FATIGUE SCIENCE INFORMING LONG COVID RECOVERY: A CASE STUDY

Abstract

CASE SETTING 42-year-old female client referred for unmanaged long covid symptoms, six months following severe acute COVID-19 infection. Referred by an occupational therapist under Life Insurance to restore health and function for return to work (RTW). Experiencing cognitive and physical fatigue, muscular aches, breathlessness, post-exertional malaise, reduced cognitive capacity and exacerbated asthma symptoms at referral. Reduced functional capacity to perform activities of daily living and usual work duties and hours. TREATMENT/REHABILITATION PROVIDED 14 hours of exercise physiology was delivered by telehealth over nine months, during fortnightly or monthly consultations. Additional multidisciplinary collaboration occurred with occupational therapist, return to work co-ordinator, and general practitioner. The intervention consisted of educational coaching sessions on the physiology of fatigue, pacing strategies, individualised wellness strategies (sleep, mindfulness/relaxation, exercise, diet), relapse planning, and RTW planning. A commercially available wearable device obtained 24/7 biometric data, which tracked resting heart rate variability (rHRV), resting heart rate, respiratory rate, and sleep performance. rHRV objectively measured fatigue. Wellness strategies were coached from analysing the impact of client behaviours on rHRV trends. Two functional goals of housework and socialising were established. RESULTS Validated inventories measured self-reported improvements in; fatigue symptoms: 12-item SPHERE-12, range: 0-68 points [42 baseline; 4 final]; function: two 11-item patient-specific functional scale [housework, socialising], range: 0-20 points [5 baseline; 19 final]; and quality of life: 16-item quality of life scale, range: 0-112 [54 baseline; 79 final]. rHRV improved [10ms baseline, 56ms final]. RTW improved from four days/week to five days/week in her pre-disability role as a client manager. REFLECTIONS/LEARNINGS rHRV provided an objective marker of fatigue. The subject responded positively to rHRV monitoring. Real time biometric data enables individualised fatigue coaching including behaviour change, wellness and planning/pacing strategies. This approach improved fatigue and restored function to perform daily activities and RTW.