Impact of fatigue as the primary determinant of functional limitations among patients with post-COVID-19 syndrome: a cross-sectional observational study.

OBJECTIVES: To describe self-reported characteristics and symptoms of treatment-seeking patients with post-COVID-19 syndrome (PCS). To assess the impact of symptoms on health-related quality of life (HRQoL) and patients' ability to work and undertake activities of daily living. DESIGN: Cross-sectional single-arm service evaluation of real-time user data. SETTING: 31 post-COVID-19 clinics in the UK. PARTICIPANTS: 3754 adults diagnosed with PCS in primary or secondary care deemed suitable for rehabilitation. INTERVENTION: Patients using the Living With Covid Recovery digital health intervention registered between 30 November 2020 and 23 March 2022. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was the baseline Work and Social Adjustment Scale (WSAS). WSAS measures the functional limitations of the patient; scores of ≥20 indicate moderately severe limitations. Other symptoms explored included fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), depression (Patient Health Questionnaire-Eight Item Depression Scale), anxiety (Generalised Anxiety Disorder Scale, Seven-Item), breathlessness (Medical Research Council Dyspnoea Scale and Dyspnoea-12), cognitive impairment (Perceived Deficits Questionnaire, Five-Item Version) and HRQoL (EQ-5D). Symptoms and demographic characteristics associated with more severe functional limitations were identified using logistic regression analysis. RESULTS: 3541 (94%) patients were of working age (18-65); mean age (SD) 48 (12) years; 1282 (71%) were female and 89% were white. 51% reported losing ≥1 days from work in the previous 4 weeks; 20% reported being unable to work at all. Mean WSAS score at baseline was 21 (SD 10) with 53% scoring ≥20. Factors associated with WSAS scores of ≥20 were high levels of fatigue, depression and cognitive impairment. Fatigue was found to be the main symptom contributing to a high WSAS score. CONCLUSION: A high proportion of this PCS treatment-seeking population was of working age with over half reporting moderately severe or worse functional limitation. There were substantial impacts on ability to work and activities of daily living in people with PCS. Clinical care and rehabilitation should address the management of fatigue as the dominant symptom explaining variation in functionality.

A patient-centred check sheet improves communication on the trauma ward round.

BACKGROUND: Effective communication on surgical ward rounds should clarify for patients their management plan and answer questions adequately. Pressures on time conspire against this interchange of information. A patient-centred surgical communication check sheet was devised to enable rapid two-way transfer of information between surgeon and patient. METHODS: A quality improvement project involved three cycles. Through the use of a patient survey, distributed following the daily ward round, areas for improvement in communication were highlighted in cycle one. The surgical communication check sheet was introduced in cycle two, and modified before cycle three following discussion with the orthopaedic department. The surgical communication check sheet was handed out to patients before the ward round, and its efficacy was measured by evaluating ward round communication using the survey as in cycle one. RESULTS: Initial results showed a variable standard of communication, which improved following the introduction of the surgical communication check sheet in cycle two. In cycle three, 84.7% patients felt that the check sheet aided communication on the ward round. Measures of communication improved between cycles one and three: the percentage of patients with unanswered questions fell from 21.8% to 16.7%, the number of patients unsure why a test was done fell from 25.9% to 12.7%, and average understanding of the management plan rose from 64.7% to 83.3%. CONCLUSIONS: The introduction of the surgical communication check sheet improved ward round communication, and was welcomed by almost 85% of patients. Accounts from patients indicate two benefits of the check sheet: the surgeon is immediately aware of a patient with questions or concerns, allowing these to be adequately addressed, and patients can formulate questions before the ward round which bolsters their confidence to ask them.