Occupational therapy-based self-management education in persons with post-COVID-19 condition related fatigue: a feasibility study with a pre-post design

Figures & data

Table 1. Description of energy management education (EME).

Structure	Delivery modality/duration	Topics
Session 1	Individual face-to-face/45–60 min	Energy account
Session 2–6	Peer group (2–5 participants)/75 min plus a break in between/1 per week	Break management; Occupational balance; Use of body and environment; Simplifying activities; Effective communication
Session 7	Individual face-to-face/45 min	My goals
Booster	Email, eight weeks after session 7	Review & reinforce

Figure 1. Study flowchart. EME: Energy Management Education; L: Lesson; SEPECSA: Self-efficacy for Performing Energy Conservation Strategies Assessment; MFIS: Modified Fatigue Impact Scale; OSA: Occupational Self-Assessment; SF36: Medical Outcome Study 36-item Short Form Health Survey; BCEM-S: Behavior Change in Energy Management – Survey.

This feasibility study had a pre-post design. 13 out of 30 eligible persons referred to EME declined to participate. Seventeen candidates were included and completed four self-reported assessments at the start of the EME and week seven after, post-intervention. The follow-up was contemporaneous with the EME booster letter at week 15; 13 persons completed the four assessments. At week 24, the Behavior Change in Energy Management – Survey was completed by 12 study participants.

Table 2. Sociodemographic characteristics of the study participants.

Gender (female/male/other): n (%)	11/6/0 (65/35/0)
Age (year): mean (SD)/median	44.1 (10.5)/45
Min – max	24–63
High level of fatigue (MFIS >39): (n)	16/17
Housing (alone/co-housing): n (%)	6/11 (35/65)
Children <18 age: n	7
Level of education (school years), n (%)
Lower-secondary education (<12)	1 (6)
Upper-secondary education (12–16)	5 (29)
Tertiary level education (>16)	10 (59)
Not stated	1 (6)
Current professional activities: n (%)	n
On medical leave	10 (59)
Fulltime work (95–100%)	1 (6)
Part-time work	5 (29)
Unemployed	1 (6)
Student	0 (0)
Retired	0 (0)
Family work	0 (0)
Onset COVID-19 infection (months): mean (SD)	12.6 (6.3)
Min – max	2–18

Table 3. Outcome data for self-efficacy, fatigue impact, competency in ADL, and QoL.

	BL (n = 17)	T1 (n = 17)	T2 (n = 13)	Within-subject effect: sig^d (partial η^2)
SEPECSA
Mean (SD)	5.66 (1.83)	7.40 (1.09)	7.56 (1.37)	<0.001^a (0.636)
95% CI	4.56; 6.77	6.74; 8.05	6.73; 8.39
Within-group Δ from BL [95% CI]^b		1.731^a [2.73; 0.73]	1.896^a [2.89; 0.90]
Within-group Δ from T1 [95% CI]^c			0.17 [8.4; −0.51]
MFIS
Mean (SD)	60.31 (4.22)	53.15 (4.07)	49.61 (5.40);	0.030^a (0.254)
95% CI	51.11; 69.51	44.28; 62.03	37.86; 61.37
Within-group Δ from BL [95% CI]^b		−7.15 [4.41; −18.71]	−10.69 [2.27; −23.66]
Within-group Δ from T1 [95% CI]^c			−3.53 [2.35; −9.42]
OSA
Mean (SD)	49.92 (10.26)	52.85 (9.48)	55.23 (9.63)	0.022^a (0.272)
95% CI	43.72; 56.12	47.12; 58.57	49.41; 61.05
Within-group Δ from BL [95% CI]^b		2.93 [7.29; −1.44]	5.31 [10.90; −0.29]
Within-group Δ from T1 [95% CI]^c			2.38 [7.16; −2.39]
SF36 PCS
Mean (SD)	27.69 (16.40)	26.87 (14.10)	31.96 (14.96)	0.171 (0.137)
95% CI	17.78; 37.60	18.35; 35.40	22.93; 41.00
Within-group Δ from BL [95% CI]^b		−0.82 [5.97; −7.60]	4.28 [11.60; −3.05]
Within-group Δ from T1 [95% CI]^c			5.09^a [10.18; 0.006]
SF36 MCS
Mean (SD)	36.22 (14.85)	39.00 (12.42)	37.50 (14.99)	0.693 (0.030)
95% CI	27.24; 45.20	31.50; 46.52	28.44; 46.56
Within-group Δ from BL [95% CI]^b		2.79 [9.17; −3.59]	1.28 [13.33; −10.78]
Within-group Δ from T1 [95% CI]^c			−1.51 [6.02; −9.04]

^aSignificant at the .05 level.

^bΔ = T1/2 − BL

^cΔ = T2 − T1

^dAdjustment for multiple comparisons: Bonferroni.

Figure 2. Energy management strategies in use before and after EME. EME: Energy Management Education.

A histogram showing which out of the 14 different energy management strategies were used by the EME participants before starting EME and two months after. The main changes regard the stable use of regular rest periods (+ 6), simplifying the execution of activities (+4), and changing the equipment location (+3).