Fatigue outcomes following COVID-19: a systematic review and meta-analysis

Abstract

ObjectivesFatigue is a pervasive clinical symptom in coronaviruses and may continue beyond the acute phase, lasting for several months or years. This systematic review and meta-analysis aimed to incorporate the current evidence for postinfection fatigue among survivors of SARS-CoV-2 and investigate associated factors.MethodsEmbase, PsyINFO, Medline, CINAHL, CDSR, Open Grey, BioRxiv and MedRxiv were systematically searched from January 2019 to December 2021. Eligible records included all study designs in English. Outcomes were fatigue or vitality in adults with a confirmed diagnosis of SARS-CoV-2 measured at >30 days post infection. Non-confirmed cases were excluded. JBI risk of bias was assessed by three reviewers. Random effects model was used for the pooled proportion with 95% CIs. A mixed effects meta-regression of 35 prospective articles calculated change in fatigue overtime. Subgroup analyses explored specific group characteristics of study methodology. Heterogeneity was assessed using Cochran’s Q and I2statistic. Egger’s tests for publication bias.ResultsDatabase searches returned 14 262 records. Following deduplication and screening, 178 records were identified. 147 (n=48 466 participants) were included for the meta-analyses. Pooled prevalence was 41% (95% CI: 37% to 45%, k=147, I2=98%). Fatigue significantly reduced over time (−0.057, 95% CI: −107 to −0.008, k=35, I2=99.3%, p=0.05). A higher proportion of fatigue was found in studies using a valid scale (51%, 95% CI: 43% to 58%, k=36, I2=96.2%, p=0.004). No significant difference was found for fatigue by study design (p=0.272). Egger’s test indicated publication bias for all analyses except valid scales. Quality assessments indicated 4% at low risk of bias, 78% at moderate risk and 18% at high risk. Frequently reported associations were female gender, age, physical functioning, breathlessness and psychological distress.ConclusionThis study revealed that a significant proportion of survivors experienced fatigue following SARS-CoV-2 and their fatigue reduced overtime. Non-modifiable factors and psychological morbidity may contribute to ongoing fatigue and impede recovery.PROSPERO registration numberCRD42020201247.

Balancing the value and risk of exercise-based therapy post-COVID-19: a narrative review

“…In addition, reduced exercise capacity as a result of critical illness hospitalisation is thought to contribute to reduced HRQoL and fatigue outcomes in recovered patients [ 91 ]. In a review examining predictors of fatigue, there was an inconsistent relationship between exercise capacity and fatigue outcomes in those who had more severe disease, with some studies finding a decrease in HRQoL despite improved exercise capacity [ 92 ]. A variety of common mental health outcomes, including post-traumatic stress disorder, anxiety and depression, were associated with fatigue 1 year post hospitalisation, although the pre-morbid burden of these was unknown.…”

“…In addition, reduced exercise capacity as a result of critical illness hospitalisation is thought to contribute to reduced HRQoL and fatigue outcomes in recovered patients [91]. In a review examining predictors of fatigue, there was an inconsistent relationship between exercise capacity and fatigue outcomes in those who had more severe disease, with some studies finding a decrease in HRQoL despite improved exercise capacity [92].…”

Trajectories of mental health outcomes following COVID-19 infection: a prospective longitudinal study

“…Long term impacts after COVID-19-infection include multi-systemic problems, disabilities, and mental health problems, of which fatigue has emerged as the most reported symptom [ 17 – 19 ]. As many as almost half of all who have a history of probable or confirmed COVID 19-infection experience symptoms after recovery from infection [ 18 ], and about 40% of COVID-19 survivors experience fatigue three months after infection, with anxiety, depression and psychiatric comorbidity generating elevated risk [ 20 ]. We have previously shown in a cohort study that individuals with a history of probable or confirmed COVID-19 infection/infections are more likely to suffer from mental health problems, with post-COVID impairments and fatigue appearing as the main predictors of mental ill-health [ 10 ].…”

Experiences of physiotherapists working with adults living with Long COVID in Canada: a qualitative study

“…The World Health Organization (WHO) COVID-19 Clinical Management: Living Guideline (30) highlights the importance of multidisciplinary, coordinated, person-centred, and safe rehabilitation with persons living with Long COVID (6,7,31,32). Specifically, physiotherapists (physical therapists), may help to mitigate disability and prevent symptoms associated with Long COVID such as dyspnea, fatigue, and pain, and guide workplace accommodations (7,17,(31)(32)(33)(34)(35)(36)(37)(38). It is critical for physiotherapists to screen for complications from COVID-19 before rehabilitation and on an ongoing basis, including PESE, cardiac impairment, exertional oxygen desaturation, and autonomic dysfunction.…”