Abstract Objective Long COVID encompasses a range of symptoms in which fatigue is one of the most prevalents. It is clear from other conditions that the definition and measurement of fatigue can be complex, but it is not clear how fatigue is defined and measured in long COVID. To advance our understanding, this review summarises the definitions and measures of long COVID fatigue being used by researchers. Design Scoping review following JBI methodology and reports using the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping reviews. Data sources Medline, Scopus, CINAHL, PsycINFO, EMCARE, Web of Science, Epistemonikos, Cochrane Central Register of Controlled Trials, Dimensions, Overton and ProQuest Dissertation & Theses Database were searched from January 2020 to May 2023. Eligibility criteria This review included quantitative and qualitative studies that included any definition of long COVID and/or measurement tool that purported to quantify either the impact, severity or symptoms of long COVID fatigue. Data extraction and synthesis Two independent reviewers screened the title, abstracts and full texts of the selected studies based on the inclusion criteria. Data extraction was performed by two independent reviewers. The data were summarised in tabular format and a narrative summary. Results The search retrieved 9839 studies, of which 57 met the inclusion criteria. Only 21 (37%) provided a definition of fatigue. Definitions ranged across physical, mental, cognitive, emotional, psychosocial, central, peripheral, postexertional symptom exacerbation and general dimensions of fatigue. Fifty-five (96%) used a measurement or assessment of fatigue. Twenty-six measures of fatigue were identified: 21 self-report measures (eg, Fatigue Assessment Scale) and five fatigability measures that purport to reflect changes in physiological processes that contribute to or reflect fatigue (eg, change in force generating capacity of a muscle). Conclusions The definitions identified demonstrate considerable diversity, each highlighting different dimensions of long COVID fatigue. Long COVID fatigue was predominantly measured through self-report methods, which were problematic. There is an urgent need to better understand long COVID fatigue and to identify the different mechanisms involved. In order to do this, we need consistency with the language around fatigue and its measurement within research and across disciplines. Open access, https://bmjopen.bmj.com/content/14/12/e088530
"Definitions of long COVID fatigue Only 21 of the 57 studies (37%) provided a definition of fatigue (table 2). These definitions have been mapped to categories based on the terms provided within them, following the framework proposed by Billones et al,16 which includes physical, cognitive and mental. Due to the use of novel terms in the reviewed definitions, two additional categories have been included: postexertional symptom exacerbation (PESE) and psychological fatigue. Post-PESE, which encompasses postexertional malaise, is used in X of the included studies to refer to an exacerbation of multiple symptoms due to exertion. Although PESE involves a worsening of multiple symptoms, the worsening of fatigue is typically a core component,82 making it essential for understanding the complexity of fatigue in long COVID." So postexertional malaise isn't postexertional symptom exacerbation but is included in post-postexertional symptom exacerbation. Surely post-postexertional symptom exacerbation would be when the symptom exacerbation has ended?
Well, this grammar does not inspire confidence. Does anyone read the first line of the abstract these days?
At least it wasn't AI-generated; ChatGPT would have put a random number in rather than a placeholder.
I thought they were inventing a new thing for a second, but it's another typo. Quite a bad one too. I really wish co-authors and reviewers would read the paper in front of them.
"Given that fatigue is such a core component of PESE and long while PESE is not a type of fatigue in itself, in the studies that we have found here, it is often being used in, it is often being used as a measure of fatigue." Are you telling me 7 co-authors and 2 or 3 reviewers have read this sentence? I'd actually quite like to read this when able, but I worry the whole paper will be like this.
Understanding was not, unfortunately, advanced. It may, in fact, have died a little inside. Probably after lots of crying and vomiting. Or, why not, some scromiting. Which is not a thing but whatever we'll make an exception here. Of all the problems with distorting this complex illness using the single symptom of fatigue, the fact that medicine is completely lost as to what it even means is up there as a top historical blunder. Specifically or generically, they don't have a clue what they're talking about, what it even means and even less so how it affects people. Not because it's too hard to understand, in fact probably mostly because it is easy to understand, but that they simply can't accept what it actually is, and have to constantly distort it in various ways to fit different agendas. They need it to be some easy thing you can just talk or walk through. But it just isn't, and they can't accept that, having built an entire whole-ass ideology and industry around this complete psychobehavioral nonsense. There is a common trope in TV and films that I think only exists in the US, where people who have no idea how to begin a speech start with the line "Webster's dictionary defines X as ..." and it's supposed to be cringeworthy. But here, no, literally just go look in a dictionary, any dictionary, not even a medical dictionary, just normal people dictionary, and understanding will not feel a deep-seated need to stab itself in the face with a spork. Even though, yes, you cannot reduce this experience to a single thing, because it is a, wait for it, holistic problem. Meaning affecting the whole, not the standard modern version that means "here's a bunch of made-up pseudoscientific woowoo that means it's not our or anyone's problem but the patient's". Of all the people who have ever been lost in history, no one has ever been lost more than the medical profession is at dealing with symptoms. Which happens to be half the job. And explains a lot about why things there are enshittifying apparently faster than anywhere else. Even accounting for an acceleration of enshittification everywhere, it's just enshittifying faster here than anywhere else.
Yes, I looked up the author and she is a PhD student. Her co-authors — some of whom will likely be her PhD supervisors — should be making sure the paper is not littered with trivial, and more important, mistakes. They should have raised concerns with the journal that Reviewer 1 wasn't doing their job and that the review almost certainly doesn't meet journal guidelines. I know there is pressure to publish, but this makes a mockery of the system. I have been in that situation, waiting patiently for reviews to come in on my first paper as a PhD student, and I'd have been gutted if I got that review back, because it signals that the reviewer couldn't even be bothered to read the manuscript. The second review is fine — someone's put quite a bit of work into it.
