Harriet McCaffrey Specialist Physiotherapist Dr Marta Prytys Clinical Psychologist Locomotor MECFS Service Aims What is post COVID syndrome Top tips and tools F atigue management interventions ID: 1047254
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1. GP Fatigue teaching16.12.2020 Harriet McCaffrey, Specialist Physiotherapist Dr Marta Prytys, Clinical PsychologistLocomotor ME/CFS Service
2. Aims What is post COVID syndromeTop tips and tools Fatigue management interventions Parallels with ME/ CFS
3. Post-COVID Syndrome DefinitionSigns and symptoms that develop during or following an infection consistent with COVID-19 which continue for more than 12 weeks and are not explained by an alternative diagnosis. The condition usually presents with clusters of symptoms, often overlapping, which may change over time and can affect any system within the body. Many people with post-COVID syndrome can also experience generalised pain, fatigue, persisting high temperature and psychiatric problems. Post-COVID-19 syndrome may be considered before 12 weeks while the possibility of an alternative underlying disease is also being assessed.
4. Post COVID syndrome67%GPs report looking after patients with symptoms 12 weeks+FatigueBreathlessnessAnxiety(NHS England, 2020)DYSREGULATION10%of patients are still experiencing symptoms 3 weeks after infection
5. VERY rough timeframes
6. (Long-COVID Symptoms study, 2020)Patient reported Symptoms of Post-COVID syndromeExtreme fatigue and exhaustion Post-exertional malaiseShort term memory problemsPalpitations Gut issuesShortness of breathJoint and muscular painSkin changesIssues with temperature regulationHeadachesIssues with concentration, “brain fog”Sore throat
7. Features of ME/ CFS How patients can present Extreme fatigue and exhaustion Post-exertional malaiseUn-refreshing sleep/ sleep disturbance HeadachesSore throat Flu/ cold like malaise Short term memory problemsIssues with concentrationDizziness Nausea Palpitations Orthostatic intolerance Gut issuesTender Lymph nodesDYSREGULATION
8. Immune system Autonomic Nervous SystemNeuroendocrine System (HPA axis)Metabolic process i.e. energy productionTheories of dysregulation in ME/ CFS
9. Biopsychosocial context StressLow mood Anxiety
10. BUT…..There are parallels between ME/CFS and Post Covid SyndromeA note of cautionSymptomsFemale to male biasMaintaining factorsHelpful interventions???
11. Key elements of fatigue interventionPsycho-education about fatigueEstablish individualised goalsValidate lived experienceConfirming diagnosis- understanding pathwayActivity management- pacingEmotional wellbeing
12. Some more “top tips” for fatigue management
13. To consider:Explain fatigue in simple termsCommunication skillsListen and help them make sense of thingsConsider the context- theirs and yoursTry using metaphorsCompassion
14. The body battery and pacingAvoid the boom and bustSet a realistic stable baseline and daily routine Start increasing activity in tiny amounts once you feel ready – pick one thingPace – Plan - PrioritiseRest/Keep charging it up before exhaustionChunking/Set the limitsSave 30% in the bottom
15. Post COVID syndrome has similar features to ME/ CFSConclusions Novel virus and limited researchCommunication is important Existing tools for fatigue management Thinking carefully about diagnostic labelsLocal and national development of pathways
16. Helpful resources patient resourcesBACME Post-viral fatigue advice:https://www.bacme.info/sites/bacme.info/files/BACME%20Post%20Viral%20Fatigue%20A%20Guide%20to%20Management%20May2020.pdfMy COVID Recovery https://www.yourcovidrecovery.nhs.uk/ Homerton links to managing fatigue post COVIDhttps://www.homerton.nhs.uk/covid-recovery-and-rehabilitation ACT mindfully/ Dropping anchor free audios:https://www.actmindfully.com.au/free-stuff/free-audio/
17. Resources for GPsNICE, RCGP, SIGN Guideline Scope:https://www.nice.org.uk/guidance/gid-ng10179/documents/final-scope NHS England & NHS Improvement National Guidance for Post-COVID assessment clinics NHS: https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/10/C0840_PostCOVID_assessment_clinic_guidance_5_Nov_2020.pdf PHE COVID -19 Long-term health effects:https://www.gov.uk/government/publications/covid-19-long-term-health-effects/covid-19-long-term-health-effects Address to Parliament Prof Trish Greenhalgh https://committees.parliament.uk/writtenevidence/12345/pdf/ Open letter to Parliament from LongCOVID SOS:https://3ca26cd7-266e-4609-b25f-6f3d1497c4cf.filesusr.com/ugd/8bd4fe_e3779d8fa84c4c32bbd8ed43d70cd3cf.pdf?index=true ME Association Response on COVID PVFS:https://meassociation.org.uk/wp-content/uploads/MEA-PVF-and-PVFS-Following-Coronavirus-Infection-30.04.20.pdf NICE CFS/ ME Guidelines:https://www.nice.org.uk/guidance/cg53/chapter/1-Guidance
18. Any questions??