Chronic Fatigue Syndrome – an occupational therapy programme

Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome leads to severe functional impairment and work disability in a considerable number of patients. The majority of patients who manage to continue or return to work, work part-time instead of full time in a physically less demanding job. The prognosis in terms of returning to work is poor if patients have been on long-term sick leave for more than two to three years. Being older and more ill when falling ill are associated with a worse employment outcome. Cognitive behavioural therapy and graded exercise therapy do not restore the ability to work. Consequently, many patients will eventually be medically retired depending on the requirements of the retirement policy, the progress that has been made since they have fallen ill in combination with the severity of their impairments compared to the sort of work they do or are offered to do. However, there is one thing that occupational health physicians and other doctors can do to try and prevent chronic and severe incapacity in the absence of effective treatments. Patients who are given a period of enforced rest from the onset, have the best prognosis. Moreover, those who work or go back to work should not be forced to do more than they can to try and prevent relapses, long-term sick leave and medical retirement.

Chronic Fatigue Syndrome: An Evaluation of an Occupational Therapy Inpatient Intervention

It has been stated that, although most chronic fatigue syndrome (CFS) patients can be treated in primary care and that cognitive behaviour therapy and prescribed, graded aerobic exercise appear to be promising in outpatient management, a minority of patients will require inpatient care (Royal Colleges of Physicians, General Practitioners and Psychiatrists 1996). To date, little has been written on the need for and impact of an inpatient approach for patients with CFS. This study builds on previous work to show how patients with complex CFS responded to a specifically designed occupational therapy inpatient programme, using the principles of cognitive behaviour therapy and graded activity.

A quasi-experimental study was carried out using current inpatients with those on the waiting list as a comparison. At 6 months following discharge, a significant difference between the groups in terms of symptoms and level of ability was not demonstrated. However, a significant effect was shown in patients' perceived health, length of time tired and management of the illness. Thirty-one (72%) of the inpatient group, compared with 10 (53%) of the comparison group, stated that they felt better than the previous year. Thirty-one (72%) of the inpatient group, compared with 7 (37%) of the comparison group, indicated better management of their illness. These findings give some evidence of the need for an inpatient CFS management programme for specific patients with complex CFS.

Severe Chronic Fatigue Syndrome (CFS/ME): Recovery is Possible

The recovery of individuals with very severe chronic fatigue syndrome/ myalgic encephalomyelitis (CFS/ME) is possible with successful multidisciplinary management. This case vignette aims to highlight the beneficial outcome of using occupational therapy lifestyle management and the Canadian Occupational Performance Measure to identify perceived problems in occupational performance and indicate change. The current management strategies in CFS/ME are discussed briefly and the challenges of the management of severe CFS/ME are described, indicating a need for a supportive team and specialist inpatient services.

In 2003, the Department of Health released funds in England to develop more widely accessible CFS/ME services. This case study illustrates a positive outcome for one individual with severe CFS/ME, following admission to a specialist inpatient facility. It is hoped that it may aid other therapists working with and developing services for people with severe presentations of CFS/ME.

An Evaluation of a Fatigue Management Intervention for People with Acquired Brain Injury: An Exploratory Study

Fatigue is one of the most prevalent symptoms reported after an acquired brain injury, reflecting a probable combination of factors: pathology, medication side effects, mood or sleep disorders, reduced exercise tolerance, decreased nutrition and hydration. Despite its prevalence and the profoundly negative effects that fatigue has on quality of life, there is little evidence regarding the effectiveness of fatigue management interventions.

This exploratory study investigated whether a weekly fatigue education group, lasting for 8 weeks, had an effect on reported fatigue, anxiety, depression, sleepiness and quality of life. Pre-intervention and post-intervention measures were taken using three standardised scales, the Hospital Anxiety and Depression Scale, the Epworth Sleepiness Scale and the Short Form–36 quality of life measure, together with the unpublished Brain Injury Fatigue Scale. A 10-point rating scale was also used to assess fatigue on a weekly basis. In addition, the participants completed written qualitative self-reports concerning the impact of fatigue on daily life, their perceptions of fatigue and their fatigue management strategies.

Seven people joined the programme. There was a significant change in the quality of life measure from pre-intervention to post-intervention, but not in the other measures. In written qualitative accounts, the participants reported managing their fatigue better and finding group support helpful. The results suggest a need for further research into the fatigue management for people with acquired brain injury.

Chronic fatigue syndrome: is there a role for occupational therapy?

Chronic Fatigue Syndrome (CFS) continues to evolve as a disabling phenomenon characterized by debilitating fatigue and consequential components that limit the functional ability of persons afflicted with the disease. A composite review of the current literature addresses a brief history, etiology, legitimacy, incidence and prevalence, prognosis, diagnosis, impact, and treatment of CFS. The primary focus illustrates available treatment strategies that have been incorporated into occupational therapy practice. As a profession that has made contributions to populations with chronic disease and symptoms similar to those suffering from CFS, the use of effective methods should reinforce the need for occupational therapy intervention with this population.