bekairy AM, Bustami RT, Almotairi M, Jarab A, Katheri AM, Aldebasi TM, et al. Validity and reliability of the Arabic version of the EuroQOL (EQ-5D). A study from Saudi Arabia. Int J health Sci. 2018;12(2):16. Lone SA, Ahmad A. COVID-19 pandemic–an African perspective. Emerg microbes infections. 2020;9(1):1300–8. Zarei M, Bose D, Nouri-Vaskeh M, Tajiknia V, Zand R, Ghasemi M. Long‐term side effects and lingering symptoms post COVID‐19 recovery. Rev Med Virol. 2022;32(3):e2289. Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nat Med. 2020;26(7):1017–32. Pan X-w, Xu D, Zhang H, Zhou W, Wang L-h. Cui X-g. Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis. Intensive Care Med. 2020;46:1114–6. Aiyegbusi OL, Hughes SE, Turner G, Rivera SC, McMullan C, Chandan JS, et al. Symptoms, complications and management of long COVID: a review. J R Soc Med. 2021;114(9):428–42. Abdullahi A, Candan SA, Abba MA, Bello AH, Alshehri MA, Afamefuna Victor E et al. Neurological and musculoskeletal features of COVID-19: a systematic review and meta-analysis. Front Neurol. 2020:687. Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross‐sectional evaluation. J Med Virol. 2021;93(2):1013–22. Jacobs LG, Gourna Paleoudis E, Lesky-Di Bari D, Nyirenda T, Friedman T, Gupta A, et al. Persistence of symptoms and quality of life at 35 days after hospitalization for COVID-19 infection. PLoS ONE. 2020;15(12):e0243882. Heneka MT, Golenbock D, Latz E, Morgan D, Brown R. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alzheimers Res Ther. 2020;12:1–3. Taquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. The Lancet Psychiatry. 2021;8(5):416–27. Gu J, Han B, Wang J. COVID-19: gastrointestinal manifestations and potential fecal–oral transmission. Gastroenterology. 2020;158(6):1518–9. Mandal S, Barnett J, Brill SE, Brown JS, Denneny EK, Hare SS, et al. Long-COVID’: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalization for COVID-19. Thorax. 2021;76(4):396–8. Weerahandi H, Hochman KA, Simon E, Blaum C, Chodosh J, Duan E, et al. Postdischarge health status and symptoms in patients with severe COVID-19. J Gen Intern Med. 2021;36:738–45. Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo PA, Cuapio A et al. More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis. medRxiv. 2021. Garrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, et al. Postdischarge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect. 2020;81(6):e4–e6. Malik P, Patel K, Pinto C, Jaiswal R, Tirupathi R, Pillai S, et al. Post-acute COVID‐19 syndrome (PCS) and health‐related quality of life (HRQoL)—A systematic review and meta‐analysis. J Med Virol. 2022;94(1):253–62. Poudel AN, Zhu S, Cooper N, Roderick P, Alwan N, Tarrant C, et al. Impact of Covid-19 on health-related quality of life of patients: A structured review. PLoS ONE. 2021;16(10):e0259164. Emrani Z, Akbari Sari A, Zeraati H, Olyaeemanesh A, Daroudi R. Health-related quality of life measured using the EQ-5D–5 L: population norms for the capital of Iran. Health Qual Life Outcomes. 2020;18(1):1–8. Nandasena H, Pathirathna M, Atapattu A, Prasanga P. Quality of life of COVID 19 patients after discharge: Systematic review. PLoS ONE. 2022;17(2):e0263941. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3839687","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":266389048,"identity":"3d96f50b-80b8-4747-95bf-6410a461bb21","order_by":0,"name":"Mokhtar abdu almoliky","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA80lEQVRIiWNgGAWjYDACdiB+YJDAwMbefODABwaGBMJamIE4AaiFj+dY4sEZxGsBQjmJHOPDPMRo4W/mTnyQUJCW2CaRlnDYts0uj5+9gfHDxxzcWiQO8242SDDISWzjeXzgcG5bcrFkzwFmyZnb8FhzmHebRIJBRWIbO9CW3DbmxA03EtiYefFokYdrYcgxOGzZVk9YiwFEC9BhHEAtjG2HCWsxhPglzbiN51jCwZ5zxxNn9hxsxusXueO9Gx98+JMsO7+9+fCHH2XVif3szQc/fMTnfShwbACRjGxgsoGweiCwh1B/iFI8CkbBKBgFIwwAADT4WhSxlljtAAAAAElFTkSuQmCC","orcid":"","institution":"University of Hail","correspondingAuthor":true,"prefix":"","firstName":"Mokhtar","middleName":"abdu","lastName":"almoliky","suffix":""},{"id":266389049,"identity":"c4eed7d2-f3a2-424c-bd9d-8dce88ce207f","order_by":1,"name":"khalil abdulqawi saleh","email":"","orcid":"","institution":"University of Hail","correspondingAuthor":false,"prefix":"","firstName":"khalil","middleName":"abdulqawi","lastName":"saleh","suffix":""},{"id":266389050,"identity":"a3e2c7bc-99bc-4aff-8804-03e2771ce138","order_by":2,"name":"Sameer abdulmalik alkubati","email":"","orcid":"","institution":"University of Hail","correspondingAuthor":false,"prefix":"","firstName":"Sameer","middleName":"abdulmalik","lastName":"alkubati","suffix":""}],"badges":[],"createdAt":"2024-01-06 12:14:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3839687/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3839687/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":49542458,"identity":"1da0a179-716b-4703-9c4a-56573ff29892","added_by":"auto","created_at":"2024-01-12 17:34:18","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":144487,"visible":true,"origin":"","legend":"\u003cp\u003eFrequency of long term complaints among COVID-19 survivors\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3839687/v1/ea799d8c770f0eca1ffbb1c6.png"},{"id":49542456,"identity":"103a6e12-7eff-444a-b801-b7601daf1cc4","added_by":"auto","created_at":"2024-01-12 17:34:18","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":39270,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003emeans of health related quality of life among COVID-19 survivors\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3839687/v1/daef37d9daffd202a3be89b4.png"},{"id":49562466,"identity":"62bb353b-11bd-4f9b-841e-6dccd99967cd","added_by":"auto","created_at":"2024-01-13 09:37:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":568163,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3839687/v1/3654ce39-9f9e-4b02-9542-81955965f004.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Long-term complaints and quality of life among COVID-19 survivors in the Hail region; KSA","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2 [COVID-19]) has been rapidly disseminated worldwide; hundreds of millions of people have acute coronavirus infections with a variety of clinical presentations (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In the midst of the COVID-19 pandemic, healthcare providers in various regions and countries have noted that many recovered patients still experience a variety of complaints for a long duration after the acute phase. Hence, long-term complaints or post-COVID-19 illness have been used for describing persistent symptoms in people who have either recovered from COVID-19 or have had the usual symptoms for far longer than would be expected (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe up-to-date statistics from the World Health Organization dashboard indicate that 767,364,883 cases of COVID-19 and 6,938,353 deaths have been reported globally; on the other hand, 13,375,580,553 vaccine doses have been administered up to May 2023 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In Saudi Arabia, where strict measures of protection and prevention were applied across the country, complete lockdown and quarantine, in addition to providing out boundaries, help other surrounding and remote countries. According to SEHHATY, the official health application in the KSA, the Ministry of Health reported that 817.127 cumulative cases were confirmed, including 9361 deaths at the beginning of this study (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Although the incidence curve has declined compared to that in the same period of the previous two years, the prolonged complications and late consequences are still unclear and cause an increased unplanned return of patients to emergency departments and related healthcare facilities (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Local health agencies have made exceptional efforts in health prevention, public precautions, and immunization, which play major roles in breaking down the chain of infection and dissemination of the coronavirus. Unfortunately, there is increasing evidence about the prolonged effect of post-COVID-19 syndrome on various body systems (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMany studies have reported particular systemic long-term effects of COVID-19; a study of 3-month postdischarge critical COVID‐19 patients in the ICU showed that 55% of patients had impaired lung function, exhibiting restrictive patterns, and 65% of patients reported inability to walk a 6-minute distance (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Another study investigated acute clinical cardiovascular manifestations and revealed that ventricular dysfunction, cardiogenic shock, myocardial ischemia/infarction, and acute heart failure are the most common manifestations among hospitalized patients with COVID‐19 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Likewise, a retrospective study indicated that COVID‐19 infection was associated with acute kidney injury and a decrease in the estimated glomerular filtration rate (eGFR) in discharged COVID-19 patients compared to non-COVID-19 patients (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). COVID-19 more typically causes myalgia and arthralgia without true inflammatory arthritis, and a major complication of severe COVID-19 is catabolic muscle wasting as a result of systemic inflammation, prolonged bed rest, and malnutrition (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudies of long-term consequences and prolonged symptoms have attracted increased interest from many researchers and health agencies that have reported a wide array of post-COVID-19 complaints. In general, more than two-thirds of COVID-19 patients reported at least one long-term symptom for 6 months after the initial acute symptoms (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). A meta-analysis of the long-term effects of COVID-19 revealed more than 50 late sequelae and complaints, of which fatigue was the most common, followed by headache, attention disorders, hair loss, and dyspnea (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMoreover, impaired quality of life is an important health outcome indicator that is measured as a primary variable (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Health-related quality of life (HRQoL) refers to a person\u0026rsquo;s level of well-being as a result of evaluating various aspects of life based on overall health conditions. The concept of decreasing HRQoL was revealed with previous similar infections of severe acute respiratory syndrome [SARS-CoV-1] and Middle East respiratory syndrome infection (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The relationship between COVID-19 and decreasing HRQoL has not been widely studied, and relatively little is known about this association. Therefore, evaluating the natural course of COVID-19 infection and assessing the HRQoL are crucial to defining long-term complaints post-COVID-19 syndrome (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Awareness of health care providers about prolonged symptoms, signs, and complaints that are present in patients previously affected by COVID-19 promotes quick assessment, allows long COVID-19 progression, minimizes the risk of chronic effects and helps re-establish pre-COVID-19 health (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Thus, this study aimed to determine the long-term complaints of COVID-19 and their impact on quality of life among COVID-19 survivors in the Hail region.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and participants\u003c/h2\u003e \u003cp\u003eA cross-sectional retrospective design was utilized to determine the long-term incidence of COVID-19 and to investigate the effect of COVID-19 on quality of life among COVID-19 survivors in the Hail region, the largest city in the northern district of Saudi Arabia. The study population comprised all confirmed cases of COVID-19 infection according to the SEHHTY application, the official application of the Ministry of Health, at the time of data collection. The application dashboard showed that 10800 cases of COVID-19 were confirmed through September 2022 in the Hail region. The sample size (295 participants) was determined with the use of the epi-info calculator in the descriptive study at the 95% CI and 0.5 level of significance. Clients who had confirmed evidence of COVID-19 infection were invited to participate in the study based on the eligibility criteria, which included a confirmed history of COVID-19 infection at least 6 months ago, while participants who complained of cognitive disabilities or were aged less than 18 years were excluded.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTools of the study: A\u003c/b\u003e structured questionnaire was developed after reviewing the related literature [6,8\u0026ndash;10]. This questionnaire comprises three parts. The first part sought to assess the sociodemographic and clinical data, history of acute infection, level of intervention, and length of hospital stay. The second part of the structured questionnaire for COVID-19 survivors was adapted from a study conducted by Huang. C et al 2021 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) assessed long-term complaints, which included headache, arthralgia/myalgia, persistent cough, dyspnea, weight loss, loss of appetite, chest pain, palpitation, dementia, depression, loss of acquired skill, sexual dysfunctions, smell and taste impairment, skin pigmentation, and repeated health seeking.\u003c/p\u003e \u003cp\u003eThe third part aimed to evaluate the level of quality of life among COVID-19 survivors using the European Quality of Life Scale-5 dimensions [EQ-5D], which is a valid and reliable scale developed by the EURO group [1987]. The Arabic version of the EQ-5D scale was developed and tested for validity and reliability by Aburuz.s et al. 2009 and Bekairi A. et al. 2018 (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The scale contains 5 dimensions of health-related quality of life: mobility, self-care, family activity, pain and discomfort, and anxiety/depression. Each dimension is scored on a five-point Likert scale ranging from extreme loss\u0026thinsp;=\u0026thinsp;1 to competence\u0026thinsp;=\u0026thinsp;5. The tool validity was assessed by five experts in the field of study to measure internal validity, incredibility, and comprehension, after which the comments and modifications were applied accordingly.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData collection\u003c/strong\u003e \u003cp\u003eOfficial permission was obtained from the health cluster in the Hail region. The database of COVID-19 cases in the health affairs office in Hail city was officially accessed to establish the sample for the study. A systematic random sample was subsequently established according to the lists of involved patients. The researchers phoned the candidates to give a clear explanation of the aim of the study, ethical concerns, and the required data. In addition to the participants\u0026rsquo; role and their right to give up, the agreement to participate was obtained verbally from each participant. Then, self-reports and written consent forms were sent via WhatsApp to the participants via Google.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003ePilot study:\u003c/h2\u003e \u003cp\u003eA pilot study of 35 participants in the presumed sample was carried out to assess the applicability, feasibility, and reliability of the scale. The results indicated that the questionnaires\u003c/p\u003e \u003cp\u003ewere easy to understand and took 15\u0026ndash;20 minutes. The internal consistency reliability was confirmed for the Self-report Questionnaire of COVID-19 Long-term Complaints and the European Quality of Life Scale-5, for which the Cronbach's alpha coefficient was 0.870 and 0.8.21, respectively, indicating good reliability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eEthical consideration:\u003c/h2\u003e \u003cp\u003e This study was reviewed and approved by the Research Ethics Committee at the University of Hail (Ethical approval No: H 2022\u0026thinsp;\u0026minus;\u0026thinsp;407) and the General Health Affairs Director, Hail Health Cluster (IRB; 2022-71). Anonymity, privacy, and confidentiality were ensured by the researchers. The participants also received a clear explanation of the data management and methods of data storage and saving.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe data were analyzed using IBM SPSS Statistics software, version 27 (IBM Corp., Armonk, NY, USA). The mean and standard deviation (SD) were used to represent normally distributed continuous variables, whereas frequencies and percentages were used to describe normally distributed categorical variables. The Kolmogorov‒Smirnov test was used to confirm the normality of the distribution. The findings showed that the data were not normally distributed, as evidenced by a p value of less than 0.05. Therefore, nonparametric statistics (such as the Mann‒Whitney test or Kruskal‒Wallis test) were employed in this investigation. Multiple linear regression was used to evaluate factors that were significantly linked to participants\u0026rsquo; quality of life after COVID-19. p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides a summary of the sociodemographic characteristics of the study participants. The mean age of the participants was 38.09\u0026thinsp;\u0026plusmn;\u0026thinsp;14.55 years, and the majority of them were male and lived in urban areas (67.1% and 61.7%). More than half (58.6%) were married, and less than half had secondary education or a governmental employer (48.5% and 41.7%, respectively). The table also shows that most of the participants (43.1%) had 3\u0026ndash;5 family members, and more than one-third of them (39.7%) performed physical exercise and activities irregularly. Regarding smoking and diet, the table indicates that approximately one-third of the participants were nonsmokers, and more than half of them had no diet regimen or consumed complementary nutrients or vitamins.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic, habits and life style Characteristics of participants (N\u0026thinsp;=\u0026thinsp;295)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e38.09\u0026thinsp;\u0026plusmn;\u0026thinsp;14.55\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e25.14\u0026thinsp;\u0026plusmn;\u0026thinsp;3.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003en\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e%\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e198\u003c/p\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e67.1\u003c/p\u003e \u003cp\u003e32.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eSingle\u003c/p\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e173\u003c/p\u003e \u003cp\u003e92\u003c/p\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.6\u003c/p\u003e \u003cp\u003e31.2\u003c/p\u003e \u003cp\u003e10.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003cp\u003e143\u003c/p\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003cp\u003e48.5\u003c/p\u003e \u003cp\u003e38.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernmental\u003c/p\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003cp\u003eUnemployment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003cp\u003e76\u003c/p\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.7\u003c/p\u003e \u003cp\u003e25.8\u003c/p\u003e \u003cp\u003e32.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e˂ 3\u003c/p\u003e \u003cp\u003e3\u0026ndash;5\u003c/p\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003cp\u003e127\u003c/p\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.9\u003c/p\u003e \u003cp\u003e43.1\u003c/p\u003e \u003cp\u003e25.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eExercises\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegular exercises\u003c/p\u003e \u003cp\u003eIrregular exercise\u003c/p\u003e \u003cp\u003eNo exercise activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003cp\u003e117\u003c/p\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.8\u003c/p\u003e \u003cp\u003e39.7\u003c/p\u003e \u003cp\u003e30.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutrition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiet regime\u003c/p\u003e \u003cp\u003eDiet consideration\u003c/p\u003e \u003cp\u003eNo diet regime\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003cp\u003e85\u003c/p\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.2\u003c/p\u003e \u003cp\u003e28.8\u003c/p\u003e \u003cp\u003e59.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmoker\u003c/p\u003e \u003cp\u003ePast smoker\u003c/p\u003e \u003cp\u003eNon-smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003cp\u003e95\u003c/p\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.9\u003c/p\u003e \u003cp\u003e32.2\u003c/p\u003e \u003cp\u003e34.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eM: mean, SD: standard deviation, BMI: body mass index.\u003c/p\u003e \u003cp\u003eThe frequency of long term complaints among participants is illustrated in Figure (1), which indicates that more than half of the participants had complained of fatigue, headache, arthralgia, or prolonged loss of appetite as a long-term consequence for more than 6 months (60%, 59%, 51.1%, and 54.9%, respectively). For the following complaints, dyspnea, chronic cough, and chest pain were reported. In addition, palpitations, memory changes, depressive episodes, confusion, sexual dysfunction, and impaired smell and taste were reported in varying percentages of participants.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe health related quality of life among the participants is displayed in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, which shows the means of participants\u0026rsquo; responses across the dimensions of the EQ-5D. The results indicate that walking and movement had the highest mean scores, followed by \u0026ldquo;self-care activities\u0026rdquo; (3.3695\u0026thinsp;\u0026plusmn;\u0026thinsp;1.63998 and 3.0441\u0026thinsp;\u0026plusmn;\u0026thinsp;1.50558, respectively). In contrast, the lowest mean score was obtained for the pain and discomfort dimension (1.759\u0026thinsp;\u0026plusmn;\u0026thinsp;1.436), while the mean total score on the EQ-5D was 11.9119\u0026thinsp;\u0026plusmn;\u0026thinsp;3.76057.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e represents the relationship between sociodemographic variables and the mean score on the EQ-5D. Marital status and family size were significantly related to the EQ-5D score (p\u0026thinsp;=\u0026thinsp;0.030 and 0.036, respectively). On the other hand, no significant associations were revealed between age, sex, educational level, occupation, or address and the total scores on the EQ-5D (p ˃0.05). Lifestyle was significantly related to the total score on the EQ-5D and to lifestyle-related variables such as activity and smoking (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In addition, significant relationships between the total EQ-5D score and history of acute illness, such as fever, cough, fatigue, headache, duration of disease, level of help, and oxygen therapy (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05), were reported. However, there was no significant relationship between nutritional status or length of stay and the total score on the EQ-5D (p ˃0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRelationship between Sociodemographic characteristics, history of acute illness and EQ-5D scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMean Rank\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e198\u003c/p\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e150.59\u003c/p\u003e \u003cp\u003e142.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.454\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;30\u003c/p\u003e \u003cp\u003e31\u0026ndash;45\u003c/p\u003e \u003cp\u003e46\u0026ndash;80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e117\u003c/p\u003e \u003cp\u003e95\u003c/p\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e147.88\u003c/p\u003e \u003cp\u003e143.64\u003c/p\u003e \u003cp\u003e149.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.884\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003cp\u003e143\u003c/p\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e147.26\u003c/p\u003e \u003cp\u003e154.01\u003c/p\u003e \u003cp\u003e140.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.458\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernmental\u003c/p\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003cp\u003eUnemployment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e123\u003c/p\u003e \u003cp\u003e76\u003c/p\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e137.20\u003c/p\u003e \u003cp\u003e153.41\u003c/p\u003e \u003cp\u003e157.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e˂ 3\u003c/p\u003e \u003cp\u003e3\u0026ndash;5\u003c/p\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003cp\u003e127\u003c/p\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e142.27\u003c/p\u003e \u003cp\u003e139.50\u003c/p\u003e \u003cp\u003e169.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegular exercises\u003c/p\u003e \u003cp\u003eIrregular exercise\u003c/p\u003e \u003cp\u003eNo exercise activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003cp\u003e117\u003c/p\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e127.09\u003c/p\u003e \u003cp\u003e140.27\u003c/p\u003e \u003cp\u003e178.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmoker\u003c/p\u003e \u003cp\u003ePast smoker\u003c/p\u003e \u003cp\u003eNon-smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97\u003c/p\u003e \u003cp\u003e95\u003c/p\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e144.24\u003c/p\u003e \u003cp\u003e132.01\u003c/p\u003e \u003cp\u003e166.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever was the chief complaint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e125.59\u003c/p\u003e \u003cp\u003e163.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCough is the chief complaint\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107\u003c/p\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e127.32\u003c/p\u003e \u003cp\u003e159.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e125\u003c/p\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134.92\u003c/p\u003e \u003cp\u003e157.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeadache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e131\u003c/p\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e136.21\u003c/p\u003e \u003cp\u003e157.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 days or less\u003c/p\u003e \u003cp\u003e4\u0026ndash;7 days\u003c/p\u003e \u003cp\u003emore than 7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003cp\u003e67\u003c/p\u003e \u003cp\u003e153\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e169.61\u003c/p\u003e \u003cp\u003e114.51\u003c/p\u003e \u003cp\u003e152.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of help\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eER-OPD\u003c/p\u003e \u003cp\u003eIPD\u003c/p\u003e \u003cp\u003eICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e107\u003c/p\u003e \u003cp\u003e122\u003c/p\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e150.39\u003c/p\u003e \u003cp\u003e135.28\u003c/p\u003e \u003cp\u003e167.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitalization\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 days or less\u003c/p\u003e \u003cp\u003e4\u0026ndash;7 days\u003c/p\u003e \u003cp\u003emore than 7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118\u003c/p\u003e \u003cp\u003e73\u003c/p\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e153.66\u003c/p\u003e \u003cp\u003e134.86\u003c/p\u003e \u003cp\u003e150.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eER-OPD: Emergency room \u0026ndash; outpatients department, IPD: In-patient department, ICU: intensive care unit\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultiple linear regression analysis revealed that marital status (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), regular or irregular exercise (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008 and 0.011), duration of hospitalization (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.011), and oxygen therapy (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.027) were the independent factors affecting quality of life post-COVID-19. \u003cb\u003eTable\u0026nbsp;(3)\u003c/b\u003e: Predictors of factors affecting quality of life after COVID-19\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFactor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eUnstandardized Coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStandardized Coefficients\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStd Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003cp\u003eSingle\u003c/p\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e1.891\u003c/p\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.587\u003c/p\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.233\u003c/p\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.224\u003c/p\u003e \u003cp\u003e0.253\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003cp\u003e0.800\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActivity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRegular exercises\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.545-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.0576\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.188-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.681-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIrregular exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.301-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.510\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.170-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.553-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo exercise activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmoking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSmoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.674-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.084-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.326-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePast smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.662-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.548\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.082-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.207-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.228\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNon-smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.850\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.783\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCough\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.769-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.098-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-1.780-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.285\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeadache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.484\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.064\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e˂ 3 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.109-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.586\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.013-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.187-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.852\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u0026ndash;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.460-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.163-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.544-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;7 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel of help\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eER-OPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.554\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.614\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.539\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.644\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.071\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.441\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOxygen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo oxygen supply\u003c/p\u003e \u003cp\u003eO2 mask supply\u003c/p\u003e \u003cp\u003eMV\u003c/p\u003e \u003cp\u003eOthers methods\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003cp\u003e-1.155-\u003c/p\u003e \u003cp\u003e1.030\u003c/p\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.519\u003c/p\u003e \u003cp\u003e0.882\u003c/p\u003e \u003cp\u003e0.666\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.140-\u003c/p\u003e \u003cp\u003e0.089\u003c/p\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-2.224-\u003c/p\u003e \u003cp\u003e1.168\u003c/p\u003e \u003cp\u003e0.657\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003cp\u003e0.244\u003c/p\u003e \u003cp\u003e0.511\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eR\u0026thinsp;=\u0026thinsp;0.478; R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.229; Adjusted R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.178; O2\u0026thinsp;=\u0026thinsp;oxygen; MV\u0026thinsp;=\u0026thinsp;mechanical ventilator\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eAt the time of this discussion, on 31 May 2023, the WHO website showed 767,364,883 cases of COVID-19 and 6,938,353 deaths globally. In addition, 13,375, 580,553 vaccine doses have been administered (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). COVID-19 has been reported as one of the most highly contagious pandemic infections and is the most common infection in the new era, causing a variety of changes in health systems, general public health and society (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e By reviewing an article carried out by Z. Mohammed et al. (2021), they reported that many recovered COVID-19 patients face a variety of long-term complications (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Therefore, in-depth investigations of the long-term effects of COVID‐19 infection will help in the appropriate analysis, evaluation and management of persistent or emerging health consequences.\u003c/p\u003e \u003cp\u003eHence, the possible pathophysiological mechanisms of long-term complications should be considered. The main mechanism includes direct viral tissue damage; the presence of the receptor angiotensin-converting enzyme 2 (ACE2); and entry of the virus into target cells through activation of its spike protein in a variety of locations in the body. Therefore, direct tissue damage may be a primary mechanism involved in the pathogenesis of SARS-CoV-2 infection, which may also contribute to its longer-term complications (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the present study, the long-term consequences of COVID-19 among COVID-19 survivors in the Hail region, KSA, were assessed, and the results revealed that 60% of participants were experiencing intermittent or continuous fatigue for more than 6 months after COVID-19. In addition to fatigue, arthralgia, and myalgia, which are common long-term consequences, these three common symptoms may occur due to disability and impaired daily activities. Similarly, in various studies, musculoskeletal symptoms were defined as complaints of COVID-19, both at the acute and postacute phases. The presence of ACE 2 receptors in skeletal muscle and synovial tissue suggested that viral invasion causes these symptoms. Even though arthritis is common with many viral illnesses, COVID-19 more typically causes myalgia and arthralgia without true inflammatory arthritis (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilarly, moderate to severe levels of fatigue were reported among 61% of the participants in the study conducted by Halpin. et al. (2020) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Similarly, Jacobs et al. (2020) reported that fatigue is the most common symptom (56.8%) occurring one month postdischarge, followed by other symptoms, such as shortness of breath (51.4%), cough (40.4%), lack of taste (21.9%), muscular pain (20.2%), diarrhea (15.8%), lack of smell (15.3%), production of phlegm (13.7%), and headache (13.1%) (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe second most common complaint in the present study was headache; 60% of participants complained of headache frequently, and 14% of them still complained of headache during the time of data collection. Similarly, headache is one of the most commonly reported symptoms among the neuropsychiatric long-term complications of COVID-19 (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Headache may be an iceberg symptom of neurocognitive complications due to systemic inflammatory damage, although pathological studies of the brain and real-time PCR have failed to detect coronavirus in cerebrospinal fluid (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). On the other hand, some studies did not report headache as a long-term complaint (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Regarding gastrointestinal alterations, the present study revealed that more than half of the participants complained of loss of appetite, and this persistent complaint may be related to the replication of the virus within the digestive tract (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eResearchers have reported dyspnea, shortness of breath or breathlessness as common long-term pulmonary complications after COVID-19 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Mandal et al. (2021) reported that 53%, 43%, and 69% of participants complained of dyspnea, cough, and fatigue, respectively (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Similarly, Weerahndi et al. (2021) reported that 74% of overall postdischarge patients complained of shortness of breath for more than one month (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). In addition, Halpin et al. (2020) reported that two-thirds of postdischarge ICU patients complained of breathlessness, whereas two-fifths of ward patients complained about breathlessness (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). In this study, 45% of participants complained of frequent and continuous dyspnea episodes for more than 6 months after discharge. The respiratory system is the primary site of coronavirus infections; thus, long-term complaints such as cough and chest pain, which can accompany dyspnea, may be related to frequent exposure to viruses during subsequent waves of pandemics.\u003c/p\u003e \u003cp\u003eThe symptoms of confusion, memory loss, and depression are related mainly to neuropsychiatric status. High levels of stress, extreme anxiety, and apprehension may aggravate symptoms and long-term complaints, particularly when individuals have a low level of knowledge about the novel cause of COVID-19 and when there is controversy among health agencies and many governments. The present study revealed that 43.7%, 28.2%, and 28.1% of participants complained of frequent episodes of confusion, memory alterations, and depression, respectively. Many studies have reported similar findings; Lopaze et al. (2021), in a systemic review and meta-analysis study, reported that attention disorders, memory loss, and depression were 26%, 16%, and 12%, respectively, among COVID-19 survivors (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Similarly, a cohort study was carried out to investigate the 6-month psychiatric outcomes among COVID-19 patients; 46.2% of the hospitalized patients had neuropsychiatric problems, whereas 33.6% of the overall participants had neuropsychiatric problems (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe effect of COVID-19 on quality of life has been assessed in many studies worldwide. Garrigues, E. et al. (2020), in their study of postdischarge persistent symptoms and related quality of life, showed that five dimensions of quality of life were altered with slight significance among ICU patients, while the overall index of the EQ-5D was 0.86. They also found that approximately one-third of participants who were active workers had not returned to their work at the time of data collection (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). However, et al. (2020) indicated that persistent symptoms for 35 days after discharge were significantly related to impaired ability to perform activities of daily living and impaired mental, social, and physical functions (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo the best of our knowledge, no study has evaluated how COVID-19 infection affects patients' quality of life in Saudi Arabia and the Arabian Peninsula. The mean quality of life score among participants in this study was 11.9\u0026thinsp;\u0026plusmn;\u0026thinsp;3.71, while pain and discomfort, anxiety/depression, and daily activities were the most common. Furthermore, we found that anxiety and depression were the most common sequelae among patients who received ICU intervention, while pain and discomfort were the most persistent postdischarge sequelae among ward-admitted patients. These findings are in agreement with those of Malik et al. (2021) in a systematic review of post-acute COVID‐19 syndrome (PCS) and health‐related quality of life (HRQoL) data; they concluded that 58% of post‐COVID‐19 patients had poor quality of life. A total of 41.5% of the participants had pain/discomfort, 37.5% had anxiety/depression, 36% had problems with mobility, 28% had problems with usual activities, and only 8% had self‐care problems. These results indicate that the majority of COVID‐19 survivors have a poor quality of life, which ultimately results in challenges for patients, healthcare providers, and public health providers (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). Along the same line, Poudal. AK et al. [2021] summarize similar results from a structured review of five studies from different countries (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFurthermore, the current study revealed that post-COVID-19 quality of life was significantly affected by infection; anxiety/depression and unexplained pain and discomfort were the most apparent deficits in the quality-of-life dimensions. This study revealed significant relationships between marital status and family size and quality of health; single participants experienced lower quality of life than married participants did. Moreover, an increased number of family members significantly improves quality of life. Family and social support in Arabian society are important, and most people live in homogenous close families and tribes; this may explain these significant relationships. Moreover, COVID-19 patients were more dependent on their relatives because of quarantine and preventive measures. Concurrently, Emrani et al. (2020) studied the effect of sociodemographic characteristics on quality of life in Iran. They found that increased age and marital status are associated with low quality of life (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e); although their study was not focused on COVID-19, it coincides with our findings regarding the effect of sociodemographic factors on quality of life among COVID-19 survivors.\u003c/p\u003e \u003cp\u003eThis study investigated the factors that predict quality of life among COVID-19 survivors. The quality of life was significantly affected by the level of activity/exercise and smoking history. A lack of exercise activities (e.g., walking) has been related to poor quality of life after discharge, which may be related to muscular resilience after COVID-19. Smoking leads to poor quality of life as a result of the systemic effects of smoking, impaired oxygen supply, and accumulation of carbon monoxide. Other factors that affect quality of life were associated with the severity of symptoms and the level of medical intervention during the acute phase. These findings correspond with those of Garrigues, E. et al. (2020), who indicated that quality of life was influenced by the most common persistent symptoms, such as fever, cough, fatigue, length of stay, and type of oxygen supply. The authors suggested that patients who experienced one or more of these symptoms reported poor quality of life after recovery (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Another recent systemic review of quality-of-life post-COVID-19 discharge concluded that quality-of-life post-COVID-19 was significantly impacted regardless of the duration of acute infection. It has been shown that advanced age, comorbidities, patients who need ICU treatment, prolonged length of study, and mechanical ventilation are associated with a greater risk of poor quality of life postdischarge (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCOVID-19 survivors in the Hail region, KSA, complained of a variety of long-term complaints after recovery. Fatigue, headache, loss of appetite, and myalgia/arthralgia were the most commonly reported long-term complaints among participants in the present study. Furthermore, health-related quality of life was significantly impaired, the mean score on the EQ-5D was poor, and pain/discomfort and anxiety/depression were the most affected dimensions. The pooled prediction factors in the present study indicate that single participants and those who live with small families and who have a prolonged length of hospital stay experience a worse quality of life than their counterparts. Moreover, the level of activity/exercise, smoking history and length of stay significantly affect the quality of life of COVID-19 survivors [26].\u003c/p\u003e "},{"header":"Abbreviations","content":"\u003cp\u003eKSA; kingdom of Saudi arabia\u003c/p\u003e\n\u003cp\u003eEQ-5D; European quality of life \u0026ndash; 5 dimension scale\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSARS-COV2; sever acute respiratory syndrome corona virus 2\u003c/p\u003e\n\u003cp\u003eHRQoL; health related quality of life\u003c/p\u003e\n\u003cp\u003eCI; confidence interval\u003c/p\u003e\n\u003cp\u003eACE 2; angiotensin converting enzyme 2\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study\u0026nbsp;was reviewed and approved\u0026nbsp;by the Research Ethics Committee\u0026nbsp;at the\u0026nbsp;University of Hail (Ethical approval No: H 2022-407) on 5/12/2022; for data collection, approval by the General Health Affairs Director, Hail Health Cluster (IRB; 2022-71) also obtained.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original contributions presented in this study are included in the article/Supplementary material for further inquiries directed to the corresponding author. Data available on: \u003cem\u003ehttps://drive.google.com/file/d/16o4Qs8X_8qfbKt183-8KdEuAcK_0xCNR/view?usp=drive_link\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study funded by the deanship of the scientific research; university of Hail, KSA; research project no (IFP-22-059)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll\u0026nbsp;the\u0026nbsp;authors contributed to the conceptualization, data collection, analysis, discussion,\u0026nbsp;review\u0026nbsp;and editing\u0026nbsp;of\u0026nbsp;the manuscript\u0026nbsp;for\u0026nbsp;submission.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eM.A.A;\u003c/em\u003e concept, data collection, review, methodology and discussion\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eK.S\u003c/em\u003e; data collection; references management\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eS.A\u003c/em\u003e; data analysis, results , and review\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e: informed consent was obtained from the participants before the data collection (the participant could not proceed to the questionnaire section unless he/she agreed to participate), the form of consent is available on: https://drive.google.com/file/d/1sgLDpF8uZgoiNV0Dp9sRaM2XBOH5q4Zw/view?usp=drive_link\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors are indebted to the deanship of scientific research and Hail University for their endless support and cooperation in this study. The authors would like to thank the Hail Health Cluster and Health Affairs Office for their cooperation and help in the data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no conflicts of interest associated with this research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDesai AD, Lavelle M, Boursiquot BC, Wan EY. Long-term complications of COVID-19. Am J Physiology-Cell Physiol. 2022;322(1):C1\u0026ndash;C11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. 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Cardiac Involvement in Patients Recovered From COVID-2019 Identified Using Magnetic Resonance Imaging. JACC Cardiovasc Imaging. 2020;13(11):2330\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerreira LN, Pereira LN, da F\u0026eacute; Br\u0026aacute;s M, Ilchuk K. Quality of life under the COVID-19 quarantine. Qual Life Res. 2021;30(5):1389\u0026ndash;405.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZenbaba D, Sahiledengle B, Beressa G, Desta F, Atlaw D, Bogale D, et al. Healthcare workers\u0026rsquo; compliance with COVID-19 preventive measures, and associated factors, in Ethiopia: A systematic review and meta-analysis. BMJ open. 2022;12(8):e060681.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang L, Zhao P, Tang D, Zhu T, Han R, Zhan C, et al. Cardiac involvement in patients recovered from COVID-2019 identified using magnetic resonance imaging. 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Emerg microbes infections. 2020;9(1):1300\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZarei M, Bose D, Nouri-Vaskeh M, Tajiknia V, Zand R, Ghasemi M. Long‐term side effects and lingering symptoms post COVID‐19 recovery. Rev Med Virol. 2022;32(3):e2289.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nat Med. 2020;26(7):1017\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePan X-w, Xu D, Zhang H, Zhou W, Wang L-h. Cui X-g. Identification of a potential mechanism of acute kidney injury during the COVID-19 outbreak: a study based on single-cell transcriptome analysis. Intensive Care Med. 2020;46:1114\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAiyegbusi OL, Hughes SE, Turner G, Rivera SC, McMullan C, Chandan JS, et al. Symptoms, complications and management of long COVID: a review. J R Soc Med. 2021;114(9):428\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbdullahi A, Candan SA, Abba MA, Bello AH, Alshehri MA, Afamefuna Victor E et al. Neurological and musculoskeletal features of COVID-19: a systematic review and meta-analysis. Front Neurol. 2020:687.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHalpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID-19 infection: A cross‐sectional evaluation. J Med Virol. 2021;93(2):1013\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJacobs LG, Gourna Paleoudis E, Lesky-Di Bari D, Nyirenda T, Friedman T, Gupta A, et al. Persistence of symptoms and quality of life at 35 days after hospitalization for COVID-19 infection. PLoS ONE. 2020;15(12):e0243882.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeneka MT, Golenbock D, Latz E, Morgan D, Brown R. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alzheimers Res Ther. 2020;12:1\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaquet M, Geddes JR, Husain M, Luciano S, Harrison PJ. 6-month neurological and psychiatric outcomes in 236 379 survivors of COVID-19: a retrospective cohort study using electronic health records. The Lancet Psychiatry. 2021;8(5):416\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGu J, Han B, Wang J. COVID-19: gastrointestinal manifestations and potential fecal\u0026ndash;oral transmission. Gastroenterology. 2020;158(6):1518\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMandal S, Barnett J, Brill SE, Brown JS, Denneny EK, Hare SS, et al. Long-COVID\u0026rsquo;: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalization for COVID-19. Thorax. 2021;76(4):396\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWeerahandi H, Hochman KA, Simon E, Blaum C, Chodosh J, Duan E, et al. Postdischarge health status and symptoms in patients with severe COVID-19. J Gen Intern Med. 2021;36:738\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo PA, Cuapio A et al. More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis. medRxiv. 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarrigues E, Janvier P, Kherabi Y, Le Bot A, Hamon A, Gouze H, et al. Postdischarge persistent symptoms and health-related quality of life after hospitalization for COVID-19. J Infect. 2020;81(6):e4\u0026ndash;e6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalik P, Patel K, Pinto C, Jaiswal R, Tirupathi R, Pillai S, et al. Post-acute COVID‐19 syndrome (PCS) and health‐related quality of life (HRQoL)\u0026mdash;A systematic review and meta‐analysis. J Med Virol. 2022;94(1):253\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePoudel AN, Zhu S, Cooper N, Roderick P, Alwan N, Tarrant C, et al. Impact of Covid-19 on health-related quality of life of patients: A structured review. PLoS ONE. 2021;16(10):e0259164.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEmrani Z, Akbari Sari A, Zeraati H, Olyaeemanesh A, Daroudi R. Health-related quality of life measured using the EQ-5D\u0026ndash;5 L: population norms for the capital of Iran. Health Qual Life Outcomes. 2020;18(1):1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNandasena H, Pathirathna M, Atapattu A, Prasanga P. Quality of life of COVID 19 patients after discharge: Systematic review. PLoS ONE. 2022;17(2):e0263941.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, long-term complaints, post-COVID-19 symptoms, health-related quality of life, ED-Q5","lastPublishedDoi":"10.21203/rs.3.rs-3839687/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3839687/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The novel pandemic coronavirus (COVID-19) has rapidly disseminated and caused millions of coronavirus infections and deaths. Post-COVID-19 sequelae with particular systemic long-term complaints were defined and ultimately led to an impairment in health-related quality of life for a long time after recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003e This study aimed to determine the long-term complaints of COVID-19 survivors and their impact on their quality of life in the Hail region, KSA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A retrospective cross-sectional study was carried out with a random sample of 295 COVID-19 survivors to determine the long-term complaints of COVID-19 and its impact on quality of life in the Hail region. Long-term complaint data related to COVID-19 were collected viaa self-report questionnaire, while quality of life was measured via the EQ-5D scale.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e More than half of the participants complained of fatigue (60%), followed by frequent headache (59%), loss of appetite (54.9%), arthralgia/myalgia (51%), cough (46%) and difficult breathing (36.9%). The overall quality of life was poor among survivors (M±SD 11.911± 3.760), while anxiety and depression were the most common. Thehealth-related quality of life was significantly related to activity, smoking status, fever, cough, fatigue, headache, duration of disease, level of help, and oxygen therapy (p\u0026lt; 0.05). Multiple linear regression revealed that marital status (\u003cem\u003ep\u003c/em\u003e= 0.001), regular and irregular physical activity (\u003cem\u003ep\u003c/em\u003e= 0.008 and 0.011), duration of hospitalization (\u003cem\u003ep\u003c/em\u003e \u0026lt;0.011), and oxygen therapy (\u003cem\u003ep\u003c/em\u003e \u0026lt;0.027) were the independent factors affecting quality of life post-COVID-19.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Approximately two-thirds of the COVID-19 survivors experienced long-term complaints, while more than half of them experienced impaired quality of life. Therefore, health care facilities must establish prolonged care plans to improve health status and promote quality of life among COVID-19 survivors.\u003c/p\u003e","manuscriptTitle":"Long-term complaints and quality of life among COVID-19 survivors in the Hail region; KSA","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-12 17:34:13","doi":"10.21203/rs.3.rs-3839687/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4cb8339c-b285-4637-b8ad-6c69d932bb22","owner":[],"postedDate":"January 12th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-01-13T09:29:20+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-12 17:34:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3839687","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3839687","identity":"rs-3839687","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}