Design and validation of an energy level diary for fatigue management in patients with post-COVID syndrome

BackgroundPost-COVID syndrome (PCS) is a frequent condition with an incidence of 7.8–10.6 per 100 unvaccinated and 3.5–5.3 events per 100 vaccinated persons. Cognitive and motor fatigue are common clinical manifestations, limiting patients’ occupational, educational, and social activities severely.O...

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Main Authors: Maryam Balke, René Garbsch, Jessica Cormann, Pantea Pape, Frank C. Mooren, Boris Schmitz
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-07-01
Series:Frontiers in Rehabilitation Sciences
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Online Access:https://www.frontiersin.org/articles/10.3389/fresc.2025.1633466/full
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author Maryam Balke
Maryam Balke
René Garbsch
René Garbsch
Jessica Cormann
Pantea Pape
Frank C. Mooren
Frank C. Mooren
Boris Schmitz
Boris Schmitz
author_facet Maryam Balke
Maryam Balke
René Garbsch
René Garbsch
Jessica Cormann
Pantea Pape
Frank C. Mooren
Frank C. Mooren
Boris Schmitz
Boris Schmitz
author_sort Maryam Balke
collection DOAJ
description BackgroundPost-COVID syndrome (PCS) is a frequent condition with an incidence of 7.8–10.6 per 100 unvaccinated and 3.5–5.3 events per 100 vaccinated persons. Cognitive and motor fatigue are common clinical manifestations, limiting patients’ occupational, educational, and social activities severely.ObjectiveThis study aimed to develop a diary to keep record of daily changes in energy levels of patients with PCS to adapt their rehabilitation program.Material and methodsWe conducted a prospective observational study at two German rehabilitation centers in a codesign approach with repeated feedback loops. Daily energy changes were analyzed and validated using the Multidimensional Fatigue Inventory-20 (MFI-20).ResultsThe final diary revealed that morning and evening energy levels of patients with PCS differed significantly, with 49.6 ± 18.6% and 33.4 ± 19.7%, respectively (p ≤ 0.0001, on admission). Energy levels decreased by ∼5% with active therapy and increased by ∼5% with passive therapy (p < 0.0001). A comparison with MFI-20 at discharge showed good negative correlation (r = −0.5358, p < 0.0001), and patient interviews revealed that most patients (N = 19; 95%) rated the diary as “useful for self-reflection” and “helpful tool to learn the process of pacing.”Discussion/conclusionThis diary is a valid and user-friendly tool to detect and control the effects of daily therapy during the rehabilitation of patients with PCS. It will facilitate individual planning and adaptation of therapies in PCS and other fatigue groups and may help to implement an effective relation of exercise load to load capacity (pacing) for optimal coping with the disease and an improved handling of daily activities in patients’ lives. Clinical Trial RegistrationClinicaltrials.gov, identifier (NCT06883500).
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spelling doaj-art-0fcef4e77de54c5e80a9743fcc3d52c32025-08-20T03:28:13ZengFrontiers Media S.A.Frontiers in Rehabilitation Sciences2673-68612025-07-01610.3389/fresc.2025.16334661633466Design and validation of an energy level diary for fatigue management in patients with post-COVID syndromeMaryam Balke0Maryam Balke1René Garbsch2René Garbsch3Jessica Cormann4Pantea Pape5Frank C. Mooren6Frank C. Mooren7Boris Schmitz8Boris Schmitz9Department of Early Neurological Rehabilitation, Cellitinnen Hospital St. Mary Cologne, Cologne, GermanyDepartment of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, GermanyDepartment of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, GermanyDRV Clinic Koenigsfeld, Center for Medical Rehabilitation, Ennepetal, GermanyDepartment of Early Neurological Rehabilitation, Cellitinnen Hospital St. Mary Cologne, Cologne, GermanyDepartment of Early Neurological Rehabilitation, Cellitinnen Hospital St. Mary Cologne, Cologne, GermanyDepartment of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, GermanyDRV Clinic Koenigsfeld, Center for Medical Rehabilitation, Ennepetal, GermanyDepartment of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, GermanyDRV Clinic Koenigsfeld, Center for Medical Rehabilitation, Ennepetal, GermanyBackgroundPost-COVID syndrome (PCS) is a frequent condition with an incidence of 7.8–10.6 per 100 unvaccinated and 3.5–5.3 events per 100 vaccinated persons. Cognitive and motor fatigue are common clinical manifestations, limiting patients’ occupational, educational, and social activities severely.ObjectiveThis study aimed to develop a diary to keep record of daily changes in energy levels of patients with PCS to adapt their rehabilitation program.Material and methodsWe conducted a prospective observational study at two German rehabilitation centers in a codesign approach with repeated feedback loops. Daily energy changes were analyzed and validated using the Multidimensional Fatigue Inventory-20 (MFI-20).ResultsThe final diary revealed that morning and evening energy levels of patients with PCS differed significantly, with 49.6 ± 18.6% and 33.4 ± 19.7%, respectively (p ≤ 0.0001, on admission). Energy levels decreased by ∼5% with active therapy and increased by ∼5% with passive therapy (p < 0.0001). A comparison with MFI-20 at discharge showed good negative correlation (r = −0.5358, p < 0.0001), and patient interviews revealed that most patients (N = 19; 95%) rated the diary as “useful for self-reflection” and “helpful tool to learn the process of pacing.”Discussion/conclusionThis diary is a valid and user-friendly tool to detect and control the effects of daily therapy during the rehabilitation of patients with PCS. It will facilitate individual planning and adaptation of therapies in PCS and other fatigue groups and may help to implement an effective relation of exercise load to load capacity (pacing) for optimal coping with the disease and an improved handling of daily activities in patients’ lives. Clinical Trial RegistrationClinicaltrials.gov, identifier (NCT06883500).https://www.frontiersin.org/articles/10.3389/fresc.2025.1633466/fullpost-COVID-19post-COVID syndromechronic fatigue syndromediary approachneurorehabiliation
spellingShingle Maryam Balke
Maryam Balke
René Garbsch
René Garbsch
Jessica Cormann
Pantea Pape
Frank C. Mooren
Frank C. Mooren
Boris Schmitz
Boris Schmitz
Design and validation of an energy level diary for fatigue management in patients with post-COVID syndrome
Frontiers in Rehabilitation Sciences
post-COVID-19
post-COVID syndrome
chronic fatigue syndrome
diary approach
neurorehabiliation
title Design and validation of an energy level diary for fatigue management in patients with post-COVID syndrome
title_full Design and validation of an energy level diary for fatigue management in patients with post-COVID syndrome
title_fullStr Design and validation of an energy level diary for fatigue management in patients with post-COVID syndrome
title_full_unstemmed Design and validation of an energy level diary for fatigue management in patients with post-COVID syndrome
title_short Design and validation of an energy level diary for fatigue management in patients with post-COVID syndrome
title_sort design and validation of an energy level diary for fatigue management in patients with post covid syndrome
topic post-COVID-19
post-COVID syndrome
chronic fatigue syndrome
diary approach
neurorehabiliation
url https://www.frontiersin.org/articles/10.3389/fresc.2025.1633466/full
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