PASC fatigue assessment recommendations

Number	Statement
1	Patients should be assessed for fatigue patterns throughout their normal day to guide activity recommendations.
1a	Patients should be assessed for their responses to initiating and escalating activity on their fatigue.
1b	Patients should be evaluated for changes in daily functioning and activity levels.
1c	Patients' physical functioning and endurance should be assessed to inform activity and therapy recommendations. (Examples of tests that can be chosen based on an individual's activity tolerance: 30 s sit to stand^[1]; 2-min step (seated or standing)^[2]; 6-min walk test^[3]; 10 m walk test^[4]).
2	Clinicians should assess for changes in activities of daily living, independent activities of daily living, school, work, and avocational (ie, hobbies).
3	A full patient history with review of pre-existing conditions should be conducted.
4	Patients should be evaluated for conditions that may exacerbate fatigue symptoms and warrant further testing and potential subspecialty referral. Particular areas include: Sleep Mood, including anxiety, depression, and PTSD. NOTE: Patients often report dissatisfaction with their care because of their persistent symptoms being attributed to psychological factors. It is important to note that mood disorders may be secondary to persistent medical issues or one of many factors leading to fatigue. Cardiopulmonary Autoimmune Endocrine
5	A medication review should be conducted to investigate medications that may be contributing to fatigue. Of note, antihistamine, anticholinergic, and antidepressant/anxiolytic medications can contribute to fatigue in patients with PASC.
6	The following basic laboratory workup should be considered in new patients or those without laboratory workup in the 3 months before visit including complete blood count with differential, chemistries including renal and hepatic function tests, thyroid-stimulating hormone, c-reactive protein or erythrocyte sedimentation rate, and creatinine kinase. Other laboratory tests may be considered based on the results of these tests or if there is specific concern for comorbid conditions.

PASC: postacute sequelae of SARS-CoV-2 infection; PTSD: post-traumatic stress disorder.

References:

Rikli RE, Jones CJ. Development and validation of criterion referenced clinically relevant fitness standards for maintaining physical independence in later years. Gerontologist 2013; 53:255.
Bohannon RW, Crouch RH. Two-minute step test of exercise capacity: Systematic review of procedures, performance, and clinimetric properties. J Geriatr Phys Ther. 2019; 42:105.
Rikli R, Jones CJ. The reliability and validity of a 6-Minute Walk Test as a measure of physical endurance in older adults. J Aging Phys Act 1998; 6:363.
Tyson S, Connell L. The psychometric properties and clinical utility of measures of walking and mobility in neurological conditions: A systematic review. Clin Rehabil 2009; 23:1018.

From: Herrera JE, Niehaus WN, Whiteson J, et al. Multidisciplinary collaborative consensus guidance statement on the assessment and treatment of fatigue in postacute sequelae of SARS-CoV-2 infection (PASC) patients. PM R 2021; 13:1027. https://onlinelibrary.wiley.com/doi/10.1002/pmrj.12684. Copyright © 2021 John Wiley & Sons Ltd. Reproduced with permission of John Wiley & Sons Inc. This image has been provided by or is owned by Wiley. Further permission is needed before it can be downloaded to PowerPoint, printed, shared or emailed. Please contact Wiley's permissions department either via email: [email protected] or use the RightsLink service by clicking on the 'Request Permission' link accompanying this article on Wiley Online Library (https://onlinelibrary.wiley.com/).

Graphic 134334 Version 1.0

خرید پکیج

PASC fatigue assessment recommendations