Symptom cluster is associated with prolonged return-to-play in symptomatic athletes with acute respiratory illness (including COVID-19): a cross-sectional study-AWARE study I

Martin Schwellnus, Nicola Sewry, Carolette Snyders, Kelly Kaulback, Paola Silvia Wood, Ishen Seocharan, Wayne Derman, James H Hull, Maarit Valtonen, Esme Jordaan
British Journal of Sports Medicine 2021 March 22

BACKGROUND: There are no data relating symptoms of an acute respiratory illness (ARI) in general, and COVID-19 specifically, to return to play (RTP).

OBJECTIVE: To determine if ARI symptoms are associated with more prolonged RTP, and if days to RTP and symptoms (number, type, duration and severity) differ in athletes with COVID-19 versus athletes with other ARI.

DESIGN: Cross-sectional descriptive study.

SETTING: Online survey.

PARTICIPANTS: Athletes with confirmed/suspected COVID-19 (ARICOV ) (n=45) and athletes with other ARI (ARIOTH ) (n=39).

METHODS: Participants recorded days to RTP and completed an online survey detailing ARI symptoms (number, type, severity and duration) in three categories: 'nose and throat ', 'chest and neck ' and 'whole body '. We report the association between symptoms and RTP (% chance over 40 days) and compare the days to RTP and symptoms (number, type, duration and severity) in ARICOV versus ARIOTH subgroups.

RESULTS: The symptom cluster associated with more prolonged RTP (lower chance over 40 days; %) (univariate analysis) was 'excessive fatigue ' (75%; p<0.0001), ' chills ' (65%; p=0.004), ' fever ' (64%; p=0.004), ' headache ' (56%; p=0.006), 'altered/loss sense of smell ' (51%; p=0.009), ' Chest pain/pressure ' (48%; p=0.033), ' difficulty in breathing ' (48%; p=0.022) and ' loss of appetite ' (47%; p=0.022). ' Excessive fatigue ' remained associated with prolonged RTP (p=0.0002) in a multiple model. Compared with ARIOTH , the ARICOV subgroup had more severe disease (greater number, more severe symptoms) and more days to RTP (p=0.0043).

CONCLUSION: Symptom clusters may be used by sport and exercise physicians to assist decision making for RTP in athletes with ARI (including COVID-19).

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