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

MS = most common
neurological disorder and
cause of disability among
young adults
Kesselring, 2005

Majority of PwMS are in

most active period of their
life

MS has great impact on

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

• 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)
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