A randomised controlled trial testing the efficacy of Fit after COVID, a cognitive behavioural therapy targeting severe post-infectious fatigue following COVID-19 (ReCOVer): study protocol

Trials. 2021 Dec 2;22(1):867. doi: 10.1186/s13063-021-05569-y.


Background: Coronavirus disease 2019 (COVID-19) results in debilitating long-term symptoms, often referred to as Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), in a substantial subgroup of patients. One of the most prevalent symptoms following COVID-19 is severe fatigue. Prompt delivery of cognitive behavioural therapy (CBT), an evidence-based treatment that has shown benefit in reducing severe fatigue in other conditions, may reduce post-COVID-19 fatigue. Based on an existing CBT protocol, a blended intervention of 17 weeks, Fit after COVID, was developed to treat severe fatigue after the acute phase of infection with SARS-CoV-2.

Method: The ReCOVer study is a multicentre 2-arm randomised controlled trial (RCT) to test the efficacy of Fit after COVID on severe post-infectious fatigue. Participants are eligible if they report severe fatigue 3 up to and including 12 months following COVID-19. One hundred and fourteen participants will be randomised to either Fit after COVID or care as usual (ratio 1:1). The primary outcome, the fatigue severity subscale of the Checklist Individual Strength (CIS-fatigue), is assessed in both groups before randomisation (T0), directly post CBT or following care as usual (T1), and at follow-up 6 months after the second assessment (T2). In addition, a long-term follow-up (T3), 12 months after the second assessment, is performed in the CBT group only. The primary objective is to investigate whether CBT will lead to a significantly lower mean fatigue severity score measured with the CIS-fatigue across the first two follow-up assessments (T1 and T2) as compared to care as usual. Secondary objectives are to determine the proportion of participants no longer being severely fatigued (operationalised in different ways) at T1 and T2 and to investigate changes in physical and social functioning, in the number and severity of somatic symptoms and in problems concentrating across T1 and T2.

Discussion: This is the first trial testing a cognitive behavioural intervention targeting severe fatigue after COVID-19. If Fit after COVID is effective in reducing fatigue severity following COVID-19, this intervention could contribute to alleviating the long-term health consequences of COVID-19 by relieving one of its most prevalent and distressing long-term symptoms.

Trial registration: Netherlands Trial Register NL8947 . Registered on 14 October 2020.

Keywords: COVID-19; Cognitive behavioural therapy; Internet therapy; Long COVID; Long-Haul COVID-19 Fatigue; Post-Acute Sequelae of SARS-CoV-2 Infection (PASC); Post-COVID-19 syndrome; Randomised controlled trial; Study protocol.

Publication types

  • Clinical Trial Protocol

MeSH terms

  • COVID-19* / complications
  • Cognitive Behavioral Therapy*
  • Fatigue / diagnosis
  • Fatigue / etiology
  • Fatigue / therapy
  • Humans
  • Multicenter Studies as Topic
  • Post-Acute COVID-19 Syndrome
  • Randomized Controlled Trials as Topic
  • SARS-CoV-2
  • Treatment Outcome