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Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndome: a cross=sectional observational study: A cross-sectional observational study

Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndome: a cross=sectional observational study: A cross-sectional observational study
Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndome: a cross=sectional observational study: A cross-sectional observational study
Objectives: to describe self-reported characteristics and symptoms of treatment-seeking patients with post-COVID-19 syndrome (PCS). To assess the impact of symptoms on health-related quality of life (HRQoL) and patients’ ability to work and undertake activities of daily living.

Design: cross-sectional single-arm service evaluation of real-time user data.

Setting: 31 post-COVID-19 clinics in the UK.

Participants: 3754 adults diagnosed with PCS in primary or secondary care deemed suitable for rehabilitation.

Intervention: patients using the Living With Covid Recovery digital health intervention registered between 30 November 2020 and 23 March 2022.

Primary and secondary outcome measures: the primary outcome was the baseline Work and Social Adjustment Scale (WSAS). WSAS measures the functional limitations of the patient; scores of ≥20 indicate moderately severe limitations. Other symptoms explored included fatigue (Functional Assessment of Chronic Illness Therapy–Fatigue), depression (Patient Health Questionnaire–Eight Item Depression Scale), anxiety (Generalised Anxiety Disorder Scale, Seven-Item), breathlessness (Medical Research Council Dyspnoea Scale and Dyspnoea-12), cognitive impairment (Perceived Deficits Questionnaire, Five-Item Version) and HRQoL (EQ-5D). Symptoms and demographic characteristics associated with more severe functional limitations were identified using logistic regression analysis.

Results: 3541 (94%) patients were of working age (18-65); mean age (SD) 48 (12) years; 1282 (71%) were female and 89% were white. 51% reported losing ≥1 days from work in the previous 4 weeks; 20% reported being unable to work at all. Mean WSAS score at baseline was 21 (SD 10) with 53% scoring ≥20. Factors associated with WSAS scores of ≥20 were high levels of fatigue, depression and cognitive impairment. Fatigue was found to be the main symptom contributing to a high WSAS score.

Conclusion: a high proportion of this PCS treatment-seeking population was of working age with over half reporting moderately severe or worse functional limitation. There were substantial impacts on ability to work and activities of daily living in people with PCS. Clinical care and rehabilitation should address the management of fatigue as the dominant symptom explaining variation in functionality.
Anxiety disorders, COVID-19, Depression & mood disorders, MENTAL HEALTH, PRIMARY CARE, Public health
2044-6055
Walker, Sarah
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Goodfellow, Henry
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Pookarnjanamorakot, Patra
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Murray, Elizabeth
cb300780-9041-44af-9ae5-e13531eb23b8
Bindman, Julia
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Blandford, Ann
1a959d23-6ce2-41bd-89ea-b81b61ec5f7a
Bradbury, Katherine
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Cooper, Belinda
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Hamilton, Fiona L.
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Hurst, John R.
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Hylton, Hannah
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Linke, Stuart
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Pfeffer, Paul
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Ricketts, William
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Robson, Chris
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Stevenson, Fiona A.
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Sunkersing, David
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Wang, Jiunn
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Gomes, Manuel
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Henley, William
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Living With Covid Recovery Collaboration
Walker, Sarah
0be802fe-56cc-4324-9cec-5ad6bd254f10
Goodfellow, Henry
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Pookarnjanamorakot, Patra
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Murray, Elizabeth
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Bindman, Julia
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Blandford, Ann
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Bradbury, Katherine
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Cooper, Belinda
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Hamilton, Fiona L.
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Hurst, John R.
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Hylton, Hannah
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Linke, Stuart
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Pfeffer, Paul
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Ricketts, William
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Robson, Chris
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Stevenson, Fiona A.
68366278-ef64-41e6-a7b2-099f1971ba8e
Sunkersing, David
1ed45570-232b-45fc-ba1d-2c5a00bde555
Wang, Jiunn
f770ba47-b221-4f54-ac1e-fc8e87fafd81
Gomes, Manuel
31e995b9-189c-40de-9664-df1f273fbf1c
Henley, William
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Walker, Sarah, Goodfellow, Henry, Pookarnjanamorakot, Patra, Murray, Elizabeth, Bindman, Julia, Blandford, Ann, Bradbury, Katherine, Cooper, Belinda, Hamilton, Fiona L., Hurst, John R., Hylton, Hannah, Linke, Stuart, Pfeffer, Paul, Ricketts, William, Robson, Chris, Stevenson, Fiona A., Sunkersing, David, Wang, Jiunn, Gomes, Manuel and Henley, William , Living With Covid Recovery Collaboration (2023) Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndome: a cross=sectional observational study: A cross-sectional observational study. BMJ Open, 13 (6), [e069217]. (doi:10.1136/bmjopen-2022-069217).

Record type: Article

Abstract

Objectives: to describe self-reported characteristics and symptoms of treatment-seeking patients with post-COVID-19 syndrome (PCS). To assess the impact of symptoms on health-related quality of life (HRQoL) and patients’ ability to work and undertake activities of daily living.

Design: cross-sectional single-arm service evaluation of real-time user data.

Setting: 31 post-COVID-19 clinics in the UK.

Participants: 3754 adults diagnosed with PCS in primary or secondary care deemed suitable for rehabilitation.

Intervention: patients using the Living With Covid Recovery digital health intervention registered between 30 November 2020 and 23 March 2022.

Primary and secondary outcome measures: the primary outcome was the baseline Work and Social Adjustment Scale (WSAS). WSAS measures the functional limitations of the patient; scores of ≥20 indicate moderately severe limitations. Other symptoms explored included fatigue (Functional Assessment of Chronic Illness Therapy–Fatigue), depression (Patient Health Questionnaire–Eight Item Depression Scale), anxiety (Generalised Anxiety Disorder Scale, Seven-Item), breathlessness (Medical Research Council Dyspnoea Scale and Dyspnoea-12), cognitive impairment (Perceived Deficits Questionnaire, Five-Item Version) and HRQoL (EQ-5D). Symptoms and demographic characteristics associated with more severe functional limitations were identified using logistic regression analysis.

Results: 3541 (94%) patients were of working age (18-65); mean age (SD) 48 (12) years; 1282 (71%) were female and 89% were white. 51% reported losing ≥1 days from work in the previous 4 weeks; 20% reported being unable to work at all. Mean WSAS score at baseline was 21 (SD 10) with 53% scoring ≥20. Factors associated with WSAS scores of ≥20 were high levels of fatigue, depression and cognitive impairment. Fatigue was found to be the main symptom contributing to a high WSAS score.

Conclusion: a high proportion of this PCS treatment-seeking population was of working age with over half reporting moderately severe or worse functional limitation. There were substantial impacts on ability to work and activities of daily living in people with PCS. Clinical care and rehabilitation should address the management of fatigue as the dominant symptom explaining variation in functionality.

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Accepted/In Press date: 30 March 2023
Published date: 7 June 2023
Additional Information: Funding Information: JB reports payments from University College London for working with the patient and public involvement group to prepare content for the digital health intervention since May 2020. KB's research portfolio is partly funded by National Institute for Health &and Care Research (NIHR) Applied Research Collaboration Wessex. HG reports working as a clinical safety officer for Living With Ltd. JRH reports receiving personal fees and fees to institution for honorariums and consultancy payments from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline and Takeda, and also sponsorship for attending meetings from AstraZeneca and GlaxoSmithKline. HH reports payment from the University of East London for providing a lecture on long COVID and COVID-19 recovery in February 2021. SL reports grants from NIHR in which the payment was made to Camden and Islington NHS Trust between the period of October–September 2022. PEP reports grants from the Medical Research Council and NIHR outside the submitted work. All other authors declare no competing interests. Funding Information: This study is funded by the National Institute for Health and Care Research (NIHR) Cross-programme (HS and DR) COVID-19 (project reference NIHR132243). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. This report is independent research supported by the NIHR ARC North Thames, NIHR ARC Wessex and NIHR ARC West. For the purpose of open access, the authors applied a creative commons attribution licence to any author accepted manuscript version arising. Publisher Copyright: © 2023 BMJ Publishing Group. All rights reserved.
Keywords: Anxiety disorders, COVID-19, Depression & mood disorders, MENTAL HEALTH, PRIMARY CARE, Public health

Identifiers

Local EPrints ID: 482717
URI: http://eprints.soton.ac.uk/id/eprint/482717
ISSN: 2044-6055
PURE UUID: cff7acdb-8ed8-4348-87f4-80a2aac8793b
ORCID for Katherine Bradbury: ORCID iD orcid.org/0000-0001-5513-7571

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Date deposited: 11 Oct 2023 16:58
Last modified: 06 Jun 2024 01:47

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Contributors

Author: Sarah Walker
Author: Henry Goodfellow
Author: Patra Pookarnjanamorakot
Author: Elizabeth Murray
Author: Julia Bindman
Author: Ann Blandford
Author: Belinda Cooper
Author: Fiona L. Hamilton
Author: John R. Hurst
Author: Hannah Hylton
Author: Stuart Linke
Author: Paul Pfeffer
Author: William Ricketts
Author: Chris Robson
Author: Fiona A. Stevenson
Author: David Sunkersing
Author: Jiunn Wang
Author: Manuel Gomes
Author: William Henley
Corporate Author: Living With Covid Recovery Collaboration

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