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Kuut TA, Müller F, Aldenkamp A, Assmann-Schuilwerve E, Braamse A, Geerlings SE, Gibney KB, Kanaan RAA, Nieuwkerk P, Olde Hartman TC, Pauëlsen D, Prins M, Slieker K, Van Vugt M, Bleeker-Rovers CP, Keijmel SP, Knoop H. A randomised controlled trial testing the efficacy of Fit after COVID, a cognitive behavioural therapy targeting severe post-infectious fatigue following COVID-19 (ReCOVer): study protocol. Trials 2021; 22:867. [PMID: 34857010 PMCID: PMC8637041 DOI: 10.1186/s13063-021-05569-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/26/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) results in debilitating long-term symptoms, often referred to as Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), in a substantial subgroup of patients. One of the most prevalent symptoms following COVID-19 is severe fatigue. Prompt delivery of cognitive behavioural therapy (CBT), an evidence-based treatment that has shown benefit in reducing severe fatigue in other conditions, may reduce post-COVID-19 fatigue. Based on an existing CBT protocol, a blended intervention of 17 weeks, Fit after COVID, was developed to treat severe fatigue after the acute phase of infection with SARS-CoV-2. METHOD The ReCOVer study is a multicentre 2-arm randomised controlled trial (RCT) to test the efficacy of Fit after COVID on severe post-infectious fatigue. Participants are eligible if they report severe fatigue 3 up to and including 12 months following COVID-19. One hundred and fourteen participants will be randomised to either Fit after COVID or care as usual (ratio 1:1). The primary outcome, the fatigue severity subscale of the Checklist Individual Strength (CIS-fatigue), is assessed in both groups before randomisation (T0), directly post CBT or following care as usual (T1), and at follow-up 6 months after the second assessment (T2). In addition, a long-term follow-up (T3), 12 months after the second assessment, is performed in the CBT group only. The primary objective is to investigate whether CBT will lead to a significantly lower mean fatigue severity score measured with the CIS-fatigue across the first two follow-up assessments (T1 and T2) as compared to care as usual. Secondary objectives are to determine the proportion of participants no longer being severely fatigued (operationalised in different ways) at T1 and T2 and to investigate changes in physical and social functioning, in the number and severity of somatic symptoms and in problems concentrating across T1 and T2. DISCUSSION This is the first trial testing a cognitive behavioural intervention targeting severe fatigue after COVID-19. If Fit after COVID is effective in reducing fatigue severity following COVID-19, this intervention could contribute to alleviating the long-term health consequences of COVID-19 by relieving one of its most prevalent and distressing long-term symptoms. TRIAL REGISTRATION Netherlands Trial Register NL8947 . Registered on 14 October 2020.
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Affiliation(s)
- T A Kuut
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
- Amsterdam University Medical Centers, Expert Center for Chronic Fatigue, Department of Medical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - F Müller
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - A Aldenkamp
- Department of Lung Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | | | - A Braamse
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S E Geerlings
- Department of Internal Medicine, Division Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - K B Gibney
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, and Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - R A A Kanaan
- Department of Psychiatry, University of Melbourne, Austin Health, Heidelberg, Australia
| | - P Nieuwkerk
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - T C Olde Hartman
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D Pauëlsen
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - M Prins
- Department of Internal Medicine, Division Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - K Slieker
- Department of Internal Medicine, Bernhoven, Uden, The Netherlands
| | - M Van Vugt
- Division of Internal Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - C P Bleeker-Rovers
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - S P Keijmel
- Department of Internal Medicine, Radboud university medical center, Nijmegen, The Netherlands
| | - H Knoop
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam University Medical Centers, Expert Center for Chronic Fatigue, Department of Medical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Badrising SK, Keijmel SP, Kok B. [Awake prone positioning in covid-19 patients]. Ned Tijdschr Geneeskd 2021; 165:D5634. [PMID: 33651518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Awake prone positioning in COVID-19 patients with respiratory failure has been applied worldwide. We hypothesize that early intervention of awake prone positioning in this patient category might avoid invasive mechanical ventilation and referral to ICU. We observed approximately 30 patients in Suriname in whom awake prone positioning was applied. Also, we reviewed the existing literature on awake prone positioning and discussion of the advantages and disadvantages of this relatively simple intervention. Prospective studies show an improvement in oxygenation, albeit sometimes temporary, but not a reduction in mortality rate or intubation. Mean duration of symptoms in these studies is 10-11 days. Awake prone positioning in COVID-19 patients with a longer duration of symptoms does not improve survival or need for intubation. No prospective studies on early prone position in COVID-19 patients have been conducted yet.
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Affiliation(s)
| | - S P Keijmel
- Radboudumc, afd. Interne Geneeskunde, Nijmegen
| | - B Kok
- Radboudumc, afd. Interne Geneeskunde, Nijmegen
- Contact: B. Kok
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Reukers DFM, van Loenhout JAF, Roof I, Senden TF, Keijmel SP, Bleeker-Rovers CP, van Jaarsveld CHM, Hautvast JLA, van der Velden K. Impact of Q-fever fatigue syndrome on patients' work status. Occup Med (Lond) 2020; 70:578-585. [PMID: 33073289 PMCID: PMC7732754 DOI: 10.1093/occmed/kqaa166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Chronic illnesses can increase the risk of unemployment, but evidence on the specific impact of Q-fever fatigue syndrome (QFS) on work is lacking. Aims The aim of this study was to describe and quantify the impact of QFS on work. Methods Changes in work status from 1 year prior to 4 years after acute Q-fever infection of QFS patients were retrospectively collected with a self-report questionnaire measuring employment status and hours of paid work per week. In addition, information on work ability, job satisfaction and need for recovery after work was collected in 2016. Data were compared to participants from the general population. Results The proportion of employed QFS patients from 1 year prior to 4 years after acute infection decreased from 78 to 41%, while remaining relatively constant in the general population (82 to 78%). Working QFS patients showed a decrease in mean hours of paid work from 35 to 22 h per week, which is significantly steeper compared to the general population (31–28 h per week) (P < 0.001). QFS patients showed a significantly lower work ability (P < 0.001), lower job satisfaction (P = 0.006) and greater need for recovery (P < 0.001) compared to the general population. Conclusions The number of QFS patients with paid work decreased over the years, while patients who continue to work experience lower work ability, job satisfaction and increased need for recovery. Occupational physicians should be aware of the occurrence and severity of the impact of QFS on work, even after many years.
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Affiliation(s)
- D F M Reukers
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - J A F van Loenhout
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Center for Research on the Epidemiology of Disasters (CRED), Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - I Roof
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - T F Senden
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Department of Neurology, Radboud University Medical Center, Donders Institute for Brain Cognition and Behaviour, Nijmegen, The Netherlands
| | - S P Keijmel
- Department of Internal Medicine, Radboud University Medical Center, Radboud Expertise Center for Q-fever, Nijmegen, The Netherlands
| | - C P Bleeker-Rovers
- Department of Internal Medicine, Radboud University Medical Center, Radboud Expertise Center for Q-fever, Nijmegen, The Netherlands
| | - C H M van Jaarsveld
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - J L A Hautvast
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - K van der Velden
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Keijmel SP, Maas JJ, de Vries E, Hautvast JLA, Bleeker-Rovers CP, Timen A. [Revision of guideline on Q fever fatigue syndrome (QFS)]. Ned Tijdschr Geneeskd 2020; 164:D4551. [PMID: 32073803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In 2012 the multidisciplinary guideline Q fever fatigue syndrome was developed for the Netherlands. The availability of new research data and developments and experiences from daily clinical practice made it necessary to revise this guideline. The multidisciplinary working group that has revised the guideline is composed of representatives from all medical professions involved in the care of patients with QFS and representatives of the patients' association. The revised guideline incorporates a number of changes, including refinement of the QFS diagnostic criteria and updates regarding advice on support and reintegration.
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Affiliation(s)
- S P Keijmel
- Radboudumc, Nijmegen: afd. Interne Geneeskunde
- Contact: S. P. Keijmel
| | - J J Maas
- Amsterdam UMC, afd. Arbodienst AMC & Coronel instituut
| | - E de Vries
- Tilburg University, afd. Kindergeneeskunde
| | | | | | - A Timen
- Rijksinstituut voor Volksgezondheid en Milieu, Landelijke Coördinatie Infectieziektebestrijding, Bilthoven
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