Chronic Fatigue and Postexertional Malaise in People Living With Long COVID: An Observational Study
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Abstract
Objective
People living with long COVID describe a high symptom burden, and a more detailed assessment is needed to inform rehabilitation recommendations. The objectives were to use validated questionnaires to measure the severity of fatigue and compare this with normative data and thresholds for clinical relevance in other diseases; measure and describe the impact of postexertional malaise (PEM); and assess symptoms of dysfunctional breathing, self-reported physical activity, and health-related quality of life.
Methods
This was an observational study with a cross-sectional survey design (data collection from February 2021 to April 2021). Eligible participants were adults experiencing persistent symptoms due to COVID-19 that did not predate the confirmed or suspected infection. Questionnaires included the Functional Assessment of Chronic Illness Therapy–Fatigue Scale and the DePaul Symptom Questionnaire–Post-Exertional Malaise.
Results
After data cleaning, 213 participants were included in the analysis. The total Functional Assessment of Chronic Illness Therapy–Fatigue Scale score was 18 (SD = 10) (where the score can range from 0 to 52, and a lower score indicates more severe fatigue), and 71.4% were experiencing chronic fatigue. Postexertional symptom exacerbation affected most participants, and 58.7% met the PEM scoring thresholds used in people living with myalgic encephalomyelitis/chronic fatigue syndrome.
Conclusion
Long COVID is characterized by chronic fatigue that is clinically relevant and at least as severe as fatigue in several other clinical conditions. PEM is a significant challenge for this patient group. Because of the potential for setbacks and deteriorated function following overexertion, fatigue and postexertional symptom exacerbation must be monitored and reported in clinical practice and in studies involving interventions for people with long COVID.
Impact
Physical therapists working with people with long COVID should measure and validate the patient’s experience. Postexertional symptom exacerbation must be considered, and rehabilitation needs to be carefully designed based on individual presentation. Beneficial interventions might first ensure symptom stabilization via pacing, a self-management strategy for the activity that helps minimize postexertional malaise.
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SciScore for 10.1101/2021.06.11.21258564: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The study was approved by the University of Calgary Conjoint Health Research Ethics Board (REB21-0159) and performed according to the Declaration of Helsinki, with the exception of preregistration.
Consent: Study details such as the purpose, research team, the risks and benefits of participating, and contact details for more information were communicated on the first page of the survey using an implied consent approach.Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Analysis was performed using Jamovi [56] and R [57]. Jamovisuggested: (jamovi, RRID:SCR_016142)Resu…
SciScore for 10.1101/2021.06.11.21258564: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics IRB: The study was approved by the University of Calgary Conjoint Health Research Ethics Board (REB21-0159) and performed according to the Declaration of Helsinki, with the exception of preregistration.
Consent: Study details such as the purpose, research team, the risks and benefits of participating, and contact details for more information were communicated on the first page of the survey using an implied consent approach.Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Analysis was performed using Jamovi [56] and R [57]. Jamovisuggested: (jamovi, RRID:SCR_016142)Results from OddPub: Thank you for sharing your data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Many participants were also living with breathing discomfort (air hunger and increased sensations of breathing effort), were unable to be physically active, had role limitations due to physical health problems, and rated their health as much worse compared to one year ago. Overall, symptom burden was not higher in people who received laboratory confirmation of COVID-19 compared to those with only an acute illness that was reasonably attributable to infection (in line with other data [66]), and comorbidities alone do not explain long COVID symptoms. Chronic fatigue is difficult for patients to articulate and easy for others to dismiss [67,68]. Our data offer insight into the severity of the most common symptom, based on comparison with several other clinical conditions where the FACIT-F has been validated (Table 3), and comparison with a clinical cut-point recommended for the diagnosis of fatigue in people with cancer [40]. Fatigue is not only extremely common in long COVID, but for many, its severity and persistence are life-altering. Our exploratory analyses are in line with data from other populations on the associations between fatigue, reduced function, increased disability, and reduced HRQL [11,69]. The measurement of fatigue should be considered, and validation of a fatigue scale (such as the FACIT-F, which has demonstrated clinical utility in several populations) in people with long COVID is a priority. In addition, the use of visual analogue scales to measure response...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
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