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560, F(3, 74) = 33.65, p 0.001) and included PHQ9 and IPAQMETS as significant predictors, and PSQI as a non-significant predictor. Twenty participants completed interviews. Three key themes were identified characteristics of fatigue, impact on life and coping strategies. Conclusion Fatigue was a common symptom of pAPS and challenging to manage. Other factors, particularly mood and physical activity, influenced fatigue. Evidence-based self-management interventions are needed.Objective To evaluate the role of neutrophil-to-lymphocyte