The use of patient-reported outcome questionnaires in patients with post-COVID-19 condition: a systematic review and meta-analysis, 2026, Khawandi+

[SNT Gatchaman]

The use of patient-reported outcome questionnaires in patients with post-COVID-19 condition: a systematic review and meta-analysis

Spoiler: Authors

Khawandi, Jana; Kivan, Husam; Al Hussein, Sahar; Azzam, Muayad; Nazzal, Jamil; Vasquez Camargo, Andrea; Kamrul, Rejina; Al Khader, Aseel; Kawtharany, Hassan; Al Zabibi, Mohammad Amin; Ahmad, Jood; Patel, Khushi; Rehman, Aqeeb Ur; Ahmed, Zayna; Piché, Alain; McNaughton, Candace D; Lam, Grace Y; Oudit, Gavin Y; Afzal, Samia; Schunemann, Holger; Wiercioch, Wojtek; Nieuwlaat, Robby; Brignardello-Petersen, Romina; Falcone, Emilia Liana; Mustafa, Reem A

BACKGROUND AND OBJECTIVE
Post-COVID-19 condition (PCC) is a complication of acute COVID-19, which often presents with a variety of symptoms. It can also impact individuals' overall well-being, capacity to carry out daily activities, engage in physical exercise, maintain employment, and their general quality of life. Therefore, this review aimed to examine the role of patient-reported outcome measures (PROMs) questionnaires in assessing patients with PCC through prevalence of abnormal tests.

METHODS
We searched three databases. Two reviewers independently screened articles using Laser Al and extracted relevant data using a piloted Google Sheets. We performed a meta-analysis using OpenMeta and RevManWeb and conducted a subgroup analysis based on the setting of the patients during their acute COVID-19 infection. We assessed the risk of bias using a modified ROBINS-I tool and the certainty using the Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS
No studies reported diagnostic test accuracy measures for questionnaires in PCC. However, 23 comparative studies reported on the prevalence of abnormal questionnaire results in patients with PCC. Outcomes showed that patients with PCC have higher abnormal results than controls, regardless of their setting during acute COVID-19 infection. The overall certainty of the evidence was low due to the high risk of bias, indirectness, and imprecision.

CONCLUSION
This review sheds light on the importance of testing PROMs in patients with PCC using these questionnaires and the need for further testing their validity in this condition.

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[SNT Gatchaman]

Key messages

• No studies were found assessing diagnostic test accuracy for questionnaire use in post-COVID-19 condition (PCC).

• The questionnaire use showed higher abnormal results in patients with confirmed or suspected PCC whether previously hospitalized or not during acute COVID-19 infection.

• More studies are needed to assess the use of these tools in raising suspicion of PCC.

 

[SNT Gatchaman]

In the years following the COVID-19 pandemic, it has become increasingly clear that recovery from acute COVID-19 symptoms does not mean it is the end of the disease for many people. Between 10 and 30% of those infected go on to develop long-lasting symptoms, now recognized as post-COVID-19 condition (PCC). Common manifestations include fatigue (reported in over 50% of cases), dyspnoea (40–70%), cognitive dysfunction (69%), and musculoskeletal pain (28%), often occurring in combination and fluctuating in severity over time.

Given this variability, it has become increasingly clear that a single biomarker or laboratory test is unlikely to rule in or out PCC. Instead, what is needed is a more comprehensive and patient-centred approach to diagnosis, something that recognizes not just the presence of symptoms, but how those symptoms affect a person’s ability to function, work, and participate in everyday life.

Patient-reported outcome measures (PROMs) are standardized instruments designed to evaluate health outcomes from the patient’s perspective. These tools capture data on physical, emotional, and social functioning, as well as health-related quality of life (HRQoL). They give us a window into how people with PCC are coping, which is often not captured by laboratory and imaging tests. Because symptoms of PCC can be vague, intermittent, or overlap with other diseases, these firsthand reports from patients are especially important. As healthcare shifts towards patient-centred care, PROMs have become a key part of PCC research, helping us understand that not only do patients face physical symptoms like fatigue but also the emotional and social aspects.

Therefore, as part of the Canadian post-COVID-19 condition guidelines (CAN-PCC; canpcc.ca) initiative, this systematic review was conducted to study the current literature on PROMs in adult PCC populations. Specifically, we aimed to identify some instruments that have been applied, and study the prevalence of abnormal tests in patients with PCC compared to those without PCC.

 

[SNT Gatchaman]

Despite the consistency of these findings, the overall certainty of evidence was rated as low to very low. Therefore, the findings should be interpreted with caution. This is primarily due to the lack of studies evaluating the diagnostic accuracy of PROMs for PCC, the indirectness of the comparisons (PCC vs. non-PCC rather than instrument vs reference standard), and the moderate-to-high risk of bias in most studies. The heterogeneity observed across analyses likely reflects differences in patient populations, outcome definitions, follow-up duration, and measurement approaches.

… the absence of diagnostic accuracy evidence may reflect a broader methodological challenge, as PCC lacks a universally accepted reference standard. This limitation complicates the application of traditional diagnostic accuracy frameworks, a challenge that has been highlighted across multiple areas of clinical research.

In addition, our study did not include some questionnaires that could potentially be used (e.g. SF-36 and C19-YRS), which were not selected in the prioritization process for guideline development; panel members had to focus on the most readily available questionnaires, as such, there might questionnaires that are now more widely used and studied that were not captured.

Therefore, despite the results showing how these questionnaires reveal abnormalities in patients with PCC, the above limitations, especially the low certainty of evidence and lack of diagnostic validation, limit our ability to draw firm conclusions regarding the importance of these questionnaires.

 

[Hutan]

From the abstract (and the quoted bits), the authors don't seem to have even got to step 1, which is recognising that "post-Covid-19 condition" is not just one thing.

Nevertheless,

The overall certainty of the evidence was low due to the high risk of bias, indirectness, and imprecision.

that seems a reasonable result.