Occupational Therapy & Fatigue Management

Andrea Weise Occupational Therapist MSc.

Rehabilitation Centre Valens

Switzerland

Objectives

1. Activate knowledge about the symptom fatigue

2. Understand its influence on daily activities & roles

3. Understand role of OT in treatment of this symptom

4. Familiarize with evidence-based occupational therapy programs based on patient education

Fatigue

• Sense of physical tiredness and lack of energy, distinct from sadness or weakness (Krupp et al, 1988)

• Subjective lack of physical and/or mental energy that is perceived by the individual or caregiver to interfere with usual and desired activities (Clin. Practice Guidelines MS Council, 1998)

• Sense of exhaustion unrelated to level of activity (Taylor, 2008)

In the words of patients

• … like walking through concrete

• My brain is active but my body feels like I’ve never ever slept in my whole life.

• … when walking to the grocery store around the corner feels like having climbed a mountain

Forms

• Primary in direct relation to an illness/ diagnosis, e.g.:

• Short circuiting fatigue/ nerve fibre fatigue / conduction block

• Heat-sensitive fatigue

• Secondary

as a result of other problems, e.g. with:

• Sleep

• Pain

• Physiology (anemy, chemotherapy, thyroid, …)

MS = most common neurological disorder and cause of disability among young adults

Kesselring, 2005

MS

Majority of PwMS are in most active period of their life

MS has great impact on

many areas of life: education, family, profession etc.

• Fatigue

– is reported by 70% -90% of pwMS

– half of them consider this to be their most disabling symptom

(Weiland et al, 2015; Bergamaschir et al, 2007)

• Fatigue

– limits ability to participate in everyday activities

– is a source of psychological distress

– impairs quality of life

(Kos et al, 2008)

Influence of Fatigue

Range of Assessments (selection)

Treatment

• Requires multidisciplinary assessment and management (Asano et al, 2014; NICE Guidelines for MS, 2003; National Service Framework long term conditions, 2005)

• Common (mainly evidence-based) approaches:

– Drugs

– Cooling

– Physical exercise / endurance training (Bansi et al, 2013)

– Patient education

– Cognitive behaviour change (Craig et al, 2008 ; Mathiowetz et al, 2005)

Role of OT in Treatment of Fatigue

• Goal: minimizing impact of fatigue - maximizing participation (Kos et al, 2003)

• Process:

1. Analysis of how fatigue is problematic in everyday life (e.g. COPM, role checklist & observation)

2. Client-centered goals (SMART)

3. Interventions that provide clients with support, knowledge & skills for continued participation in their personal life

4. Evaluation (AOTA, 2008)

OT-Interventions

Focus:

• Being active

• Dealing with fatigue in everyday life

• Re-Organising / restructuring activities, routines & roles

• Resource management

Energy conservation strategies:

• Prioritizing & Planning

• Rest, breaks & recouperation

• Organisation & adaption of materials used & environment

• Adaptation of activities’ performance, e.g. posture

Programme Packer et al (1995)

Structure of Groups’ Course

1. Session: Importance of rest

2. Session: Communication & body mechanics

3. Session: Activity stations

4. Session: Priorities

5. Session: Balancing schedule

6. Session: Course review & future plans

Psychoeducational structure of each Session

• Orientation: Warming up activities / outline of session

• Dissatisfaction: Homework review

• Working: Teaching session / practice activity

Homework assignment

• Termination: Conclusion

Programme Harrison (COT, 2007)

• Individual sessions & homework

• 3 week programme, 2-3 times per week

• Individually adaptable to goals

• Structure:

– Analysis of individual routines, activities & performance problems (COPM)

– Knowledge about: • Fatigue

• Structuring daily life / activitities

• Coping / Strategies

• relaxation

– Restructuring personal life using strategies & knowledge

– Evaluation (COPM)

Programme Fox et al (2014 )

Examples of OT-Tools

Take-home message

• Fatigue = sense of physical tiredness unrelated to level of activity that is perceived to interfere with usual and desired activities/ routines/ roles

• … is reported by 70% -90% of pwMS; half of them consider this their most disabling symptom

• … requires multidisciplinary assessment and management

• Range of assessments

• Role of OT in treatment of fatigue: minimizing impact of fatigue - maximizing participation

• Evidence-based OT-interventions: fatigue management mainly based on patient education and cognitive behavioural change