NHS Glos. ICS: Long COVID – Impacting Fatigue

80% of Participants Report Improvements in their Self-Efficacy to Manage Fatigue


In addition to the results published in our report of June 2022 for referrals from the NHS Gloucestershire ICS Long COVID recovery pathway, we’ve conducted a secondary analysis that offers deeper insights into patient impact.

All KiActiv® Health participants are asked to complete a patient reported outcome measures (PROMs) questionnaire consisting of multiple validated scales both pre and post 12-week programme. This enables us to gauge the impact of the programme on various metrics, including quality of life, mental wellbeing and self-efficacy.

At the time of analysis, 109 participants have started their KiActiv® Health programme, of which 72 (66%) have completed and 28 (26%) remain within their initial 12 weeks. Of the 72 completers, 44 (61%) have completed both the pre and post PROMs questionnaire.

PROMs Analysis – Self-Efficacy for Managing Fatigue 

Group Split

Individuals suffering from Long COVID typically report lingering fatigue as one of their primary symptoms. One particular question within the self-efficacy section of our questionnaire focusses on the individual’s self-efficacy when it comes to managing their fatigue:

This question originates from the self-efficacy for managing chronic disease scale, a validated metric commonly used to assess self-efficacy, and asks the patient to rate their self-efficacy for managing fatigue between 1-10 (1 being low and 10 being high). We analysed a group of 44 participants who had completed both the pre and post version of the questionnaire (from a possible 72 completers; 61% response rate) to assess whether an individual’s self-reported self-efficacy for managing their fatigue at baseline had any impact on their experience and outcomes whilst participating in KiActiv® Health.

To conduct the analysis, participants were split into three different groups depending on their response to the self-efficacy for managing fatigue question in the pre-questionnaire. The following categories were defined:

  • High self-efficacy for managing fatigue – a score of 7-10 (n=5)
  • Moderate self-efficacy for managing fatigue – a score of 4-6 (n=19)
  • Low self-efficacy for managing fatigue – a score of 1-3 (n=20)

Changes to Distribution of Participants Between Self-Efficacy Groups

The general distribution of participants across self-efficacy groups at pre-programme and at post-programme is shown in Figure 1 (below). Please note, self-efficacy scores were sorted in ascending order to display distribution, so participant #1 in pre-graph (top) is not necessarily participant #1 in post-graph (bottom) and so on.

Figure 1: Distribution of self-efficacy for managing fatigue scores at pre and post (n=44). Light blue dashed lines indicate thresholds between low, moderate and high self-efficacy. Pre-score distribution indicated in top graph; post-score distribution indicated in bottom graph.  

In the pre-programme questionnaire, 20 participants (45%) were classified in the low self-efficacy to manage their fatigue group (see Figure 2, below). Impressively, only 4 participants (9%) remained in the low self-efficacy group, with all others progressing into the moderate or high self-efficacy groups by the end of their 12-week programme (see Figure 2, below). Similarly, 84% of participants classed as having moderate self-efficacy to manage their fatigue were able to progress into the high self-efficacy for managing their fatigue by the end of the 12-week programme. Pre-programme, just 5 participants (11%) were in the high self-efficacy group. Post-programme, this had increased to 27 participants (61%) (see Figure 2, below).

Figure 2:  Group split for self-efficacy for managing fatigue scores at pre and post (n=44). Data labels above light blue bars denote % split at pre; Data labels above dark blue bars denote % split at post.

Changes to Self-Efficacy Score

Participants in the low self-efficacy group exhibited the greatest overall improvement, followed by the moderate and high self-efficacy groups, respectively (see Figure 3, below). Individuals reporting low self-efficacy in the pre-programme questionnaire reported a six-fold greater improvement compared to their counterparts from the high self-efficacy group pre-programme. Despite this, it’s clear that self-efficacy was improved across the board, with those in the high group at baseline maintaining a high level of self-efficacy for managing their fatigue post-programme.

Figure 3:  Self-efficacy for managing fatigue score pre vs. post, grouped by self-efficacy to manage fatigue at baseline (n=44). Data labels denote average change between pre-post self-efficacy scores for each group.

Changes to Quality-of-Life Score

Similarly, participants who self-reported low self-efficacy at baseline saw the greatest improvements in quality of life, measured using the WHOQOL-Bref combined score (see Figure 4, below). For context, a +0.876 or greater increase is deemed ‘clinically meaningful,’ which means individuals in the low and moderate self-efficacy for managing fatigue groups at baseline both saw clinically meaningful increases in their quality of life, on average. Although the high self-efficacy group did not make a clinically meaningful increase, their average quality-of-life score was high to begin with. This was sustained post-programme, with this group recording the highest average quality-of-life score of all 3 groups (see Figure 4, below).

Figure 4:  WHOQOL-Bref combined Quality of Life score pre vs. post, grouped by self-efficacy to manage fatigue at baseline (n=44). Data labels denote average change between pre and post Quality of Life scores for each group.

Changes to Mental Wellbeing Score

We assess mental wellbeing using the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Participants in the moderate self-efficacy for managing fatigue at baseline group saw the biggest post-programme improvements in SWEMWBS, closely followed by those in the low self-efficacy group (see Figure 5, below). For context, an improvement of 1.0 or greater is considered ‘statistically important,’ which means that all 3 groups saw statistically important improvements to their mental wellbeing.

Figure 5:  Short Warwick Edinburgh Mental Wellbeing score (SWEMWBS) pre vs. post, grouped by self-efficacy to manage fatigue at baseline (n=44). Data labels denote average change between pre and post mental wellbeing scores for each group.

Self-Efficacy – Impact on Engagement Analysis

On average, the low self-efficacy to manage fatigue group visited the platform over three times more frequently than the high self-efficacy group (see Figure 6, below). Whilst further analysis is required here, this could be explained by the low self-efficacy group having a greater need to utilise the technology to support them in managing their fatigue-related symptoms. It’s important to recognise the difference in group size here too, as low (n=20), moderate (n=19) and high (n=5) group weightings may have influenced these outcomes.

Figure 6: Average percentage platform visit days within each group logged into the platform (n=44). A higher number indicates a greater level of engagement. The programme consists of 84 days. However, participants only get access to their platform after their baseline week. This means that platform visit days are expressed as a percentage of 77 days. Grouped by self-efficacy to manage fatigue at baseline. Low (n=20); Moderate (n=19); High (n=5). Data labels denote y-axis value.

KiActiv® Health Evaluation Questionnaire

A second questionnaire is sent to all participants post-programme, presenting an opportunity for them to provide further feedback on the programme. At the time of analysis, 34 from a possible 72 participants (47%) had taken the opportunity to provide feedback using the evaluation questionnaire. Further analysis showed that the vast majority of participants felt that they had improved their understanding of everyday physical activity, were now confident in managing their own health and physical activity, and felt that KiActiv® Health had benefitted them in some way (see Figure 7, below).

Figure 7: Percentage of participants who answered “yes” to the above question within their KiActiv® Health post-programme evaluation questionnaire (n=34). PA = physical activity.

25th July 2022