Lower socioeconomic status strengthens the risk of otitis media with effusion after COVID-19 infection: a case-crossover study in Northeast China.

There is evidence that structured fatigue self-management programmes for people with chronic neurological disorders can improve participation and functioning [, ]. Several interventions have been developed and evaluated, including programmes that combine physical activity, education, and behavioural strategies to support long-term fatigue management within rehabilitation and, increasingly, primary care contexts [–]. In primary care, however, such approaches are often delivered as single-component interventions, or embedded within broader self-management programmes for chronic conditions. Evidence for comprehensive fatigue-specific programmes remains limited and heterogeneous []. As a result, it remains unclear how these programmes are actually delivered and experienced in primary care. This is especially relevant given the growing number of individuals with chronic neurological disorders who require long-term support within primary care [, ]. As health systems increasingly shift long-term care from specialist to primary care settings [, ], understanding what enables or constrains delivery, and what patients and therapists perceive as valuable or burdensome, is essential for sustainable implementation. This need is particularly urgent given the high prevalence and impact of fatigue among individuals with chronic neurological diseases, affecting more than half of patients and substantially limiting daily functioning and quality of life [, ]. Fatigue is a complex, multifactorial symptom, with diagnosis explaining only 11% of its severity []. In combination with physical and cognitive limitations, fatigue reduces physical activity and social participation, placing substantial emotional, financial, and social burdens on patients, their families, and their social networks []. Since no cure is currently available for most chronic neurological disorders, care is primarily focused on maintaining functional abilities and supporting participation in daily life. Effective fatigue management is therefore essential to improving quality of life for these individuals and their families. To address this, a multidisciplinary group programme has been developed, which marks a shift from a disease-oriented approach to a patient- and problem-oriented approach []. This self-management intervention, called ‘Energetic’, has been designed to enhance social participation and functional endurance in individuals with chronic neurological conditions and fatigue, irrespective of the specific diagnosis []. By focusing on fatigue as a shared, multifactorial experience across conditions, this approach focuses on individuals’ experiences and daily life goals rather than diagnosis-specific pathways []. This is particularly relevant for symptoms like fatigue that transcend diagnostic categories []. It may enhance person-centred care and support self-management [], but can be challenging to integrate within diagnosis-oriented healthcare systems [].