An approach to persons with chronic fatigue syndrome based on the model of human occupation: part one, impact on occupational performance and participation

First Step to empowering change: enhancing self-efficacy, energy management, and physical activity in patients with sleep apnea

Introduction

Fatigue often leads to a sedentary lifestyle, negatively impacting health, mortality, and quality of life. Engaging in physical activity can be challenging for individuals experiencing fatigue, particularly those with sleep apnea. This study's objective was to assess the "First Step" concepts' usability in constructing and implementing different interventions through qualitative data. The intervention targets patients with sleep apnea, focusing on individualized energy distribution and meaningful engagement in physical activity.

Methods

Two programs were developed based on the First Step concept, a rehabilitation program and a patient education program. Initially, 13 patients were recruited, split between the groups, with two dropping out. Primarily evaluated through qualitative data, patients in both groups attended group interviews. For one of the programs supplementary quantitative data were collected through the 6-min walk test (6MWT), Sit-to-Stand test, and Canadian Occupational Performance Measure (COPM). Patients in the rehabilitation program also monitored daily step counts using activity trackers.

Results

Patients found the energy management education enlightening, enabling them to make conscious changes in their daily lives. They reported the program's positive reception, with social interaction playing a crucial role in its success. Of the six patients who completed the rehabilitation program, significant improvements in 6MWT scores were observed, indicating enhanced walking endurance. While no changes were seen in the Sit-to-Stand test, COPM results showed notable improvements in performance and satisfaction with chosen activities.

Discussion

The incorporation of the First Step concept empowered patients with sleep apnea to manage fatigue, conserve energy, engage in meaningful activities, and improve their wellbeing. Merging occupational therapy and physiotherapy interventions effectively addressed daily challenges while promoting physical activity. Adaptations to the program, guided by patient feedback, suggest a preference for longer, more personalized sessions. This approach offers a promising pathway to improving quality of life for individuals with chronic conditions.

Conclusion

Our study highlights the usability of the First Step concept, integrating occupational therapy and physiotherapy, to address challenges in individuals with sleep apnea. The tailored, multidisciplinary intervention prioritizes meaningful activities, focuses on energy distribution and physical exercise, yielding improved satisfaction and performance. Further research is warranted to enhance this salutogenic approach for chronic conditions.

Associations between daily routines and social support among women with chronic fatigue syndrome

BACKGROUND

Chronic fatigue syndrome (CFS) is characterised by extreme fatigue, as well as physical and cognitive symptoms. CFS is thrice as prevalent in women than in men.

OBJECTIVE

To compare women with and without CFS concerning social support and participation in daily routine occupations, and to assess the relationships between the two variables among women with CFS.

METHODS

This study included 110 women aged 24-69: 41 were diagnosed with CFS and 64 were not diagnosed with CFS. Participants completed the Occupational Questionnaire and the Medical Outcomes Study (MOS) Social Support Survey.

RESULTS

Women with CFS reported lower participation in instrumental activities of daily living and work occupations than women without CFS. However, they spend more time resting and enjoying it. In addition, they reported less social support than women without CFS. Positive correlations were found between the number of close friends and time spent in play and leisure occupations and a negative correlation with sleep/rest.

CONCLUSIONS

Women with CFS participate less in IADL and work occupations and more in rest/sleep than women without CFS and their social support is attenuated.

SIGNIFICANCE

Intervention plans should be developed for women with CFS, focussing on expanding their participation while considering their social support resources.

The experience of type 2 diabetes: Application of the Model of Human Occupation

Introduction

Integrating type 2 diabetes (T2DM) self-care behaviors into daily life is complex and poorly understood. Occupational therapists, as experts in life context, habits, roles, and routines, can foster new ways of understanding and promoting daily engagement in T2DM self-care. The Model of Human Occupation (MOHO), a conceptual practice model, may have applicability to better understanding the experience of living with T2DM and engaging in necessary self-care behaviors.

Methods

We conducted focus group interviews with individuals with T2DM ( n = 10). We applied the MOHO to understand the experience of living with T2DM and engaging in related self-care behaviors.

Findings

Participants discussed each element of MOHO and how it related to living with and managing type 2 diabetes. Participants identified obtaining skills for self-advocacy with family, individualized/adapted exercise, stable health-promoting environments and routines, and problem-solving skills for disruptions to routine as critical needs for managing T2DM. These intervention strategies are well-aligned with MOHO and occupational therapy practice.

Conclusion

We found that MOHO was a useful tool for exploring the experience and daily management of T2DM.

Environmental accommodations for university students affected by Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

BACKGROUND

Today, 24% of college and university students are affected by a chronic health condition or disability. Existing support programs, including disability services, within colleges and universities are often unaccustomed to addressing the fluctuating and unpredictable changes in health and functioning faced by students with severe chronic illnesses. This situation is especially difficult for students with lesser-known, invisible diseases like Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), a complex disease affecting up to 2.5 million Americans which often begins in late adolescence or young adulthood.

OBJECTIVE

Educate occupational therapists (OTs) about ME/CFS and steps they can take to assist students.

METHODS

This work is based on a review of the scientific literature and our collective professional/ personal experiences.

RESULTS

ME/CFS' effects on multiple organ systems combined with the unusual symptom of post-exertional malaise frequently and substantially decrease function. Currently, no effective disease-modifying treatments have been established. Nevertheless, OTs can help student maximize their participation in university life by identifying potential obstacles, formulating practical solutions and negotiating with their institutions to implement reasonable, environmental accommodations.

CONCLUSIONS

Through understanding this disease, being aware of possible support options, and recommending them as appropriate, OTs are in unique position to greatly improve these students' lives.

Lived experiences in daily life with myalgic encephalomyelitis

Introduction

Myalgic encephalomyelitis is a complex systemic condition, causing severe symptoms that limit the quality of life of the people living with it. This study examined changes in life, coping strategies, and the ability to obtain a successful occupational adaptation in people with myalgic encephalomyelitis in Denmark, viewed from the perspective of the model of human occupation.

Method

In-depth qualitative interviews with seven persons with myalgic encephalomyelitis aged 31–61 years were analysed with qualitative content analysis.

Results

The participants experienced severe changes in their lives leading to impaired occupational competences which affected their occupational identity and made them lonely. Pacing and environmental changes were the preferred coping strategies in their attempt to adapt to the new circumstances.

Conclusion

The participants experienced major changes in everyday life with the onset of myalgic encephalomyelitis. Pacing and environmental changes were not sufficient strategies to secure a successful occupational adaptation. Thus, people living with myalgic encephalomyelitis need assistance to enable a successful occupational adaptation and preserve hope. Access to occupational therapy within the Danish programme for people living with myalgic encephalomyelitis may support more effective occupational adaptation in the population.

Occupational adaptation - analyzing the maturity and understanding of the concept through concept analysis

Background: Occupational adaptation is a key occupational therapy concept, yet lacks clarity and consensus, impacting on its application in practice, theory and research. Concept analysis is a rigorous methodology which enables identification of unique features, gaps in knowledge, and the need for further concept refinement.Aim: This study aimed to determine the conceptual maturity of occupational adaptation, and identify steps needed to understand and use occupational adaptation.Methods: Four databases were searched using the term 'occupational adaptation' and a principle-based concept analysis was conducted from epistemological, pragmatic, linguistic, and logical perspectives. A mapping of the concept's evolution and analysis of the maturity of its structural features also occurred.Results: Seven hundred and fourty-eight papers were identified, which reduced to 161 after abstract and full-text review. A diverse range of applications and two primary theoretical frames of reference were identified. The definition, attributes, preconditions, outcomes, and boundaries of the concept lacked maturity, limiting clinical utility.Conclusions and significance: Occupational adaptation is a concept applied across many practice and research contexts, yet the concept is not fully mature. Concept refinement is required before further applied research is conducted. A shared understanding of occupational adaptation through refinement and research may consolidate its importance and future utility.

The Use of Occupational Adaptation in Research: A Scoping Review

The aim of this scoping review was to identify and describe how occupational adaptation has been used in different research studies published from 1992 to 2015 and to identify possible gaps in study design. Four categories of studies were identified: those focused on understanding how occupational adaptation occurs in different life situations and different health conditions, those focused on the use of occupational adaptation as a guide or model in organizing the occupational therapy process, and those using occupational adaptation as a part of instrument development. Several gaps in research are evident including updating the theory development on occupational adaptation, types of maladaptation, studies conducted in less affluent countries, quantitative studies with robust designs, inclusion of men and younger persons as subjects, vulnerable groups, health promotion, and community settings.

Comorbidity in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis: A Nationwide Population-Based Cohort Study

BACKGROUND

Previous studies have shown evidence of comorbid conditions in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).

OBJECTIVE

To estimate the prevalence of comorbidities and assess their associations using a nationwide population-based database of a Spanish CFS/ME cohort.

METHOD

A nationally representative, retrospective, cross-sectional cohort study (2008-2015) assessed 1757 Spanish subjects who met both the 1994 Centers for Disease Control and Prevention/Fukuda definition and 2003 Canadian Criteria for CFS/ME. Sociodemographic and clinical data, comorbidities, and patient-reported outcome measures at baseline were recorded. A cluster analysis based on baseline clinical variables was performed to classify patients with CFS/ME into 5 categories according to comorbidities. A multivariate logistic regression analysis was conducted adjusting for potential confounding effects such as age and sex; response and categorical predictor variables were also assessed.

RESULTS

A total of 1757 CFS/ME patients completed surveys were collected. We identified 5 CFS/ME clusters: group 1-fibromyalgia, myofascial pain, multiple chemical hypersensitivity, sicca syndrome, epicondylitis, and thyroiditis; group 2-alterations of ligaments and subcutaneous tissue, hypovitaminosis D, psychopathology, ligamentous hyperlaxity, and endometriosis. These 2 subgroups comprised mainly older women, with low educational level, unemployment, high levels of fatigue, and poor quality of life; group 3-with hardly any comorbidities, comprising mainly younger women, university students or those already employed, with lower levels of fatigue, and better quality of life; group 4-poorly defined comorbidities; and group 5-hypercholesterolemia.

CONCLUSION

Over 80% of a large population-based cohort of Spanish patients with CFS/ME presented comorbidities. Among the 5 subgroups created, the most interesting were groups 1-3. Future research should consider multidisciplinary approaches for the management and treatment of CFS/ME with comorbid conditions.

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.

Coping and Occupational Participation in Chronic Fatigue Syndrome

Existing studies have shown that individuals with chronic fatigue syndrome demonstrate functional impairment in several domains related to occupational participation. Researchers have not yet explored whether coping styles may be associated with occupational participation in individuals with this condition. The aim of this study was to examine the effects of coping styles on occupational participation among adults with chronic fatigue syndrome. The authors hypothesized that occupational participation would be associated with coping strategies oriented toward information seeking and maintaining activity, and that this relationship would endure despite individual differences in illness severity. The study used a cross-sectional design to describe the associations between coping and occupational participation for 47 individuals diagnosed as having chronic fatigue syndrome. Findings from linear regression analysis revealed that the coping style of maintaining activity was positively associated with occupational participation, whereas illness accommodation was negatively associated. Implications of the findings for continued research and clinical practice in occupational therapy are discussed.

The occupational and quality of life consequences of chronic fatigue syndrome/myalgic encephalomyelitis in young people

INTRODUCTION: Chronic fatigue syndrome, termed myalgic encephalomyelitis in the United Kingdom (CFS/ME), is a debilitating condition involving severe exhaustion, cognitive difficulties, educational and vocational losses, and disruption of social activities and relationships. CFS/ME may affect volition (that is, value, interest and sense of competence). PURPOSE: To test Model of Human Occupation (MOHO) concepts by comparing young people with and without CFS/ME in terms of occupational participation, volition and health-related quality of life during infection and over time. METHOD: Three hundred and one people (12-18 years old) diagnosed with glandular fever were evaluated at the time of acute infection (baseline). Six months following diagnosis, 39 of them met the criteria for CFS/ME. A further 39 who recovered were randomly selected and matched to CFS/ME participants. Both groups were re-evaluated at 12 months and 24 months. The Occupational Self Assessment and the Child General Health Questionnaire were used to compare occupational participation. RESULTS: Those with CFS/ME reported lower levels of perceived competency, more difficulties with physical functioning and poorer general health status than those who recovered. CONCLUSION: Those with CFS/ME report lower perceived competency, and compromises in physical functioning, school performance, social activities, emotional functioning and general health. This supports the MOHO assertion that impairments affect volition and quality of life.