Optimising and beta-testing a user-centred, accessible, self-management rehabilitation smartphone app (reCOVer) for long-COVID fatigue using qualitative interview methods.

Abstract

Fatigue is one of the most common and disabling symptoms of long-COVID, yet individuals often struggle to access appropriate services and must self-manage. This study aimed to adapt an existing smartphone app, originally developed for fatigue in autoimmune rheumatic disease, for individuals with long-COVID. A multidisciplinary steering group reviewed current clinical and scientific evidence to inform the adaptation of the app, reCOVer. The app includes an activity pacing diary, goal-setting tool, assertiveness and communication cards, and guidance on fatigue, sleep, relaxation, and setbacks. Beta-testing was conducted with 11 individuals with long-COVID (aged 21-57). Each participant took part in two serial qualitative interviews: the first explored their experience of fatigue and initial reactions to the app; the second, after 7-10 days of use, captured usability and acceptability feedback. Participants found reCOVer helpful, particularly for increasing awareness of unhelpful patterns (e.g., boom-bust cycles) and supporting behaviour change through pacing. Communication tools were valuable when cognitive difficulties were prominent. Suggested improvements included text-to-speech functionality, clearer goal-setting instructions, and better articulation of app benefits. reCOVer shows promise as a self-management tool for long-COVID fatigue. Further research, such as a pilot RCT, is needed to evaluate feasibility and effectiveness.