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Health Qual Life Outcomes . Impact of post-exertional malaise frequency and fatigue in Long COVID patients on health-related quality of life

tetano

Editor, Senior Moderator
Health Qual Life Outcomes


. 2026 May 11;24(1):64.
doi: 10.1186/s12955-026-02523-x.
Impact of post-exertional malaise frequency and fatigue in Long COVID patients on health-related quality of life

Theresa Thölking[SUP] 1 [/SUP], Frank Müller[SUP] 1 2 [/SUP], Tim Riester[SUP] 1 [/SUP], Viktoria Lampe[SUP] 1 [/SUP], Lena-Marie Theil[SUP] 1 [/SUP], Eva Hummers[SUP] 1 [/SUP], Kousha Sarpari[SUP] 1 [/SUP], Alexandra Dopfer-Jablonka[SUP] 3 4 [/SUP], Christine Happle[SUP] 3 5 6 7 [/SUP], Sandra Steffens[SUP] 3 8 [/SUP], Mareike Meier-Maiwald[SUP] 3 4 9 [/SUP], Marie Mikuteit[SUP] 8 9 [/SUP], Dominik Schröder[SUP] 10 [/SUP]


Affiliations
Abstract

Purpose: The aim of this study was to investigate the impact of post-exertional malaise (PEM) frequency and PEM severity on health-related quality of life (HRQoL) among individuals with Long COVID.
Methods: We conducted a cross-sectional online survey including adults in Germany with self-reported Long COVID and PEM. Fatigue severity was assessed with the Fatigue Assessment Scale (FAS), and HRQoL was measured using the EQ-5D-3L (descriptive index and visual analogue scale [EQ-VAS]). Associations between PEM frequency, fatigue, and HRQoL were examined using correlations and non-parametric group comparisons. Multiple linear regression models were fitted to predict HRQoL while controlling for age, sex, employment status, and subjective social status.
Results: Higher PEM frequency was associated with significantly lower EQ-5D index scores (ρ = - 0.32, p<.001). PEM severity was also strongly correlated with reduced HRQoL (EQ-5D index: ρ = - 0.43, p<.001). In multivariable regression models, greater fatigue and higher PEM frequency independently predicted poorer HRQoL, even after adjustment for sociodemographic factors.
Conclusion: Both PEM frequency and PEM severity substantially impair HRQoL in individuals with Long COVID. These findings underscore the clinical relevance of PEM as a key symptom and highlight the need for targeted management strategies to mitigate its impact on daily life.
Clinical trial number: German Clinical Trials Register DRKS00026007; registration date: 9 September 2021.


 
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