Advanced Wellbeing Research Centre, Health Research Institute, Sheffield Hallam University, Sheffield, United Kingdom.
Department of Health Sciences, University of York, York, United Kingdom.
PLoS One. 2021 Nov 9;16(11):e0259533. doi: 10.1371/journal.pone.0259533. eCollection 2021.
Fatigue syndromes have been widely observed following post-viral infection and are being recognised because of Covid19. Interventions used to treat and manage fatigue have been widely researched and this study aims to synthesise the literature associated with fatigue interventions to investigate the outcomes that may be applicable to 'long Covid'.
The study was registered with PROSPERO (CRD42020214209) in October 2020 and five electronic databases were searched. Papers were screened, critically appraised and data extracted from studies that reported outcomes of fatigue interventions for post-viral syndromes. The narrative synthesis includes statistical analysis associated with effectiveness and then identifies the characteristics of the interventions, including identification of transferable learning for the treatment of fatigue in long Covid. An expert panel supported critical appraisal and data synthesis.
Over 7,000 research papers revealed a diverse range of interventions and fatigue outcome measures. Forty papers were selected for data extraction after final screening. The effectiveness of all interventions was assessed according to mean differences (MD) in measured fatigue severity between each experimental group and a control following the intervention, as well as standardised mean differences as an overall measure of effect size. Analyses identified a range of effects-from most effective MD -39.0 [95% CI -51.8 to -26.2] to least effective MD 42.28 [95% CI 33.23 to 51.34]-across a range of interventions implemented with people suffering varying levels of fatigue severity. Interventions were multimodal with a range of supportive therapeutic methods and varied in intensity and requirements of the participants. Those in western medical systems tended to be based on self- management and education principles (i.e., group cognitive behavioural therapy (CBT).
Findings suggest that the research is highly focussed on a narrow participant demographic and relatively few methods are effective in managing fatigue symptoms. Selected literature reported complex interventions using self-rating fatigue scales that report effect. Synthesis suggests that long Covid fatigue management may be beneficial when a) physical and psychological support, is delivered in groups where people can plan their functional response to fatigue; and b) where strengthening rather than endurance is used to prevent deconditioning; and c) where fatigue is regarded in the context of an individual's lifestyle and home-based activities are used.
病毒性感染后广泛观察到疲劳综合征，并因 COVID-19 而被认识。用于治疗和管理疲劳的干预措施已广泛研究，本研究旨在综合与疲劳干预相关的文献，以调查可能适用于“长新冠”的结果。
该研究于 2020 年 10 月在 PROSPERO（CRD42020214209）上注册，并对五个电子数据库进行了搜索。筛选论文，对报告病毒性综合征后疲劳干预结果的研究进行了批判性评价和数据提取。叙述性综合包括与有效性相关的统计分析，然后确定干预措施的特征，包括确定可用于治疗长新冠疲劳的可转移学习。一个专家小组支持了批判性评价和数据综合。
超过 7000 篇研究论文揭示了各种干预措施和疲劳结果测量方法。经过最终筛选，有 40 篇论文被选作数据提取。根据干预后每个实验组与对照组之间测量疲劳严重程度的平均差异（MD），以及作为整体效应大小衡量标准的标准化平均差异，评估了所有干预措施的有效性。分析确定了一系列效果-从最有效的 MD -39.0[95%置信区间（CI）-51.8 至-26.2]到最不有效的 MD 42.28[95%CI 33.23 至 51.34]-涵盖了一系列不同严重程度疲劳的人群实施的不同干预措施。干预措施是多模式的，采用了一系列支持性治疗方法，强度和参与者的要求各不相同。在西方医疗体系中，干预措施往往基于自我管理和教育原则（即，小组认知行为疗法（CBT）。
研究结果表明，研究高度集中于一个狭窄的参与者人群，并且相对较少的方法对管理疲劳症状有效。所选文献报告了使用自我评估疲劳量表的复杂干预措施，这些量表报告了效果。综合研究表明，当以下情况时，长新冠疲劳管理可能是有益的：a）在提供身体和心理支持的小组中，人们可以计划对疲劳的功能性反应；b）在使用增强而非耐力来防止身体机能下降的情况下；c）在将疲劳视为个人生活方式的背景下，并使用家庭活动。
