Chronic fatigue and post-exertional malaise in people living with long COVID, 2021 Twomey, DeMars et al

Preprint

Abstract
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.

Competing Interest Statement
JDM is a physiotherapist and owner of Breath Well Physio (Alberta, Canada) and has been treating people living with long COVID in private practice since July 2020. JDM and RT have piloted a free virtual program (Breath, Speak, Pace) for people living with long COVID in Alberta, Canada, funded by the Canadian Lung Association. This program will be continuing in partnership with Synaptic Health (Registered Charity No. 830838280RR001). JDM delivered a paid course for rehabilitation professionals working with people with long COVID in April 2021. The authors have no other conflicts of interest to disclose.

https://www.medrxiv.org/content/10.1101/2021.06.11.21258564v1

 

Please not just more use of questionnaires!

 

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