{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T10:42:22Z","timestamp":1763116942105,"version":"build-2065373602"},"reference-count":52,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,10,6]],"date-time":"2022-10-06T00:00:00Z","timestamp":1665014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Among the extra-pulmonary manifestations of COVID-19, neuromuscular signs and symptoms are frequent. We aimed to assess the correlation between neuromuscular abnormalities (electrophysiological) and mobility measures (Berg Balance Scale and Timed-Up-and-Go test) twice, at least 6 weeks after hospital discharge and 6 months later, taking into account cognitive performance, nutrition, muscle strength, and submaximal exercise capacity. Materials and Methods: 43 patients (51.4 \u00b1 9.3 years old) accepted to participate in the study; they had a dyspnea score \u2264 3 (Borg scale), and no history of neurology\/neuromuscular\/orthopedic disorders, but high frequency of overweight\/obesity and weight loss during hospital stay. The two evaluations included physical examination, cognitive assessment, nutritional evaluation, muscle strength (hand-grip and quadriceps dynamometry), electromyography, Barthel Index, Six-Minute- Walk-Test (6MWT), Berg Balance Scale and Timed-Up-and-Go test. Bivariate and repeated measures covariance analyses were performed (significance level of 0.05). Results: Electrophysiological abnormalities were evident in 67% of the patients, which were associated with diminished performance on the 6MWT, the Berg Balance Scale and the Timed-Up-and-Go test. At each evaluation and between evaluations, scores on the Berg Balance Scale were related to the body mass index (BMI) at hospital admission and the 6MWT (MANCoVA R \u2265 0.62, p = 0.0001), while the time to perform the Timed-Up-and-Go test was related to the electrophysiological abnormalities, weight loss during hospital stay, sex, handgrip strength, and the 6MWT (MANCoVA, R \u2265 0.62, p &lt; 0.0001). We concluded that, after hospital discharge, patients with moderate to severe COVID-19 may have neuromuscular abnormalities that can be related to BMI\/weight loss, and contribute to mobility decrease. In patients with moderate to severe COVID-19 and high BMI\/ large weight loss, neuromuscular and intended mobility assessments could be required to provide early rehabilitation. Apart from the 6MWT, handgrip dynamometry and the Timed-Up-and-Go test were useful tools to quickly assess fitness and mobility.<\/jats:p>","DOI":"10.3390\/medicina58101401","type":"journal-article","created":{"date-parts":[[2022,10,9]],"date-time":"2022-10-09T04:00:02Z","timestamp":1665288002000},"page":"1401","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Body Weight May Have a Role on Neuropathy and Mobility after Moderate to Severe COVID-19: An Exploratory Study"],"prefix":"10.3390","volume":"58","author":[{"given":"Ignacio","family":"Figueroa-Padilla","sequence":"first","affiliation":[{"name":"Unidad de Investigaci\u00f3n M\u00e9dica en Otoneurolog\u00eda, Instituto Mexicano del Seguro Social, Ciudad de M\u00e9xico 06720, Mexico"},{"name":"Hospital General Regional 72, Instituto Mexicano del Seguro Social, Tlalnepantla de Baz 54030, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dalia E.","family":"Rivera Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Hospital General Regional 72, Instituto Mexicano del Seguro Social, Tlalnepantla de Baz 54030, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7793-9268","authenticated-orcid":false,"given":"Erick F.","family":"Ch\u00e1zaro Rocha","sequence":"additional","affiliation":[{"name":"Hospital General Regional 72, Instituto Mexicano del Seguro Social, Tlalnepantla de Baz 54030, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alma L.","family":"Eugenio Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Unidad de Investigaci\u00f3n M\u00e9dica en Otoneurolog\u00eda, Instituto Mexicano del Seguro Social, Ciudad de M\u00e9xico 06720, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2165-1422","authenticated-orcid":false,"given":"Kathrine","family":"J\u00e1uregui-Renaud","sequence":"additional","affiliation":[{"name":"Unidad de Investigaci\u00f3n M\u00e9dica en Otoneurolog\u00eda, Instituto Mexicano del Seguro Social, Ciudad de M\u00e9xico 06720, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1056\/NEJMoa2001017","article-title":"A novel coronavirus from patients with pneumonia in China, 2019","volume":"382","author":"Zhu","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1038\/s41591-021-01283-z","article-title":"Post-acute COVID-19 syndrome","volume":"27","author":"Nalbandian","year":"2021","journal-title":"Nat. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1001\/jama.2020.12839","article-title":"Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): A review","volume":"324","author":"Wiersinga","year":"2020","journal-title":"J. Am. Med. Assoc."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Samidurai, A., and Das, A. (2020). Cardiovascular Complications Associated with COVID-19 and Potential Therapeutic Strategies. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21186790"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"n136","DOI":"10.1136\/bmj.n136","article-title":"Managing the long term effects of COVID-19: Summary of NICE, SIGN, and RCGP rapid guideline","volume":"372","author":"Shah","year":"2021","journal-title":"Br. Med. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e2269","DOI":"10.1212\/WNL.0000000000012930","article-title":"Frequency of Neurologic Manifestations in COVID-19. A Systematic Review and Meta-analysis","volume":"97","author":"Misra","year":"2021","journal-title":"Neurology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"993","DOI":"10.15585\/mmwr.mm6930e1","article-title":"Symptom Duration and Risk Factors for Delayed Return to Usual Health Among Outpatients with COVID-19 in a Multistate Health Care Systems Network\u2014United States, March\u2013June 2020","volume":"69","author":"Tenforde","year":"2020","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1001\/jama.2020.12603","article-title":"For the Gemelli Against COVID-19. Post-Acute Care Study Group. Persistent Symptoms in Patients After Acute COVID-19","volume":"324","author":"Bernabei","year":"2020","journal-title":"JAMA"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e000406","DOI":"10.1136\/fmch-2020-000406","article-title":"Clinicopathological characteristics of 8697 patients with COVID-19 in China: A meta-analysis","volume":"8","author":"Zhu","year":"2020","journal-title":"Fam. Med. Community Health"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1111\/joim.13089","article-title":"Clinical and epidemiological characteristics of 1420 European patients with mild-to-moderate coronavirus disease 2019","volume":"288","author":"Lechien","year":"2020","journal-title":"J. Intern. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1186\/s13054-021-03794-0","article-title":"The impact of COVID-19 critical illness on new disability, functional outcomes and return to work at 6 months: A prospective cohort study","volume":"25","author":"Hodgson","year":"2021","journal-title":"Crit. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/S0140-6736(20)32656-8","article-title":"6-month consequences of COVID-19 in patients discharged from hospital: A cohort study","volume":"397","author":"Huang","year":"2021","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"American Thoracic Society (2002). ATS statement: Guidelines for the six-minute walk test. Am. J. Respir. Crit. Care Med., 166, 111\u2013117.","DOI":"10.1164\/ajrccm.166.1.at1102"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1186\/s12931-021-01814-9","article-title":"Exertional intolerance and dyspnea with preserved lung function: An emerging long COVID phenotype?","volume":"22","author":"Lam","year":"2021","journal-title":"Respir. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e11026","DOI":"10.7717\/peerj.11026","article-title":"Assessment of activities of daily living in patients post COVID-19: A systematic review","volume":"9","year":"2021","journal-title":"PeerJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/j.puhe.2021.12.012","article-title":"Return to work after COVID-19 infection\u2014A Danish nationwide registry study","volume":"203","author":"Jacobsen","year":"2022","journal-title":"Public Health"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"American Occupational Therapy Association (2014). Occupational Therapy Practice Framework: Domain and Process. 3rd Edition. Am. Occup. Ther., 68, s1\u2013s48.","DOI":"10.5014\/ajot.2014.68S1"},{"key":"ref_18","first-page":"5","article-title":"Successful aging as a continuum of functional independence: Lessons from physical disability models of aging","volume":"3","author":"Lowry","year":"2012","journal-title":"Aging Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1002\/gps.2325","article-title":"Everyday functioning in mild cognitive impairment and its relationship with executive cognition","volume":"25","author":"Aretouli","year":"2010","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1038\/sj.ejcn.1602067","article-title":"Nutritional status, well-being and functional ability in frail elderly service flat residents","volume":"59","author":"Olin","year":"2005","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"101044","DOI":"10.1016\/j.eclinm.2021.101044","article-title":"Cognitive deficits in people who have recovered from COVID-19","volume":"39","author":"Hampshire","year":"2021","journal-title":"Eclinical Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"G\u00e9rard, M., Mahmutovic, M., Malgras, A., Michot, N., Scheyer, N., Jaussaud, R., Nguyen-Thi, P.-L., and Quilliot, D. (2021). Long-Term Evolution of Malnutrition and Loss of Muscle Strength after COVID-19, A Major and Neglected Component of Long COVID-19. Nutrients, 13.","DOI":"10.3390\/nu13113964"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1007\/BF00424810","article-title":"Perceived exertion related to heart rate and blood lactate during arm and leg exercise","volume":"56","author":"Borg","year":"1987","journal-title":"Eur. J. Appl. Physiol. Occup. Physiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini-Mental State\u201d a Practical Method for Grading the Cognitive State of Patients for the Clinician","volume":"12","author":"Folstein","year":"1975","journal-title":"J. Psychiatr. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1016\/S0899-9007(98)00171-3","article-title":"The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients","volume":"15","author":"Vellas","year":"1999","journal-title":"Nutrition"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/S0261-5614(02)00214-5","article-title":"Nutritional risk screening (NRS 2002, a new method based on an analysis of controlled clinical trials","volume":"22","author":"Kondrup","year":"2003","journal-title":"Clin. Nutr."},{"key":"ref_27","first-page":"61","article-title":"Functional Evaluation, The Barthel Index","volume":"14","author":"Mahoney","year":"1965","journal-title":"Md. State Med. J."},{"key":"ref_28","unstructured":"Medical Research Council (MRC) (1976). Aids to the Examination of the Peripheral Nervous System\u2014MRC, Memorandum, No.45 (Superseding War Memorandum No.7)."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Preston, D.C., and Shapiro, B.E. (2013). Electromyography and Neuromuscular Disorders, Clinical-Electrophysiologic Correlations, Elsevier-Saunders.","DOI":"10.1016\/B978-1-4557-2672-1.00016-7"},{"key":"ref_30","unstructured":"Lee, H.J., and DeLisa, J.A. (2005). Manual of Nerve Conduction Study and Surface Anatomy for Needle Electromyography, Lippincott Williams & Wilkins. [4th ed.]."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1002\/mus.25203","article-title":"Electrodiagnostic Reference Values for Upper and Lower Limb Nerve Conduction Studies in Adult Populations","volume":"54","author":"Chen","year":"2016","journal-title":"Muscle Nerve"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"304","DOI":"10.3138\/ptc.41.6.304","article-title":"Measuring balance in the elderly, preliminary development of an instrument","volume":"41","author":"Berg","year":"1989","journal-title":"Physiother. Can."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","article-title":"The timed \u201cUp & Go\u201d, a test of basic functional mobility for frail elderly persons","volume":"39","author":"Podsiadlo","year":"1991","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_34","first-page":"769","article-title":"Physical Medicine and Rehabilitation and Pulmonary Rehabilitation for COVID-19","volume":"99","author":"Wang","year":"2020","journal-title":"Ann. Phys. Rehabil. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1590\/0004-282x-anp-2021-0030","article-title":"Peripheral neuropathy in COVID-19 is due to immune-mechanisms, pre-existing risk factors, anti-viral drugs, or bedding in the Intensive Care Unit","volume":"79","author":"Finsterer","year":"2021","journal-title":"Arq. Neuro Psiquiatr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2685","DOI":"10.1007\/s00415-020-10321-8","article-title":"Mononeuritis multiplex, an unexpectedly frequent feature of severe COVID-19","volume":"268","author":"Needham","year":"2021","journal-title":"J. Neurol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"108631","DOI":"10.1016\/j.diabres.2020.108631","article-title":"Widespread sensory neuropathy in diabetic patients hospitalized with severe COVID-19 infection","volume":"172","author":"Odriozola","year":"2021","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Balbi, P., Saltalamacchia, A., Lullo, F., Fuschillo, S., Ambrosino, P., Moretta, P., Lanzillo, B., and Maniscalco, M. (2022). Peripheral Neuropathy in Patients Recovering from Severe COVID-19, A Case Series. Medicina, 58.","DOI":"10.3390\/medicina58040523"},{"key":"ref_39","first-page":"e5030","article-title":"Body Mass Index and Risk of COVID-19 Diagnosis, Hospitalization, and Death, A Cohort Study of 2 524 926 Catalans","volume":"106","author":"Recalde","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2420","DOI":"10.1016\/j.clnu.2020.10.043","article-title":"COVID-19 is associated with clinically significant weight loss and risk of malnutrition, independent of hospitalisation, A post-hoc analysis of a prospective cohort study","volume":"40","author":"Sofia","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1093\/ije\/19.3.655","article-title":"Epidemiology of carpal tunnel syndrome in women of childbearing age. Findings in a large cohort study","volume":"19","author":"Vessey","year":"1990","journal-title":"Int. J. Epidemiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1046\/j.1529-8027.2000.00007.x","article-title":"Peroneal neuropathy after weight loss","volume":"5","author":"Arpa","year":"2000","journal-title":"J. Peripher. Nerv. Syst."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1136\/jnnp.47.5.564","article-title":"Slimmer\u2019s paralysis peroneal neuropathy during weight reduction","volume":"47","author":"Sotaniemi","year":"1984","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e849","DOI":"10.1212\/WNL.0000000000012344","article-title":"Skeletal Muscle and Peripheral Nerve Histopathology in COVID-19","volume":"97","author":"Suh","year":"2021","journal-title":"Neurology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2809","DOI":"10.1016\/j.clinph.2020.09.017","article-title":"Neuromuscular involvement in COVID-19 critically ill patients","volume":"131","author":"Araque","year":"2020","journal-title":"Clin. Neurophysiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"110726","DOI":"10.1016\/j.jpsychores.2022.110726","article-title":"A research agenda for post-COVID-19 fatigue","volume":"154","author":"Verveen","year":"2022","journal-title":"J. Psychosom. Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1136\/bmj.38933.585764.AE","article-title":"Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: Prospective cohort study","volume":"333","author":"Hickie","year":"2006","journal-title":"BMJ"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1177\/014107689108400224","article-title":"A report\u2014Chronic fatigue syndrome: Guidelines for research","volume":"84","author":"Sharpe","year":"1991","journal-title":"J. R. Soc. Med."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Bisaccia, G., Ricci, F., Recce, V., Serio, A., Iannetti, G., Chahal, A.A., St\u00e5hlberg, M., Khanji, M.Y., Fedorowski, A., and Gallina, S. (2021). Post-acute sequelae of COVID-19 and cardiovascular autonomic dysfunction: What do we know?. J. Cardiovasc. Dev. Dis., 8.","DOI":"10.3390\/jcdd8110156"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1002\/jcsm.12738","article-title":"Muscle strength is associated with COVID-19 hospitalization in adults 50 years of age or older","volume":"12","author":"Cheval","year":"2021","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1080\/07853890.2020.1748220","article-title":"Handgrip strength is inversely associated with fatal cardiovascular and all-cause mortality events","volume":"52","author":"Laukkanen","year":"2020","journal-title":"Ann. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1034\/j.1399-3003.1999.14b06.x","article-title":"Six minute walking distance in healthy elderly subjects","volume":"14","author":"Troosters","year":"1999","journal-title":"Eur. Respir. J."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/10\/1401\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:47:12Z","timestamp":1760143632000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/58\/10\/1401"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,6]]},"references-count":52,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["medicina58101401"],"URL":"https:\/\/doi.org\/10.3390\/medicina58101401","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2022,10,6]]}}}