Health-related quality of life issues, including symptoms, in patients with active COVID-19 or post COVID-19; a systematic literature review

Qual Life Res. 2021 Dec;30(12):3367-3381. doi: 10.1007/s11136-021-02908-z. Epub 2021 Jun 19.


Purpose: This systematic review was performed to identify all relevant health-related quality of life (HRQoL) issues associated with COVID-19.

Methods: A systematic literature search was undertaken in April 2020. In four teams of three reviewers each, all abstracts were independently reviewed for inclusion by two reviewers. Using a pre-defined checklist of 93 criteria for each publication, data extraction was performed independently by two reviewers and subsequently compared and discussed. If necessary, a third reviewer resolved any discrepancies. The search was updated in February 2021 to retrieve new publications on HRQoL issues including issues related to the long-term consequences of COVID-19.

Results: The search in April 2020 identified 3342 potentially relevant publications, and 339 publications were selected for full-text review and data extraction. We identified 75 distinct symptoms and other HRQoL issues categorized into 12 thematic areas; from general symptoms such as fever, myalgia, and fatigue, to neurological and psychological issues. The updated search revealed three extra issues experienced during active disease and long-term problems with fatigue, psychological issues and impaired cognitive function.

Conclusion: This first comprehensive systematic review provides a detailed overview of the wide range of HRQoL issues experienced by patients with COVID-19 throughout the course of the disease. It demonstrates the devastating impact of the disease and provides critically important information for clinicians, to enable them to better recognize the disease and to provide knowledge important for treatment and follow-up. The results provided the foundation for the international development of a COVID-19 specific patient-reported HRQoL questionnaire.

Keywords: COVID-19; Concerns; Health-related quality of life; Patient-reported outcome; Symptoms.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • COVID-19 / epidemiology
  • COVID-19 / psychology*
  • Fatigue
  • Humans
  • Pandemics
  • Patient Reported Outcome Measures
  • Quality of Life / psychology*
  • SARS-CoV-2
  • Surveys and Questionnaires