Reproducibility and validity of heart rate variability and respiration rate measurements in participants with prolonged fatigue complaints

Long-term outcomes following vocational rehabilitation treatments in patients with prolonged fatigue

Background

Multi-component vocational rehabilitation (VR) provides positive short-term outcomes in patients with prolonged fatigue.

Purpose

The purpose of this study is to evaluate the long-term outcomes of Dutch multi-component VR up to 18 months after treatment.

Method

In a pre–post-study, measurements were taken before treatment (t0), after treatment (t1) and in long-term follow-ups at 6 (t2), 12 (t3) and 18 months (t4) after treatment. Primary outcomes (fatigue, work participation and workability) and secondary outcomes [physical and social functioning, mental health and heart rate variability (HRV)] were assessed over time using linear mixed models analyses. Post hoc long-term outcomes were compared with t0 and t1.

Results

Sixty patients with severe fatigue complaints participated. The primary outcomes significantly (p < 0.001) improved at follow-ups compared with t0 and showed no relapse compared with t1. Moreover, fatigue decreased (p < 0.002) whereas workability (p < 0.001) and work participation (p < 0.001) increased further after treatment (t1). The secondary outcomes, physical functioning, mental health, social functioning and HRV, improved significantly (p < 0.001, p < 0.001, p < 0.001 and p = 0.049, respectively) over the long term compared with t0. At 6-month follow-up (t2), mental health (p < 0.003) and social functioning (p = 0.003) further increased after the treatment was stopped.

Conclusion

Multi-component VR treatments seem to significantly and in a clinically relevant way decrease fatigue symptoms and improve individual functioning and work participation in patients with severe prolonged fatigue over the long term and without showing relapse.

Process and outcome evaluation of vocational rehabilitation interventions in patients with prolonged fatigue complaints

BACKGROUND

Prolonged fatigue can cause physical, mental and occupational disability. Fatigue often persists because of a combination of biopsychosocial factors.

PURPOSE

To evaluate the process and outcomes of three existing outpatient vocational rehabilitation interventions (VRI) in patients with prolonged fatigue complaints. The VRIs differ with regard to the content and treatment duration, enrolment procedure and financing.

METHOD

A pre-post design was used with repeated measurements before treatment, after treatment and 3 months after treatment. Primary outcomes (fatigue and work participation) and secondary outcomes (physical and social functioning, mental health and physiological indicators (heart rate variability)) were assessed over time using linear mixed models analysis. A process evaluation (i.e. patient reach, content completeness and patient satisfaction) was conducted as well.

RESULTS

One hundred patients participated. Post-treatment, fatigue decreased (p < .001) and work participation (p < .010), physical functioning (p < .001) and mental health (p < .001) improved considerably in all three VRIs. Social functioning improved in one VRI (p = .022), but did not in the other two (p = .442, p = .196, respectively). Physiologically, heart rate variability improved in two VRIs (p = .044, p = .038, respectively). VRIs were administered according to the programme protocol. Almost all patients met their personal goals and the majority was satisfied with the outcomes of diminished constraints at work.

CONCLUSION

Three VRIs showed significant and clinically relevant outcomes over time regarding decreased fatigue and improved functioning and work participation in fatigued patients. The VRIs administered patient-tailored biopsychosocial interventions as planned and patients were satisfied with the interventions.