Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndrome: a cross-sectional observational study
John R Hurst,
Ann Blandford,
William Henley,
Elizabeth Murray,
Katherine Bradbury,
Sarah Walker,
Manuel Gomes,
Fiona A Stevenson,
Fiona L Hamilton,
Paul Pfeffer,
William Ricketts,
Henry Goodfellow,
Julia Bindman,
Hannah Hylton,
Stuart Linke,
Chris Robson,
Belinda Cooper,
Patra Pookarnjanamorakot,
David Sunkersing,
Jiunn Wang,
Living With Covid Recovery Collaboration
Affiliations
John R Hurst
UCL Respiratory, University College London, London, UK
Ann Blandford
UCLIC, Department of Computer Science, University College London, London, UK
William Henley
Department of Health and Community Sciences (Medical School), University of Exeter, Exeter, UK
Elizabeth Murray
Primary Care and Population Health, University College London, London, UK
Katherine Bradbury
7 Psychology, University of Southampton, Southampton, UK
Sarah Walker
5 NIHR Oxford Biomedical Research Centre, Nuffield Department of Medicine, University of Oxford, Oxford, UK
Manuel Gomes
Department of Applied Health Research, University College London, London, UK
Fiona A Stevenson
Research Department of Primary Care and Population Health, University College London, London, UK
Fiona L Hamilton
Research Department of Primary Care and Population Health, University College London, London, UK
Paul Pfeffer
Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
William Ricketts
Respiratory Medicine, Barts Health NHS Trust, London, UK
Henry Goodfellow
Department of Primary Care and Population Health, University College London, London, UK
Julia Bindman
Research Department of Primary Care and Population Health, University College London, London, UK
Hannah Hylton
Department of Respiratory Medicine, Barts Health NHS Trust, London, UK
Stuart Linke
Research Department of Primary Care and Population Health, University College London, London, UK
Chris Robson
0 Queen Street Place, London, EC4R 1AG, Living With Ltd, London, UK
Belinda Cooper
Research Department of Primary Care and Population Health, University College London, London, UK
Patra Pookarnjanamorakot
General Medicine, Whittington Health NHS Trust, London, UK
David Sunkersing
1 Institute of Health Informatics, University College London, London, UK
Jiunn Wang
Department of Applied Health Research, University College London, London, UK
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.
