"Long-term COVID-19" – fatigue assessment and treatment recommendations at a glance!

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Patients infected with SARS-CoV-2 still experience a range of symptoms long after recovering from the acute phase of the disease, including fatigue, shortness of breath, palpitations, cognitive dysfunction, sleep disturbances, fever, gastrointestinal symptoms, anxiety, depression, etc., which can last for several months, collectively known as "Long COVID" (Long COVID).

In August 2021, the American Society of Physical Medicine and Rehabilitation (AAPM&R) released its first "Long COVID" guidelines, which focus on the assessment and treatment of fatigue.

Recommendations for assessment of fatigue

1. Evaluate the patient's fatigue patterns during the normal day to guide activity recommendations.

Assess the patient's response to fatigue initiation and escalation activity

Assess changes in the patient's daily functioning and activity levels

Assess the patient's physical function and endurance (e.g., choose a 30-second sit-down test based on an individual's activity tolerance; 2-minute tread test; 6-minute walking test; 10-minute walk test) in order to inform activity and treatment recommendations.

2. Clinicians should evaluate changes in activities of daily living, independent activities of daily living, study, work, and hobbies.

3. Conduct a complete medical history and past history review.

4. Assess whether the patient is likely to worsen fatigue symptoms and require further examination and referral to a subspecialty, including sleep, mood (including anxiety, depression, post-traumatic stress disorder [PTSD]).

Note: Patients often report that they are dissatisfied with treatment because these persistent symptoms are attributed to psychological factors. It is important to note that mood disorders can be secondary to ongoing medical problems or become one of the many factors that contribute to fatigue.

5. Review of the drugs used by the patient, investigate the drugs that may cause fatigue. Notably, antihistamine, anticholinergic, and antidepressant/anxiety medications may cause fatigue in these patients.

6. New patients or patients without laboratory tests in the 3 months prior to the visit should consider the following basic laboratory tests: complete blood count, biochemical tests including liver and kidney, function, thyroid-stimulating hormone, C-reactive protein or erythrocyte sedimentation rate, creatinine kinase.

Other laboratory tests may also be considered based on the findings described above or the patient's comorbidities.

Treatment of fatigue is recommended

1. Start an individualized, structured, phased activity regression plan

Individualized, symptom-oriented activity recovery procedures are recommended for patients with fatigue, and the goal of rehabilitation programs is to restore patients to their previous level of activity and improve their quality of life.

2. Discuss energy saving strategies

It is recommended that patients be educated on energy-saving strategies to aid rehabilitation, and one framework is the "4Ps": pace, prioritization, positioning, and planning.

3. Encourage reduced dietary patterns or hydration

General nutritional recommendations should reflect the underlying comprehensive health status of individual patients. General nutrition guidelines recommend that diets include vegetables, fruits, whole grains, healthy fats, fish, poultry, legumes and eggs, dairy products, and a limited intake of red meat. It is also recommended to consume adequate water and avoid alcohol consumption.

4. Work with the right specialist to treat underlying conditions such as pain, insomnia/sleep disorders (including poor sleep hygiene) and emotional problems that can lead to fatigue.

以上内容来源：Herrera JE, Niehaus WN,et al. Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients. PM R. 2021 Sep;13(9):1027-1043.