Validade e responsividade da escala de fadiga de manchester no pós-Covid

Abstract

Introduction: Fatigue has been the most prevalent symptom reported after the acute resolution of the infection, and with great personal, work, economic and social impact. Therefore, in the absence of a specific standard questionnaire to assess fatigue in COVID19, the Manchester Fatigue Scale for Chronic Obstructive Pulmonary Disease may be a valid alternative since it was developed to assess fatigue in people with respiratory involvement. Objective: To investigate the validity and responsiveness measurement properties of the Manchester Fatigue Scale in people after discharge from hospitalization for COVID19. Methods: Longitudinal observational study involving people immediately after hospital discharge due to COVID19. Fifty-three participants were assessed for spirometry, comorbidities, dyspnea on activity by the Modified Medical Research Council (mMRC), exercise capacity by the Six-Minute Step Test (6MST), quality of life by the Saint George's Respiratory Questionnaire (SGRQ) and depression by the Hospital for Anxiety and Depression (HADS). Concurrent validity was examined by the relationship between EFDM and mMRC scale. The convergent validity was examined by the relationship between the EFMD and other fatigue indicators such as the symptom domain of the SGRQ, with performance and with the perception of fatigue in the 6MST. The discriminant validity of the EFMD was compared with strata of the mMRC symptom scale. EFMD responsiveness was tested by analyzing the effect of time at baseline and after three months of the first assessment. Results: The mean age of participants was 55.3 ± 12.6 years and 52% were men. EFDM fatigue was moderately associated with physical impact on the SGRQ (rs = -0.30) and exercise performance (rs = -0.49). The convergent validity can be observed by the moderate association of all domains and the total score of the EFMD with depression (rs =0.54 to 0.67) and also with symptoms in activities (mMRC) (rs = -0.37 to -0.44). Discriminant validity was observed by the difference in EFDM fatigue scores according to strata of symptoms in activities by mMRC (p< 0.001 for all domains and total). The internal responsiveness of the EFMD was observed by the significant reduction in the total score and in all domains measured from baseline to after three months of follow-up (p< 0.001 for all). The effect size (ES) was considered large for all domains and for the total EFMD score (ES > 0.50; p<0.001 for all). Conclusion: The EFMD is valid and responsive to measure fatigue in individuals after hospitalization for COVID19 and can be and useful tool for clinicians and researchers involved in the management of people affected by COVID19 with long-lasting symptoms.