TY - JOUR
T1 - Fatigue outcomes following COVID-19
T2 - a systematic review and meta-analysis
AU - Poole-Wright, Kim
AU - Guennouni, Ismail
AU - Sterry, Olivia
AU - Evans, Rachael A
AU - Gaughran, Fiona
AU - Chalder, Trudie
N1 - Funding Information:
FG has received support or honoraria from, Lundbeck, Otsuka and Sunovion and has a family member with previous professional links to Lilly and GSK. FG is in part supported by the National Institute for Health Research’s (NIHR’s) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, the Maudsley Charity and the NIHR Applied Research Collaboration South London at King’s College Hospital NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NIHR or the department of health and social care. RAE has received support or honoria from Boeringher Ingelheim and is a member of the ERS Group 01.02 Pulmonary Rehabilitation. TC is the author of several self-help books on chronic fatigue for which she has received royalties. TC (KCL) has received ad hoc payments for workshops carried out in long-term conditions. TC is on the Expert Advisory Panel for Covid-19 Rapid Guidelines. She is also in receipt of grants from NIHR and St Thomas’ Charity. TC collaborates with The Post-hospitalisation Covid-19 Study. TC is the Director of the Persistent Physical Symptoms Service. There are no other relationships or activities that could have influenced the submitted work.
Publisher Copyright:
© 2023 BMJ Publishing Group. All rights reserved.
PY - 2023/4/26
Y1 - 2023/4/26
N2 - Objectives Fatigue 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. Methods Embase, 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 I 2 statistic. Egger's tests for publication bias. Results Database 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, I 2 =98%). Fatigue significantly reduced over time (-0.057, 95% CI: -107 to -0.008, k=35, I 2 =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, I 2 =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. Conclusion This 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 number CRD42020201247.
AB - Objectives Fatigue 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. Methods Embase, 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 I 2 statistic. Egger's tests for publication bias. Results Database 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, I 2 =98%). Fatigue significantly reduced over time (-0.057, 95% CI: -107 to -0.008, k=35, I 2 =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, I 2 =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. Conclusion This 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 number CRD42020201247.
KW - fatigue
KW - Covid 19
UR - http://www.scopus.com/inward/record.url?scp=85158873430&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2022-063969
DO - 10.1136/bmjopen-2022-063969
M3 - Article
SN - 2044-6055
VL - 13
JO - BMJ Open
JF - BMJ Open
IS - 4
M1 - e063969
ER -
