Suitability of just-in-time adaptive intervention in post-COVID-19-related symptoms: A systematic scoping review

Patients with post-COVID-19-related symptoms require active and timely support in self-management. Just-in-time adaptive interventions (JITAI) seem promising in meeting these needs, as they aim to provide tailored interventions based on patient-centred measures. This systematic scoping review explores the suitability and examines key components of a potential JITAI in post-COVID-19 syndrome. Databases (PsycINFO, PubMed, and Scopus) were searched using terms related to post-COVID-19-related symptom clusters (fatigue and pain; respiratory problems; cognitive dysfunction; psychological problems) and to JITAI. Studies were summarised to identify potential components (interventions options, tailoring variables and decision rules), feasibility and effectiveness, and potential barriers. Out of the 341 screened records, 11 papers were included (five single-armed pilot or feasibility studies, three two-armed randomised controlled trial studies, and three observational studies). Two articles addressed fatigue or pain-related complaints, and nine addressed psychological problems. No articles about JITAI for respiratory problems or cognitive dysfunction clusters were found. Most interventions provided monitoring, education or reinforcement support, using mostly ecological momentary assessments or smartphone-based sensing. JITAIs were found to be acceptable and feasible, and seemingly effective, although evidence is limited. Given these findings, a JITAI for post-COVID-19 syndrome is promising, but needs to fit the complex, multifaceted nature of its symptoms. Future studies should assess the feasibility of machine learning to accurately predict when to execute timely interventions.Author summary: Patients with post-COVID-19 syndrome (PCS) experience a lot of various, continuously fluctuating symptoms. Certain mobile health technologies, such as just-in-time adaptive intervention (JITAI), may help in dealing with these symptoms, and have been utilised in other health conditions. In this study, we investigate to what extent it would be possible to develop a JITAI for post-COVID-19 and what that would look like based on 11 existing JITAI-related articles. We found evidence for JITAI being helpful to deal with psychological problems (such as depression) and to a lesser extent with aspects of fatigue, using sensing technologies or user-reported variables. Our findings suggest that JITAI have potential to help PCS patients. However, more research is necessary to develop a JITAI to help patients deal with other symptoms (such as cognitive problems and breathing difficulties), as well as on how to predict when interventions can occur at the right time for fatigue. These findings may also be helpful to develop interventions in other disorders, such as chronic fatigue syndrome.