Post-COVID-19 health-related quality of life in India: A systematic review and meta-analytic assessment of recovery outcomes

Table 1 Search terminology: Medical Subject Headings terms and synonyms used for literature retrieval

Concept	Medical Subject Headings terms	Synonyms
COVID-19	COVID-19, SARS-CoV-2, coronavirus	2019-nCoV, novel coronavirus, COVID
Health-Related Quality of Life	Health-related quality of life, HRQoL, quality of life, well-being	Patient-reported outcomes, life quality, wellness, health status
Post-COVID Recovery	Post-recovery, post-acute sequelae, long COVID, post-COVID syndrome	COVID-19 recovery, post-acute COVID, chronic COVID syndrome
India	India, Indian patients, South Asia	Indian population, India-specific
Measurement tools	SF-36, EuroQol 5-Dimensional questionnaire, PROMIS, WHOQOL, HRQoL instruments	Health-related quality of life scales, health surveys, patient-reported outcome measures

COVID: Coronavirus disease; HRQoL: Health-related quality of life; PROMIS: Patient-Reported Outcomes Measurement Information System; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2; SF-36: Short Form-36 Health Survey; WHOQOL: World Health Organization Quality of Life; 2019-nCoV: 2019 novel coronavirus.

Table 2 Inclusion and exclusion criteria for studies assessing post-coronavirus disease 2019 health-related quality of life in India

Criteria	Inclusion	Exclusion
Population	Adults (≥ 18 years) with confirmed COVID-19 infection in India	Studies involving paediatric populations (< 18 years)
Focus area	Studies specifically assessing HRQoL post-COVID-19 in Indian patients	Studies focusing on other regions or populations outside of India
Outcome	HRQoL assessed using validated/standardized instruments (e.g., Short Form-36 Health Survey, EuroQol 5-Dimensional questionnaire, Patient-Reported Outcomes Measurement Information System)	Studies without HRQoL outcomes or using non-validated HRQoL measures
Study design	Observational, longitudinal, cohort, and cross-sectional studies	Case reports, editorials, reviews, and non-peer-reviewed sources
Language	Studies published in English	Studies published in languages other than English
Time period	Studies published from 2020 to 2024	Studies published outside the specified time frame
COVID-19 specificity	Studies focused on patients’ post-COVID-19 recovery (including post-acute sequelae)	Studies involving other infectious diseases or comorbid conditions unrelated to COVID-19

COVID-19: Coronavirus disease 2019; HRQoL: Health-related quality of life.

Table 3 Characteristics of included studies assessing health-related quality of life among post-coronavirus disease 2019 patients in India, mean ± SD/median (interquartile range)

Ref.	Region	Study design	Sample size	HRQoL assessment tool	Type of comorbidities measured in the sample population	Duration of study	Age (in years)	Male	Female	Findings
Barani et al[30], 2022	Tamil Nadu	Cross sectional study	372	EQ-5D-5 L	DM, HTN, CVD, CKD, RD, Cancer	2 months (from November 2020 to December 2020)	44.5 ± 15.3	57.5%	42.5%	The mean EQ-5D utility score was 0.925 ± 0.150, and the mean EQ-VAS was 90.68 ± 11.81. Men had a higher utility value than women. Those with comorbidities and longer hospital stays had lower utility scores
Christopher et al[34], 2024	Vellore, Tamil Nadu	Cross-sectional study	207	SGRQ	DM, HTN, Ischemic heart disease, RD, CKD, Cancer	6 months (from August 2020 to January 2021)	48.7 ± 14.2	68.1%	31.9%	The COVID-19 pneumonia group when compared to the mild COVID-19 group had a greater mean total SGRQ score (29.2 vs 11.0; P < 0.0001). It was found that post-COVID-19 lung damage leads to significant impairment of lung function, and quality of life
Elumalai et al[35], 2023	Tamil Nadu	Cross-sectional study	1047	EQ-5D-5 L	DM, HTN, CVD, RD, Thyroid	7 months (from June 2020 to January 2021)	38 (29-51)	68%	32%	The mean EQ-5D-5 L utility score was 0.98 ± 0.05 and EQ-VAS was 92.14 ± 0.39. The symptomatic group, older age group, female gender and those with comorbidity had persistent symptoms, had relatively low utility score for HRQoL
Gupta et al[32], 2022	Kota, Rajasthan, India	Cross-sectional, semi-structured and questionnaire-based study	173	EQ-5D-5 L	Anemia, pre-eclampsia, antepartum eclampsia, hypothyroidism	4 months (from March 2021 to June 2021)	26.3 ± 6.6	-	100%	Post-COVID, 82.56% were asymptomatic, while 1744% had symptoms. Using EQ-5D-5 L, most reported no problems in any dimension, with some issues in mobility (3.46%), usual activities (5.2%), pain/discomfort (7.52%), and anxiety/depression (8.1%). Anxiety/depression reached level 2 in 1.73% of subjects
Hegde et al[27], 2022	Karnataka, India	Retrospective observational study	118	EQ-5D-5 L	-	7 months (from June 2020 to December 2020)	45.28 ± 17.76	58.5%	41.5%	Anxiety/depression scores changed significantly over time (at discharge, 4 weeks, and 8 weeks). Scores improved notably between discharge and 8 weeks. At 4 weeks, age was linked to higher anxiety/depression. Overall health index scores also showed significant differences across the three time points
Jain et al[29], 2023	Jhansi	Multicentric cross sectional	491	EUROHIS-QOL 8, GAD-7, and MDI	-	3 months (from July 2020 to September 2020)	52.23 ± 7.31	62%	38%	The mean EUROHIS-QOL score was found to be 328 ± 0.98. New-onset psychological disorders and sleep disturbances were observed in severe COVID-19 survivors. Long term quality of life and work ability remained poor for survivors who had prolong ICU admission. GAD-7 Scale: The mean score was 18.63 ± 3.28, reflecting moderate to severe anxiety levels. MDI: The mean score was 4.12 ± 1.45, indicative of mild to moderate depressive symptoms
Neelima and Chivukula[31], 2023	Andhra Pradesh	Cross-sectional study	107	EQ-5D-5 L	DM, HTN, asthma, thyroid	5 months (from August 2022 to January 2023)	55.24 ± 9.94	66.6%	33.4%	The mean EQ-5D-5 L utility score was 0.51 ± 0.43 and EQ-VAS was 68.97 ± 22.27. Patients with comorbidities had lower EQ-5D-5 L scores. A significant negative correlation between ICU stay duration and EQ-5D-5 L score was noted. COVID-19 patients with comorbidities had a significantly poorer quality of life
Revathishree et al[25], 2022	Thandalam, Chennai, Tamil Nadu, India	Prospective cross-sectional study	250	FCV-19S (fear/anxiety of COVID-19 individuals)	DM, HTN, asthma, thyroid, CAD	1 month (from June 1, 2020 to June 30, 2020)	41.13 ± 9.93	70.8%	29.2%	High the clinical category score, higher FCV-19S. Post treatment score suggested COVID-19 survivors had a definite improvement in their quality of life, but still had mental stress even after full recovery. Survivors also faced social discrimination
Sarda et al[33], 2022	Delhi	Cross-sectional study	251	Fatigue Severity Scale, WHOQOL-BREF	Musculoskeletal disorders, RD, fatigue, GID, ND, SD	3 month (from May 2020 to July 2020)	35.8 ± 12.5	67.3%	32.7%	Long COVID-19 patients showed higher fatigue severity and lower WHOQOL-BREF scores than those without, with males having higher WHOQOL-BREF scores than females, and a negative correlation between WHOQOL-BREF scores and symptom duration
Shah et al[26], 2023	Unclear	Prospective cross-sectional study	388	EQ-5D-3 L scale	DM, HTN, CVD, Thrombosis	5 months (from February 2021 to June 2021)	48 (36-59)	62.6%	37.4%	EQ-5D-3 L showed significant improvement in quality of life at 3 months compared to 1 month, especially in non-ICU patients. The mean EQ-VAS score also improved at 3 months. Illness severity correlated with quality of life. The study showed ongoing improvement in quality of life
Wasim and Kuriakose[28], 2024	Bangaluru, Karnataka	Observational study	264	Short Form-36 Health Survey (RAND 36-Item Health Survey Instrument) questionnaire	Not reported	-	22.37 ± 3.11	44%	56%	Long COVID symptoms were found in 43.2% of subjects. The duration of symptoms ranged from less than one month (46.6%) to more than five months (10.2%). In the quality of life, mental health was the most affected domain. The overall averages for the physical component were 7111 ± 8.24 and 64.20 ± 10.73 for the mental component

CAD: Coronary artery disease; COVID-19: Coronavirus disease 2019; CVD: Cardiovascular disease; DM: Diabetes mellitus; EQ-VAS: EuroQol Visual Analogue Scale; EQ-5D-5 L: 5-level EuroQol 5-Dimensional questionnaire; EUROHIS-QOL: European Health Interview Survey-Quality of Life; FCV-19S: Fear of Coronavirus Disease 2019 Scale; GAD-7: Generalized Anxiety Disorder-7 item Scale; GID: Gastrointestinal disease; HRQoL: Health-related quality of life; HTN: Hypertension; ICU: Intensive care unit; MDI: Major depression inventory; ND: Neurological disease; RD: Respiratory disease; SD: Sleep disturbances; SGRQ: St. George’s Respiratory Questionnaire; WHOQOL-BREF: World Health Organization Quality of Life-Brief Version.