Long-term health outcomes and risk factors for low self-rated health in non-hospitalised adults with post-COVID-19 condition: a 2.5-year cohort study

Knowledge regarding the clinical course and prognosis in non-hospitalised individuals with post-COVID-19 condition (PCC) remains limited. This study aimed to explore the impact of PCC on physical function, physical activity, and mental health in non-hospitalised adults, and to identify risk factors for low self-rated health. Extended knowledge may inform follow-up strategies and targeted interventions in non-hospitalised individuals with PCC. A cohort study was conducted at a specialised post-COVID clinic, with assessments of physical function (six-minute walk test, one-minute sit-to-stand test, maximal inspiratory pressure, mMRC dyspnoea), physical activity (Frändin/Grimby activity scale), mental health (depression: PHQ-9; anxiety: GAD-7), and self-rated health (EQ VAS) at 12 and 30 months after COVID-19. A total of 130 non-hospitalised adults with PCC were included. Data were collected between August 2020 and December 2024. Participants were predominantly middle-aged, previously physically active women. Physical and mental impairments, and low physical activity remained prevalent at follow-up, despite some improvements over time. Impaired performance in the one-minute sit-to-stand test, a Frändin/Grimby activity level < 3, and a PHQ-9 score ≥ 10 at baseline were associated with lower EQ VAS scores at follow-up. There were long-term negative impacts of PCC on health outcomes 2.5 years after COVID-19 in non-hospitalised individuals, including impairments in physical and mental health, low physical activity, and low self-rated health. Impaired physical function, low physical activity, and depressive symptoms were identified as risk factors for low self-rated health. These findings expand current knowledge of prognosis in PCC, underscore the need for systematic follow-up using simple clinical tools to identify individuals at high risk, and inform targeted interventions to improve long-term outcomes.