Einfluss dysfunktionaler Schon- und Durchhaltemuster auf die Aufrechterhaltung von Post-COVID Fatigue?

Zusammenfassung

Hintergrund

Nach einer SARS-CoV-2-Infektion entwickeln ca. 10% der Patient*innen eine Post-COVID-Symptomatik, Fatigue ist eines der häufigsten Symptome. Diese führt zu einer erheblichen Einschränkung der Lebens-qualität und zu einem hohen Arbeitsausfall. Bei der Chronifizierung von Schmerzen sind dysfunktionale Muster im Sinne des Avoidance/Endurance Konzepts relevant und die klinische Erfahrung mit PCS-Patienten zeigt, dass diese auch hier eine Rolle spielen könnten.

Fragestellung

Die explorative Beobachtungsstudie überprüft die Annahme, dass maladaptive Angst-Vermeidungsreaktionen oder Durchhaltereaktionen bei der Aufrechterhaltung von Post-COVID-Fatigue-Symptomen einen signifikanten Einfluß haben.

Methode

Bei N=97 Patient*innen mit Post-COVID-Fatiguesymptomatik aus einer Rehabilitationseinrichtung wurden mit den Selbstbeurteilungsfragebögen Fatigue (FSMC), Avoidance-Endurance-Verhalten (AEQ) sowie psychologische und arbeitsbezogene Variablen erfasst, zusätzlich wurde ein 6-Minuten Gehtest durchgeführt.

Ergebnisse

Es ergab sich folgendes Verteilungsmuster: 2/3 distress Durchhalten, 1/3 Vermeiden und keine adäquaten Coper. Das Ängstlich-Vermeidende-Reaktionsmuster konnte signifikant Varianz in der Fatigueausprägung aufklären (F (3, 88)=17,072, p<0,001; R²=0,368). Die Vermeidung körperlicher Aktivität steht mit einer erhöhten Anzahl an AU-Tagen in Verbindung.

Schlussfolgerungen

Die Ergebnisse unterstützen die Annahme, dass maladaptive Reaktionsmuster einen Beitrag zur Chronifizierung der Post-COVID-Symptomatik leisten, dies sollte allerdings in einer prospektiven Studie überprüft werden. Dies spricht angesichts dieser chronifizierten Stichprobe für die Bedeutung dieser Konstrukte. Durch Screenings könnte man diese im Vorfeld herausfiltern und gezieltere, individuell abgestimmte Therapien durchführen.

Abstract

Background

Following a SARS-CoV-2 infection, around 10% of patients develop post-COVID symptoms, with fatigue being one of the most common symptoms. This leads to a considerable reduction in quality of life and a high level of absenteeism from work. In the chronification of pain, dysfunctional patterns in the sense of the avoidance/endurance concept are relevant and clinical experience with PCS patients shows that these could also play a role here.

Research question

The explorative observational study tests the assumption that maladaptive fear-avoidance reactions or endurance reactions have a significant influence on the maintenance of post-COVID fatigue symptoms.

Methods

In N=97 patients with post-COVID fatigue symptoms from a rehabilitation facility, fatigue (FSMC), avoidance-endurance behaviour (AEQ) and psychological and work-related variables were recorded using self-report questionnaires, and a 6-minute walking test was also carried out.

Results

The following distribution pattern emerged: 2/3 distress perseveration, 1/3 avoidance and no adequate copers. The anxiety-avoidance response pattern was able to explain significant variance in the expression of fatigue (F (3, 88)=17,072, p<0,001; R²=0,368). The avoidance of physical activity is associated with an increased number of sick days.

Conclusions

The results support the assumption that maladaptive response patterns contribute to the chronification of post-COVID symptoms. In view of this chronified sample, this speaks in favour of the importance of these constructs. Screening could be used to filter these out in advance and implement more targeted, individually tailored therapies.

Schlüsselwörter

Post-COVID-19 Syndrom - Avoidance-Endurance-Modell - Bewältigungsstile - Dysfunktionales Durchhalten - Ängstliche Vermeiden

Keywords

post-COVID-19 syndrome - avoidance-endurance model - coping styles - dysfunctional endurance - anxious avoidance

Publication History

Received: 15 August 2024

Accepted: 09 January 2025

Article published online:
27 February 2025

• Literatur

• 1 World Health Organization. A clinical case definition of post COVID-19 condition by a Delphi consensus. 6 October 2021. 2021 [cited 2023 Aug 21]; Available from: https://apps.who.int/iris/bitstream/handle/10665/345824/WHO-2019-nCoV-Post-COVID-19-condition-Clinical-case-definition-2021.1-rus.pdf
• 2 Davis HE, McCorkell L, Vogel JM. et al. Author Correction: Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol 2023; 21: 408 10.1038/s41579-023-00896-0. Erratum for: Nat Rev Microbiol 2023; 21: 133–146. DOI: 10.1038/s41579-022-00846-2 PMID: 37069455; PMID: PMC10408714
• 3 Henningsen P, Köllner V. Post-COVID-Syndrom – Alles nur Immunologie? Argumente für ein bio-psycho-soziales Erklärungsmodell. Ärztliche Psychother 2023 2023; 18: 68-71
• 4 Saunders C, Sperling S, Bendstrup E. A new paradigm is needed to explain long COVID. Lancet Respir Med 2023; 11: e12-e13 Epub 2023 Jan 5. 36620963
• 5 Allwang C, Junne F. Postvirale Phänomene nach SARS-Cov-2: Implikationen für die psychosoziale Versorgung [Post-Viral Phenomena after SARS-Cov-2: Implications for Psychosocial Care]. Psychother Psychosom Med Psychol 2021; 71: 487-488 German Epub 2021 Dec 6. 34872152
• 6 Hasenbring MI, Verbunt JA. Fear-avoidance and endurance-related responses to pain: new models of behavior and their consequences for clinical practice. Clin J Pain 2010; 26: 747-753 20664333
• 7 Kupferschmitt A, Köllner V. Psychotherapeutische Begleitung bei Post-COVID-Syndrom. Die Psychotherapie. 2023 68. 475-488
• 8 Kupferschmitt A, Etzrodt F, Kleinschmidt J. et al. Nicht nur multimodal, sondern auch interdisziplinär: Ein Konzept für fächerübergreifende Zusammenarbeit in der Rehabilitation des Post-COVID-Syndroms. PPmP - Psychother·Psychosom·Medizinische Psychol [Internet]. 2022 May 23 [cited 2022 Jun 11] 72. Available from: http://www.thieme-connect.com/products/ejournals/html/10.1055/a-1838-3055
• 9 Hasenbring MI, Andrews NE, Ebenbichler G. Overactivity in Chronic Pain, the Role of Pain-related Endurance and Neuromuscular Activity: An Interdisciplinary, Narrative Review. Clin J Pain 2020; 36: 162-171 31833914
• 10 Samwel HJ, Kraaimaat FW, Crul BJ. et al. The role of fear-avoidance and helplessness in explaining functional disability in chronic pain: a prospective study. Int J Behav Med 2007; 14: 237-241 18001239
• 11 Vincent HK, Adams MC, Vincent KR. et al. Musculoskeletal pain, fear avoidance behaviors, and functional decline in obesity: potential interventions to manage pain and maintain function. Reg Anesth Pain Med 2013; 38: 481-491 24141874
• 12 Renz-Polster H, Scheibenbogen C. Post-COVID-Syndrom mit Fatigue und Belastungsintoleranz: Myalgische Enzephalomyelitis bzw. Chronisches Fatigue-Syndrom. [Post-COVID syndrome with fatigue and exercise intolerance: myalgic encephalomyelitis/chronic fatigue syndrome]. Inn Med (Heidelb) 2022; 63: 830-839 German Epub 2022 Jul 13. 35925074; PMC9281337
• 13 Kupferschmitt A, Hinterberger T, Montanari I. et al. Relevance of the post-COVID syndrome within rehabilitation (PoCoRe): study protocol of a multi-centre study with seven rehabilitation clinics of different specialisations: cardiological-psychosomatic rehab, pneumological-psychosomatic rehab, neurological. BMC Psychol 2022; 10: 189 35906662; PMC9335465
• 14 Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606-613 11556941; PMC1495268
• 15 Hasenbring MI, Hallner D, Rusu AC. Fear-avoidance- and endurance-related responses to pain: Development and validation of the Avoidance-Endurance Questionnaire (AEQ). Eur J Pain 2009; 13: 620-628 Epub 2008 Dec 19. 19101182
• 16 Wolff SV, Willburger R, Hallner D. et al. Avoidance-Endurance Fast-Screen (AE-FS) : Inhalts- und Vorhersagevalidität eines 9-Item-Screeninginstruments für Patienten mit unspezifischen subakuten Rückenschmerzen [Avoidance-endurance fast screening (AE-FS) : Content and predictive validity of a 9-item screening instrument for patients with unspecific subacute low back pain]. Schmerz 2018; 32: 283-292 German 29987513
• 17 Löwe B, Kroenke K, Herzog W. et al. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord 2004; 81: 61-66 29987513
• 18 Penner IK, Raselli C, Stöcklin M. et al. The Fatigue Scale for Motor and Cognitive Functions (FSMC): validation of a new instrument to assess multiple sclerosis-related fatigue. Mult Scler 2009; 15: 1509-1517 Epub 2009 Dec 7. 19995840
• 19 Zamunér AR, Moreno MA, Camargo TM. et al. Assessment of Subjective Perceived Exertion at the Anaerobic Threshold with the Borg CR-10 Scale. J Sports Sci Med 2011; 10: 130-136. 24149305; PMC3737915
• 20 Dourado VZ. Equações de Referência para o Teste de Caminhada de Seis Minutos em Indivíduos Saudáveis [Reference Equations for the 6-Minute Walk Test in Healthy Individuals.]. Arq Bras Cardiol. 2011 S0066-782X2011005000024. Portuguese. Epub ahead of print. 21359481
• 21 Alameri H, Al-Majed S, Al-Howaikan A. Six-min walk test in a healthy adult Arab population. Respir Med 2009; 103: 1041-1046 Epub 2009 Feb 20. 19230640
• 22 Gibbons WJ, Fruchter N, Sloan S. et al. Reference values for a multiple repetition 6-minute walk test in healthy adults older than 20 years. J Cardiopulm Rehabil 2001; 21: 87-93 11314289
• 23 Chernick MR. Bootstrap methods: A guide for practitioners and researchers. John Wiley & Sons, Ltd; 2021
• 24 Titze C, Hasenbring MI, Kristensen L. et al. Patterns of Approach to Activity in 851 Patients with Severe Chronic Pain: Translation and Preliminary Validation of the 9-item Avoidance-Endurance Fast-Screen (AEFS) into Danish. Clin J Pain 2021; 37: 226-236 Available from: https://journals.lww.com/clinicalpain/fulltext/2021/03000/patterns_of_approach_to_activity_in_851_patients.10.aspx
• 25 Castell BD, Kazantzis N, Moss-Morris RE. Cognitive behavioral therapy and graded exercise for chronic fatigue syndrome: A meta-analysis. Clinical Psychology: Science and Practice 2011; 18: 311-324
• 26 Ray C, Jefferies S, Weir WRC. Coping with chronic fatigue syndrome: illness responses and their relationship with fatigue, functional impairment and emotional status. Psychological Medicine 1995; 25: 937-945
• 27 Surawy C, Hackmann A, Hawton K. et al. Chronic fatigue syndrome: a cognitive approach. Behav Res Ther 1995; 33: 535-544 7598674
• 28 Wegner DM, Schneider DJ, Carter SR. et al. Paradoxical effects of thought suppression. J Pers Soc Psychol 1987; 53: 5-13 3612492
• 29 Leeuw M, Goossens ME, Linton SJ. et al. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med 2007; 30: 77-94 Epub 2006 Dec 20. 17180640
• 30 Folkman S, Lazarus RS, Dunkel-Schetter C. et al. Dynamics of a stressful encounter: cognitive appraisal, coping, and encounter outcomes. J Pers Soc Psychol 1986; 50: 992-1003 3712234
• 31 White PD, Goldsmith K, Johnson AL. et al. Recovery from chronic fatigue syndrome after treatments given in the PACE trial. Psychol Med 2013; 43: 2227-2235 23363640; PMC3776285
• 32 Moulton CD, Jordan C, Hayee B. et al. All-or-Nothing Behavior and Catastrophic Thinking Predict Fatigue in Inflammatory Bowel Disease: A Prospective Cohort Study. Inflamm Bowel Dis 2024; 30: 1903-1906 37619243; PMC11447110
• 33 Buchmann J, Baumann N, Meng K. et al. Endurance and avoidance response patterns in pain patients: Application of action control theory in pain research. PLoS One 2021; 16: e0248875 33765020 PMC7993813
• 34 Hasenbring MI, Hallner D, Klasen B. et al. Pain-related avoidance versus endurance in primary care patients with subacute back pain: psychological characteristics and outcome at a 6-month follow-up. Pain 2012; 153: 211-217 Epub 2011 Nov 16 22093816
• 35 Huijnen IP, Verbunt JA, Peters ML. et al. Differences in activity-related behaviour among patients with chronic low back pain. Eur J Pain 2011; 15: 748-755 Epub 2010 Dec 30. 21195646
• 36 Henningsen P, Zipfel S, Sattel H. et al. Management of Functional Somatic Syndromes and Bodily Distress. Psychother Psychosom 2018; 87: 12-31 Epub 2018 Jan 6. 29306954
• 37 Schauenburg H. Post-COVID and ME/CFS – DoWe Need New Disease Theories?. Z Psychosom Med Psychother 2023; 69: 304-315 Epub 2023 Oct 13 37830884