The research, led by occupational therapist Rina Juel Kaptain of University College of Northern Denmark and colleagues at the Parker Institute in Copenhagen and the University of Southern Denmark, took an exploratory cross-sectional approach. The team recruited 30 adults diagnosed with Long COVID who were enrolled in an interdisciplinary, municipality-based rehabilitation program between April and December 2022. All had been referred from a clinic for long-term sequelae of COVID-19 at a county university hospital after their symptoms had persisted for at least six weeks. Of 53 people invited to take part, 57 percent agreed to share clinical data collected as part of their routine care.

The study’s central innovation lies in the assessment tool it deployed. Rather than relying on coarse questionnaires that simply ask whether a person can or cannot perform a task, the researchers used the ADL Interview, or ADL-I, a validated occupational therapy instrument that probes the quality of task performance across 47 activities: 31 personal ADL tasks such as eating, grooming, and dressing, and 16 instrumental ADL tasks such as cooking, shopping, and cleaning. For each task, respondents describe whether they perform it without extra time or effort, with added time, with added effort or fatigue, with risk of injury, with partial assistance, or not at all. These ratings are then converted, through a Rasch rating scale model, into an overall interval-level measure of self-reported ADL ability, adjusted for the difficulty of each task.

The results reveal a striking and consistent pattern. Nearly every participant reported degraded performance quality in both personal and instrumental domains, but the dominant problems were not outright dependence. Instead, they were subtler: extra time consumed and extra effort expended. Within the personal ADL domain, between 60 and 97 percent of participants reported communication difficulties, including taking part in conversation, using the phone, reading, and writing by hand or word processor. Roughly half reported similar time-and-effort burdens when walking between floors or moving about the neighborhood, and nearly half reported the same when washing or bathing. Almost a third reported added effort simply to wash their hair.

The instrumental domain showed even broader disruption. More than half of the participants reported decreased quality of performance across transportation, cooking, shopping, and cleaning tasks. Sixteen participants had trouble riding a bicycle or moped, and 21 reported problems driving a car, again mostly because of increased time or effort, though a smaller group described safety risks, a need for help, or inability to complete the task. Cooking a hot meal, making shopping plans, and both small- and large-quantity shopping were each affected in more than half the sample. By contrast, nearly all participants remained competent at heating up liquid or prepared food and preparing a cold meal, suggesting that simpler, shorter tasks remained within reach while complex, multi-step activities did not.

Statistically, the picture sharpened further. Using Spearman’s rho and point biserial correlations, the researchers examined whether ADL ability was linked to a range of health-related, social, and personal factors: age, sex, cohabitation, comorbidity, symptom presence, and work status. Only one factor rose above weak association. Fatigue, measured with the Modified Fatigue Impact Scale, showed a moderate negative correlation with ADL ability (r = −0.50, p = 0.01), meaning that the more severely participants were affected by fatigue, the poorer their rated quality of everyday task performance. None of the remaining variables, including age, showed meaningful relationships, a finding the authors describe as surprising given that ADL ability typically declines with age in the general population. Long COVID, they suggest, may disrupt typical age-related patterns of function.

The centrality of fatigue is consistent with a broader literature. Previous research has found that more than 70 percent of people with Long COVID report fatigue as their worst symptom, and that physical activity, stress, and disturbed sleep can all exacerbate it. Fatigue is also a well-documented driver of functional limitation in other chronic conditions, including heart failure, fibromyalgia, chronic pain, hypertension, and stroke, and self-reported fatigue in older adulthood has been shown to predict the need for ADL assistance years later. The Danish findings extend this pattern to Long COVID, reinforcing the idea that energy dysregulation lies at the heart of the condition’s functional toll.

The study also documented a heavy occupational cost. Only 10 percent of participants were able to maintain their regular working hours; more than half worked reduced hours, and one third were on full-time sick leave. This aligns with earlier research showing that only a minority of previously employed people with Long COVID return to their pre-illness working hours. Notably, the tasks that most often deteriorated, communication, planning, transportation, and household management, are precisely the capacities that underpin employment and social participation. The authors point out that difficulty with conversation, reading, and writing is particularly consequential, and cite prior work showing that 73 percent of Long COVID patients report difficulties socializing.

For rehabilitation practice, the findings carry concrete implications. Because most participants retained independence but lost efficiency, the authors argue that rehabilitation planning should assess not just whether patients can perform a task, but how much time, effort, and risk the performance involves. They highlight the role of occupational therapy in energy management interventions, teaching patients to understand the factors that influence their energy levels and to apply strategies such as pacing, prioritizing activities, planning ahead, and modifying their environment. Evidence suggests such interventions can be delivered effectively both in person and remotely, and recent data show meaningful improvements in fatigue, energy-management competence, and ADL performance, a flexibility that matters given the fluctuating nature of Long COVID symptoms.

The authors are careful to note the study’s limits. The sample of 30 participants was small and drawn retrospectively from people who had completed municipal rehabilitation, so the findings may not generalize to those with milder symptoms or limited healthcare access. Still, the heterogeneity of the sample, spanning ages 28 to 73, both sexes, varied symptom profiles, and different times since diagnosis, strengthens the correlational analyses. And the use of a standardized, task-specific instrument administered by a certified occupational therapist gives the study a granularity that binary assessments cannot match. The conclusion is sobering but actionable: Long COVID does not merely make people unable to do things; it makes the doing of ordinary life slower, costlier, and more fragile, and rehabilitation that targets energy and efficiency, not just independence, may be key to restoring it.

Subject of Research: Quality of activities of daily living task performance and fatigue in adults with Long COVID

Article Title: Activities of daily living following Long COVID: An exploratory cross-sectional study

Article References: Kaptain, R. J., Jensen, K. E. B., Nielsen, K. T., & Wæhrens, E. E. (2025). Activities of daily living following Long COVID: An exploratory cross-sectional study. Scandinavian Journal of Occupational Therapy, 32(1), Article 2597212. https://doi.org/10.1080/11038128.2025.2597212

Image Credits: AI Generated

DOI: 10.1080/11038128.2025.2597212

Keywords: Long COVID, activities of daily living, ADL-I, fatigue, occupational therapy, rehabilitation, functional disability, post-acute sequelae of COVID-19, energy management, cross-sectional study, personal ADL, instrumental ADL

The research team assessed functional disability using a two-component framework that distinguishes between basic and instrumental domains of daily living. The Physical Self-Maintenance Scale, or PSMS, captures fundamental self-care capacities such as bathing, dressing, toileting, continence, feeding, and grooming, which together define basic activities of daily living. The Instrumental Activities of Daily Living scale, known as IADL, probes more complex and cognitively demanding tasks, including the ability to use a telephone, shop, prepare food, manage housework, do laundry, travel independently, take medications, and handle finances. This layered architecture matters clinically because instrumental disability typically emerges earlier in the trajectory of functional decline, often signaling a window during which intervention can still preserve independence, whereas basic ADL impairment marks a deeper erosion of autonomy that usually demands intensive support.

The headline numbers are striking. The overall prevalence of functional disability in the sample stood at 36.41 percent, a figure that underscores how widespread functional limitation already is among middle-aged and older residents of this mountainous, multi-ethnic province. Breaking the composite measure into its components, the researchers found that 35.58 percent of participants experienced disability in instrumental activities, while 4.27 percent had lost capacity in basic self-care activities. The large gap between these two figures is itself informative: it suggests that the early stages of functional decline in these populations manifest primarily as difficulty with the complex, socially embedded tasks of independent living rather than as an inability to perform elementary self-maintenance, a pattern consistent with the established natural history of disability progression.

Perhaps the study’s most methodologically important contribution lies in how it handled the problem of comparing disability across ethnic groups whose age structures differ markedly. Crude prevalence rates can mislead when one population is substantially older than another, because age is the single most powerful driver of functional decline. To address this, the investigators calculated standardized prevalence rates for the 11 ethnic minority groups using the age distribution of the Han population as the reference standard. This statistical adjustment, an application of direct standardization, removes age-structure distortion and permits a more honest comparison of the underlying burden. After standardization, the Bulang group showed the highest age-adjusted prevalence of IADL disability at 59.50 percent, while the Nu group recorded the highest age-adjusted rate of basic ADL disability at 9.37 percent, figures that substantially exceed the provincial averages and point to genuine disparities rather than demographic artifacts.

Drilling into specific instrumental tasks revealed further heterogeneity. The Lisu, Nu, and Bulang groups reported the greatest difficulty with transportation, at 51.33, 50.15, and 49.58 percent respectively, meaning that roughly half of older adults in these communities struggle to move beyond their homes. The Bulang group also registered the highest proportion of difficulty using the telephone, at 33.74 percent. These are not trivial deficits. Transportation dependence and communication barriers sever older adults from markets, clinics, social networks, and emergency services, creating a cascading vulnerability in which each loss compounds the next. In a province defined by rugged terrain and geographically dispersed villages, such figures translate into concrete risks of untreated illness and social isolation, and they hint at infrastructure and accessibility deficits that health policy alone cannot remedy without complementary investment in rural connectivity.

To identify the factors associated with disability risk, the team employed multivariable logistic regression, reporting results as odds ratios with 95 percent confidence intervals. Advanced age emerged as a consistent and powerful predictor across all three outcomes: the odds of functional disability, basic ADL disability, and IADL disability all roughly two-and-a-half-fold higher in the oldest categories, with odds ratios of 2.56, 2.81, and 2.52 respectively. Nutritional status, proxied by body mass index, also carried weight. A BMI below 18.50, indicating underweight status, was associated with elevated risk across the board, with odds ratios of 1.41 for overall disability, 2.20 for basic ADL disability, and 1.35 for IADL disability. This association aligns with a substantial literature linking undernutrition, sarcopenia, and frailty, and it flags older underweight adults as a priority group for screening and nutritional support.

Education exerted a robust protective effect that the authors describe in notably strong terms. Higher educational attainment was associated with sharply reduced odds of disability across all outcomes, with odds ratios of 0.32 for overall functional disability, 0.49 for basic ADL disability, and 0.31 for IADL disability. In practical terms, more educated adults carried roughly a two-thirds to nearly seventy percent lower risk of losing functional independence. The mechanisms are plausibly manifold: education correlates with health literacy, higher lifetime earnings, better access to care, cognitively stimulating occupations, and the physical reserve that gerontologists describe as reserve capacity against decline. In Yunnan’s context, where educational access has historically been uneven across ethnic and geographic lines, this finding suggests that the educational gaps of past generations are now being repaid in the currency of functional health.

The sex differences the study uncovered add an instructive wrinkle. Women were more likely to experience overall functional disability, with an odds ratio of 1.41, and instrumental disability, with an odds ratio of 1.40, while men were more likely to experience basic ADL disability, expressed as an odds ratio of 0.64 for women. This divergence likely reflects a combination of longer female longevity, different lifetime occupational and caregiving exposures, and the fact that instrumental tasks are strongly shaped by gendered social roles. Whatever the precise drivers, the pattern implies that effective interventions will need to be gender-sensitive rather than uniform, recognizing that men and women in these communities lose different capacities at different stages of decline.

The authors conclude that functional disability remains disproportionately prevalent among ethnic minority populations in Yunnan, with substantial heterogeneity both between minority groups and the Han majority and among minority groups themselves, and they call for targeted, culturally sensitive interventions addressing health vulnerability to reduce disparities and promote equitable healthy aging. The study was supported by Yunnan Fundamental Research Projects, the Yunnan High-level Talent Introduction Plan, the Yunnan Philosophy and Social Science Innovation Team, and a First-Class Discipline Team grant from Kunming Medical University, and it was approved by the university’s ethics committee with informed consent obtained from all interviewees. As China’s aging population grows and its minority regions continue to lag in health infrastructure, findings of this kind will be essential raw material for the design of long-term care systems that do not leave entire communities behind. What the Yunnan data make clear is that healthy aging is not a uniform target but a mosaic of local realities, each demanding its own calibrated response.

Subject of Research: Prevalence and determinants of functional disability among middle-aged and older adults across 12 ethnic groups in Yunnan, China

Article Title: Prevalence and associated factors of functional disability among middle-aged and older adults: evidence from 12 ethnic groups in Yunnan, China

Article References: Zhang, J., Bai, H., Li, R., Wang, Y., Ma, J., Li, Y., Gao, Y., Liu, H., Huang, R., Yan, C., Deng, R., & Huang, Y. (2026). Prevalence and associated factors of functional disability among middle-aged and older adults: evidence from 12 ethnic groups in Yunnan, China. International Journal for Equity in Health. https://doi.org/10.1186/s12939-026-03039-y

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03039-y

Keywords: functional disability, ethnic minorities, aging population, activities of daily living, IADL, PSMS, Yunnan China, health equity, logistic regression, prevalence, older adults, disparities