Keywords: COVID; Rehabilitation; Fatigue
Purpose: People hospitalised with COVID-19 may experience ongoing symptoms of anxiety and fatigue. It is often difficult for people with lasting symptoms to return to routine activities of daily living. Additionally, national lockdown measures have limited people's working situations, social life and support networks. The combination of lasting symptoms and changes in lifestyle may lead to an increased prevalence of anxiety and/or fatigue. Being hospitalised, and on bed rest, surrounded by an unfamiliar environment (noisy, hot) may be among other factors leading to increased fatigue and/or anxiety. There is little known about the interaction between fatigue and anxiety in people post COVID-19. This study aims to explore the interaction between fatigue and anxiety in people who have been discharged following a COVID-19 admission.
Methods: People discharged following COVID-19 were followed up by telephone to assess their individual rehabilitation needs as part of their routine clinical care. People consented to an observational cross-sectional study to allow for data analysis. The Hospital Anxiety and Depression Scale (HADS) and the Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scale were completed. Data was analysed using an independent t-test using the HADS Anxiety (HADS-A) and FACIT. The data was stratified on their level of anxiety based on ≥11 or <11 as high or low anxiety respectively. For fatigue, the data was grouped as “severe fatigue” or “not severe fatigue” based on <30 or ≥30 on the FACIT respectively.
Results: 300 people who had COVID-19 completed the questionnaires (56% male, mean [SD] age 58.11 [13.53]). The mean [SD] length of hospital stay was 10.27 [15.41] days and the mean number of days from discharge to telephone follow up was 45 [31] days. The mean [SD] FACIT score was 30.55 [13.67] and HADS-A was 4.29 [4.86].147 (49%) people had severe fatigue and 69 (23%) scored HADS-A of ≥11. There was a statistically significant difference in the FACIT for those with high anxiety (26.50 [12.05]) compared to the group with low anxiety (31.21 [13.82]), P = 0.04. There was a statistically significant difference in the HADS-A in those with severe fatigue (5.29 [5.12]) compared to those without severe fatigue (3.43 [4.46]), P < 0.01.
Conclusion(s): 49% of people discharged from hospital following COVID-19 had severe fatigue, and 23% had high anxiety. When stratified by the level of fatigue, people with severe fatigue had higher anxiety scores. When stratified by the level of anxiety, people with higher anxiety had severe fatigue scores. There were statistically significant differences between the severe fatigue and not severe fatigue groups in HADS-A scores but both groups had low levels of anxiety.
Impact: These results demonstrate the interaction of fatigue and anxiety, and those with severe fatigue tend to be more anxious. This is an important consideration for the management of post COVID-19, where people may present with complex symptoms of both fatigue and anxiety. Rehabilitation programmes should aim to include strategies to manage fatigue and anxiety.
Funding acknowledgements: Nil funding.