# A digital platform with activity tracking for energy management support in long COVID: a randomised controlled trial

## TL;DR

A digital energy management app for long COVID did not significantly reduce post-exertional malaise compared to usual care, though both groups improved over time.

## Contribution

The study evaluates a novel just-in-time app-based intervention for energy management in long COVID through a randomized controlled trial.

## Key findings

- The intervention app did not significantly reduce post-exertional malaise compared to control.
- Both groups showed improvement over time, indicating the intervention was safe but not effective.
- The study suggests future research should explore this framework in conditions with less recovery potential.

## Abstract

In a 6-month pragmatic randomised controlled trial (RCT; ISRCTN16033549), we compared a just-in-time intervention to support energy management in adults with long COVID (LC) to standard care. Participants received either the ‘Pace Me’ app and a wearable activity tracker (intervention) or an app only with data entry screens (control). The intervention group received just-in-time messages on energy management when they reached 50%, 75%, and 100% of their daily ‘activity allowance’. The primary outcome was post-exertional malaise (PEM) measured by the DePaul Symptom Questionnaire-PEM (DSQ-PEM). Of 369 participants assessed for eligibility, 250 participants were randomised 1:1, and 77 controls and 84 intervention participants were included in the final per-protocol analysis. There was no time by group interaction for the DSQ-PEM. The intervention group value was 48 (95% CI 44-53) at baseline and 46 (95% CI 41-51) post-intervention (arbitrary units). The control group value was 47 (95% CI 42-52) at baseline and 44 (95% CI 39-49) at follow-up (interaction effect p = 0.614, η²p = 0.002; trivial). No individual question exhibited an interaction effect (p > 0.05). Although the intervention had minimal effect compared to control, the substantial recovery rates previously reported in LC, coupled with our wide inclusion criteria may have masked intervention effects. Therefore, future studies should consider this energy management framework in conditions without such recovery rates, such as CFS.

Long COVID is associated with challenges in energy management, with limited interventions available. In this study, a just-in-time app-based energy management intervention for long COVID did not reduce postexertional malaise compared to usual care, though both groups improved over time, showing the approach was safe but not effective.