Early experiences of rehabilitation for individuals post-COVID to improve fatigue, breathlessness exercise capacity and cognition – A cohort study

Daynes, Enya; Gerlis, Charlotte; Chaplin, Emma; Gardiner, Nikki; Singh, Sally

doi:10.1177/14799731211015691

Cited by 165 publications

(288 citation statements)

References 6 publications

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“…To date, it remains unknown which treatment strategies are effective to improve fatigue in patients with long COVID. Several treatment strategies for fatigue are proposed based upon knowledge from the fast-growing evidence regarding COVID-19 and other pathologies, such as multidisciplinary rehabilitation, energy conservation techniques, pacing, cognitive behavioral therapy, graded exercise therapy, or physical training [ 25 , 54 , 60 - 65 ]. Future research needs to provide evidence regarding underlying pathways, evaluate the effectiveness of existing treatment strategies, and identify susceptible candidates, as it is expected that not everyone will benefit from the same treatment strategy due to the multifactorial nature of fatigue.…”

Section: Discussionmentioning

confidence: 99%

Severe Fatigue in Long COVID: Web-Based Quantitative Follow-up Study in Members of Online Long COVID Support Groups

Herck¹,

Goërtz²,

Houben-Wilke³

et al. 2021

J Med Internet Res

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Background Fatigue is the most commonly reported symptom in patients with persistent complaints following COVID-19 (ie, long COVID). Longitudinal studies examining the intensity of fatigue and differentiating between physical and mental fatigue are lacking. Objective The objectives of this study were to (1) assess the severity of fatigue over time in members of online long COVID peer support groups, and (2) assess whether members of these groups experienced mental fatigue, physical fatigue, or both. Methods A 2-wave web-based follow-up study was conducted in members of online long COVID peer support groups with a confirmed diagnosis approximately 3 and 6 months after the onset of infectious symptoms. Demographics, COVID-19 diagnosis, received health care (from medical professionals or allied health care professionals), fatigue (Checklist Individual Strength–subscale subjective fatigue [CIS-Fatigue]; 8-56 points), and physical and mental fatigue (self-constructed questions; 3-21 points) were assessed. Higher scores indicated more severe fatigue. A CIS-Fatigue score ≥36 points was used to qualify patients as having severe fatigue. Results A total of 239 patients with polymerase chain reaction/computed tomography–confirmed COVID-19 completed the survey 10 weeks (SD 2) and 23 weeks (SD 2) after onset of infectious symptoms, respectively (T1 and T2). Of these 239 patients, 198 (82.8%) were women; 142 (59.4%) had no self-reported pre-existing comorbidities; 208 (87%) self-reported being in good health before contracting COVID-19; and 62 (25.9%) were hospitalized during acute infection. The median age was 50 years (IQR 39-56). The vast majority of patients had severe fatigue at T1 and T2 (n=204, 85.4%, and n=188, 78.7%, respectively). No significant differences were found in the prevalence of normal, mild, and severe fatigue between T1 and T2 (P=.12). The median CIS-Fatigue score was 48 points (IQR 42-53) at T1, and it decreased from T1 to T2 (median change: –2 points, IQR –7 to 3; P<.001). At T1, a median physical fatigue score of 19 points (IQR 16-20) and a median mental fatigue score of 15 points (IQR 10-17) were reported; these scores were lower at T2 for physical but not for mental fatigue (median change for physical fatigue –1 point, IQR –3 to 0, P<.001; median change for mental fatigue 0 points, IQR –3 to 3, P=.52). At the time of completing the follow-up survey, 194/239 (81.2%) and 164/239 (68.6%) of all patients had received care from at least one medical professional and one allied health care professional, respectively. Conclusions Fatigue in members of online long COVID support groups with a confirmed COVID-19 diagnosis decreases from 10 to 23 weeks after onset of symptoms. Despite this, severe fatigue remains highly prevalent. Both physical and mental fatigue are present. It remains unclear whether and to what extent fatigue will resolve spontaneously in the longer term. Trial Registration Netherlands Trial Register NTR8705; https://www.trialregister.nl/trial/8705.

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Section: Discussionmentioning

confidence: 99%

Severe Fatigue in Long COVID: Web-Based Quantitative Follow-up Study in Members of Online Long COVID Support Groups

Herck¹,

Goërtz²,

Houben-Wilke³

et al. 2021

J Med Internet Res

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“…These uncertainties, and the fact that little data exists to date, mean treatment may require a multidisciplinary care pathway [86,87]. Limited reporting of interventions with overinterpretations regarding safety [21] do not serve the long COVID research, allied health professional, nor patient community. It is essential that future clinical trials (including pilot/feasibility studies) report modifications, symptom exacerbation and other adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…To date, the identification of PEM in people living with long COVID has been driven by one remarkable patient-led effort that asked participants to identify PEM based on a definition of PEM [8,9]. However, to date, preliminary studies exploring progressive exercise have not reported any measure of PEM at enrollment, nor reported monitoring tolerability or symptom exacerbation in response to exertion [21,22]. This may be because the presence of PEM in people living with long COVID has not been clearly identified using self-report tools that are validated in people with ME/CFS.…”

Section: Introductionmentioning

confidence: 99%

Chronic fatigue and post-exertional malaise in people living with long COVID

Twomey

DeMars²,

Franklin

et al. 2021

Preprint

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Purpose: People living with long COVID describe a high symptom burden, and a more detailed assessment of chronic fatigue and post-exertional malaise (PEM) may inform the development of rehabilitation recommendations. The aims of this study 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 PEM; and describe symptoms of dysfunctional breathing, self-reported physical activity/sitting time, and health-related quality of life. Methods: This was an observational study involving an online survey for adults living with long COVID (data collection from February-April, 2021) following a confirmed or suspected SARS-CoV-2 infection. Questionnaires included the Functional Assessment of Chronic Illness Therapy-Fatigue Scale (FACIT-F) and DePaul Symptom Questionnaire-Post-Exertional Malaise. Results: After data cleaning, n=213 participants were included in the analysis. Participants primarily identified as women (85.5%), aged 40-59 (78.4%), who had been experiencing long COVID symptoms for ≥6 months (72.3%). The total FACIT-F score was 18±10 (where the score can range from 0-52, and a lower score indicates more severe fatigue), and 71.4% were experiencing chronic fatigue. Post-exertional symptom exacerbation affected most participants, and 58.7% met the scoring thresholds used in people living with myalgic encephalomyelitis/chronic fatigue syndrome. PEM occurred alongside a reduced capacity to work, be physically active, and function both physically and socially. Conclusion: Long COVID is characterized by chronic fatigue that is clinically relevant and is at least as severe as fatigue in several other clinical conditions, including cancer. PEM appears to be a common and significant challenge for the majority of this patient group. Patients, researchers, and allied health professionals are seeking information on safe rehabilitation for people living with long COVID, particularly regarding exercise. Fatigue and post-exertional symptom exacerbation must be monitored and reported in studies involving interventions for people with long COVID.

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“…Our findings suggest that many non-critically ill hospitalized COVID-19 survivors’ ability to resume pre-COVID-19 roles and responsibilities were negatively impacted at least in the short, and possibly, long term 33 . Other studies have found that impaired functional status extended well beyond hospital discharge as patients were reporting persistent symptoms that impact their functional abilities six months after disease onset 29 – 31 , 34 – 36 .…”

Section: Discussionmentioning

confidence: 78%

Characterizing non-critically ill COVID-19 survivors with and without in-hospital rehabilitation

Musheyev

Janowicz

Borg

et al. 2021

Sci Rep

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This study investigated pre-COVID-19 admission dependency, discharge assistive equipment, discharge medical follow-up recommendation, and functional status at hospital discharge of non-critically ill COVID-19 survivors, stratified by those with (N = 155) and without (N = 162) in-hospital rehabilitation. “Mental Status”, intensive-care-unit (ICU) Mobility, and modified Barthel Index scores were assessed at hospital discharge. Relative to the non-rehabilitation patients, rehabilitation patients were older, had more comorbidities, worse pre-admission dependency, were discharged with more assistive equipment and supplemental oxygen, spent more days in the hospital, and had more hospital-acquired acute kidney injury, acute respiratory failure, and more follow-up referrals (p < 0.05 for all). Cardiology, vascular medicine, urology, and endocrinology were amongst the top referrals. Functional scores of many non-critically ill COVID-19 survivors were abnormal at discharge (p < 0.05) and were associated with pre-admission dependency (p < 0.05). Some functional scores were negatively correlated with age, hypertension, coronary artery disease, chronic kidney disease, psychiatric disease, anemia, and neurological disorders (p < 0.05). In-hospital rehabilitation providing restorative therapies and assisting discharge planning were challenging in COVID-19 circumstances. Knowledge of the functional status, discharge assistive equipment, and follow-up medical recommendations at discharge could enable appropriate and timely post-discharge care. Follow-up studies of COVID-19 survivors are warranted as many will likely have significant post-acute COVID-19 sequela.

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Early experiences of rehabilitation for individuals post-COVID to improve fatigue, breathlessness exercise capacity and cognition – A cohort study

Cited by 165 publications

References 6 publications

Severe Fatigue in Long COVID: Web-Based Quantitative Follow-up Study in Members of Online Long COVID Support Groups

Severe Fatigue in Long COVID: Web-Based Quantitative Follow-up Study in Members of Online Long COVID Support Groups

Chronic fatigue and post-exertional malaise in people living with long COVID

Characterizing non-critically ill COVID-19 survivors with and without in-hospital rehabilitation

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