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Casson S, Jones MD, Cassar J, Kwai N, Lloyd AR, Barry BK, Sandler CX. The effectiveness of activity pacing interventions for people with chronic fatigue syndrome: a systematic review and meta-analysis. Disabil Rehabil 2023; 45:3788-3802. [PMID: 36345726 DOI: 10.1080/09638288.2022.2135776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/29/2022] [Accepted: 10/09/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To investigate whether activity pacing interventions (alone or in conjunction with other evidence-based interventions) improve fatigue, physical function, psychological distress, depression, and anxiety in people with chronic fatigue syndrome (CFS). MATERIALS AND METHODS Seven databases were searched until 13 August 2022 for randomised controlled trials that included activity pacing interventions for CFS and a validated measure of fatigue. Secondary outcomes were physical function, psychological distress, depression, and anxiety. Two reviewers independently screened studies by title, abstract and full text. Methodological quality was evaluated using the PEDro scale. Random-effects meta-analyses were performed in R. RESULTS 6390 articles were screened, with 14 included. Good overall study quality was supported by PEDro scale ratings. Activity pacing interventions were effective (Hedges' g (95% CI)) at reducing fatigue (-0.52 (-0.73 to -0.32)), psychological distress (-0.37 (-0.51 to -0.24)) and depression (-0.29 (-0.49 to -0.09)) and improving physical function (mean difference 7.18 (3.17-11.18)) when compared to no treatment/usual care. The extent of improvement was greater for interventions that encouraged graded escalation of physical activities and cognitive activities. CONCLUSION Activity pacing interventions are effective in reducing fatigue and psychological distress and improving physical function in CFS, particularly when people are encouraged to gradually increase activities. REGISTRATION PROSPERO CRD42016036087. IMPLICATIONS FOR REHABILITATIONA key feature of chronic fatigue syndrome (CFS) is a prolonged post-exertional exacerbation of symptoms following physical activities or cognitive activities.Activity pacing is a common strategy often embedded in multi-component management programs for CFS.Activity pacing interventions are effective in reducing fatigue and psychological distress and improving physical function in CFS, particularly when patients are encouraged to gradually increase their activities.Healthcare professionals embedding activity pacing as part of treatment should work collaboratively with patients to ensure successful, individualised self-management strategies.
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Affiliation(s)
- Sally Casson
- The Kirby Institute, The University of New South Wales, Sydney, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Matthew D Jones
- School of Health Sciences, The University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Joanne Cassar
- The Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Natalie Kwai
- The Kirby Institute, The University of New South Wales, Sydney, Australia
- School of Medical Sciences, University of Sydney, Sydney, Australia
| | - Andrew R Lloyd
- The Kirby Institute, The University of New South Wales, Sydney, Australia
| | - Benjamin K Barry
- School of Health Sciences, The University of New South Wales, Sydney, Australia
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Carolina X Sandler
- The Kirby Institute, The University of New South Wales, Sydney, Australia
- School of Health Sciences, Campbelltown Campus, Western Sydney University, Sydney, Australia
- Menzies Health Institute Queensland, Griffith University, Queensland, Australia
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Kim S, Xu Y, Dore K, Gewurtz R, Larivière N, Letts L. Fatigue self-management led by occupational therapists and/or physiotherapists for chronic conditions: A systematic review and meta-analysis. Chronic Illn 2022; 18:441-457. [PMID: 34515530 PMCID: PMC9397391 DOI: 10.1177/17423953211039783] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the effectiveness of occupational therapist-/physiotherapist-guided fatigue self-management for individuals with chronic conditions. METHODS Eight databases, including MEDLINE and EMBASE, were searched until September 2019 to identify relevant studies. Randomised controlled trials and quasi-experimental studies of self-management interventions specifically developed or delivered by occupational therapists/physiotherapists to improve fatigue symptoms of individuals with chronic conditions were included. A narrative synthesis and meta-analysis were conducted to determine the effectiveness of fatigue self-management. RESULTS Thirty-eight studies were included, and fatigue self-management approaches led by occupational therapists/physiotherapists were divided into six categories based on the intervention focus: exercise, energy conservation, multimodal programmes, activity pacing, cognitive-behavioural therapy, and comprehensive fatigue management. While all exercise programmes reported significant improvement in fatigue, other categories showed both significant improvement and no improvement in fatigue. Meta-analysis yielded a standardised mean difference of the overall 13 studies: 0.42 (95% confidence interval:-0.62 to - 0.21); standardised mean difference of the seven exercise studies was -0.55 (95% confidence interval: -0.78 to -0.31). DISCUSSION Physical exercises inspired by the self-management principles may have positive impacts on fatigue symptoms, quality of life, and other functional abilities.
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Affiliation(s)
- Sungha Kim
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| | - Ying Xu
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| | - Kelly Dore
- Department of Medicine, 12362McMaster Education Research, Innovation & Theory (MERIT), 12370David Braley Health Science Centre, Hamilton, ON, Canada
| | - Rebecca Gewurtz
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
| | - Nadine Larivière
- Department of Medicine, 12362McMaster Education Research, Innovation & Theory (MERIT), 12370David Braley Health Science Centre, Hamilton, ON, Canada
| | - Lori Letts
- 63662School of Rehabilitation Science, 3710McMaster University, Hamilton, ON, Canada
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Vink M, Vink-Niese F. Work Rehabilitation and Medical Retirement for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Patients. A Review and Appraisal of Diagnostic Strategies. Diagnostics (Basel) 2019; 9:diagnostics9040124. [PMID: 31547009 PMCID: PMC6963831 DOI: 10.3390/diagnostics9040124] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 01/31/2023] Open
Abstract
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.
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Affiliation(s)
- Mark Vink
- Family and Insurance Physician, 1096 HZ Amsterdam, The Netherlands.
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Affiliation(s)
- Diane L Cox
- Director of Research and Head of the Graduate School, Professor of Occupational Therapy, University of Cumbria, United Kingdom of Great Britain and Northern Ireland
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Jacobsen HB, Kallestad H, Landrø NI, Borchgrevink PC, Stiles TC. Processes in acceptance and commitment therapy and the rehabilitation of chronic fatigue. Scand J Psychol 2017; 58:211-220. [DOI: 10.1111/sjop.12363] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/03/2017] [Indexed: 01/25/2023]
Affiliation(s)
- Henrik Børsting Jacobsen
- Hysnes Rehabilitation Center; St. Olav's University Hospital; Trondheim Norway
- National Competence Center for Complex Symptom Disorders; St. Olav's University Hospital; Trondheim Norway
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology; Trondheim Norway
| | - Håvard Kallestad
- Norwegian University of Science and Technology; Department of Neuroscience; Trondheim Norway
- Department of Psychiatry; St. Olav's University Hospital; Trondheim Norway
| | - Nils Inge Landrø
- National Competence Center for Complex Symptom Disorders; St. Olav's University Hospital; Trondheim Norway
- Clinical Neuroscience Research Group; Department of Psychology; University of Oslo; Oslo Norway
| | - Petter C. Borchgrevink
- Hysnes Rehabilitation Center; St. Olav's University Hospital; Trondheim Norway
- National Competence Center for Complex Symptom Disorders; St. Olav's University Hospital; Trondheim Norway
- Department of Circulation and Medical Imaging; Norwegian University of Science and Technology; Trondheim Norway
| | - Tore C. Stiles
- National Competence Center for Complex Symptom Disorders; St. Olav's University Hospital; Trondheim Norway
- Department of Psychology; Norwegian University of Science and Technology; Trondheim Norway
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McDermott C, Richards SCM, Ankers S, Selby M, Harmer J, Moran CJ. An Evaluation of a Chronic Fatigue Lifestyle Management Programme Focusing on the Outcome of Return to Work or Training. Br J Occup Ther 2016. [DOI: 10.1177/030802260406700606] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents the results of an audit of clinical outcomes from an occupational therapist led service for patients with chronic fatigue syndrome (CFS). The service offers group outpatient lifestyle management sessions, in which patients are encouraged to restructure lifestyle patterns in order to facilitate improvements in fatigue and function. The cohort studied consisted of 98 consecutive patients attending the service who fulfilled the 1994 Centers for Disease Control criteria for CFS. The median illness duration was 5 years. The treatment offered consisted of six group sessions in lifestyle management together with three additional review sessions. The primary outcome measure was a return by the patient to employment, voluntary work or training. The cohort was followed up at a median of 18 months using a self-report questionnaire. Among the treated patients, 42% (31/74) reported new part-time or full-time employment, voluntary work or training. The results of this study suggest that a lifestyle management programme offered by an occupational therapist led specialist service may provide positive outcomes, in terms of a return by patients to work and training, and indicates the need for a randomised controlled trial to provide definitive evidence of this.
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Abstract
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.
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Affiliation(s)
- Lucy Burley
- Formerly at CFS Diagnostic and Management Service, Essex Centre for Neurological Sciences, Oldchurch Hospital, Romford, Essex
| | - Diane L Cox
- University of Cumbria (St Martin's College), Lancaster
| | - Leslie J Findley
- CFS Diagnostic and Management Service, Essex Centre for Neurological Sciences, Oldchurch Hospital, Romford, Essex
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Kos D, van Eupen I, Meirte J, Van Cauwenbergh D, Moorkens G, Meeus M, Nijs J. Activity Pacing Self-Management in Chronic Fatigue Syndrome: A Randomized Controlled Trial. Am J Occup Ther 2015; 69:6905290020. [PMID: 26356665 PMCID: PMC4564796 DOI: 10.5014/ajot.2015.016287] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of an activity pacing self-management (APSM) intervention in improving performance of daily life activities in women with chronic fatigue syndrome (CFS). METHOD A total of 33 women with CFS (age 41.1±11.2 yr) were randomly allocated to APSM (experimental group; n=16) or relaxation (control group; n=17). Main outcome measures included the Canadian Occupational Performance Measure (COPM; primary) and Checklist Individual Strength (CIS). RESULTS COPM scores changed significantly over time in both groups (p=.03). The change in Satisfaction scores showed a significant difference in favor only of APSM (effect size=0.74 [0.11, 1.4]). CIS scores decreased significantly in the experimental group only (p<.01). CONCLUSION APSM was found to be feasible and effective in optimizing participation in desired daily life activities in women with CFS. Replication in a larger sample with long-term follow-up is required.
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Affiliation(s)
- Daphne Kos
- Daphne Kos, PhD, OT, is Assistant Professor, Department of Rehabilitation Sciences, Neuromotor Research Group, KU Leuven-University of Leuven, Belgium; Lecturer, Division of Occupational Therapy, Department of Health and Social Care, Artesis Plantijn University College, Antwerp, Belgium; and Member, Pain in Motion Research Group, Brussels, Belgium;
| | - Inge van Eupen
- Inge van Eupen, OT, is Lecturer, Division of Occupational Therapy, Department of Health and Social Care, Artesis Plantijn University College, Antwerp, Belgium
| | - Jill Meirte
- Jill Meirte, PT, is PhD Researcher, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium. At the time of the study, she was Lecturer, Artesis Plantijn University College, Antwerp, Belgium
| | - Deborah Van Cauwenbergh
- Deborah Van Cauwenbergh, PT, is PhD Researcher, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium. At the time of the study, she was Lecturer, Artesis Plantijn University College, Antwerp, Belgium
| | - Greta Moorkens
- Greta Moorkens, PhD, MD, is Associate Professor, Department of General Internal Medicine of University of Antwerp, Belgium; and Warrant-Manager, University Hospital, Antwerp, Belgium
| | - Mira Meeus
- Mira Meeus, PhD, PT, is Associate Professor, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Belgium; Associate Professor, Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium; and Member, Pain in Motion Research Group, Brussels, Belgium. At the time of the study, she was Lecturer, Artesis Plantijn University College, Antwerp, Belgium
| | - Jo Nijs
- Jo Nijs, PhD, PT, is Associate Professor, Departments of Human Physiology and Physiotherapy, Faculty of Physical Education and Physiotherapy, Vrije Universiteit, Brussels, Belgium; Physiotherapist, Department of Physical Medicine and Physiotherapy, University Hospital, Brussels, Belgium; and Member, Pain in Motion Research Group, Brussels, Belgium. At the time of the study, he was Lecturer, Artesis Plantijn University College, Antwerp, Belgium
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Pemberton S, Cox DL. Experiences of daily activity in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and their implications for rehabilitation programmes. Disabil Rehabil 2013; 36:1790-7. [PMID: 24369769 DOI: 10.3109/09638288.2013.874503] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Chronic Fatigue Syndrome, also known as Myalgic Encephalomyelitis (CFS/ME), has a significant impact upon daily functioning. Most recommended treatments aim to alter activity patterns based upon assumptions of activity avoidance. However, as there is limited research on the experience of activity and occupational beliefs in people with CFS/ME, this study took a qualitative approach to understand the meaning of activity in people with this disabling condition. METHOD This study applied a social constructivist grounded theory methodology. Semi-structured interviews took place with 14 participants attending a Specialist CFS/ME Service in England. FINDINGS The emergent themes described a premorbid state of constant action with difficulty stopping an activity once it had commenced. When this pattern was interrupted by illness, participants attempted to maintain their previous level of occupational engagement. Negative associations and emotions were described in response to the concept of doing nothing or limited activity. A recurring cycle was reported of increasing activity levels when symptoms improved, followed by post exertional symptoms. CONCLUSIONS Consequently, participants' beliefs about concepts of both activity and inactivity need to be considered within the application of rehabilitation programmes for CFS/ME that aim to modify activity related behaviours. IMPLICATIONS FOR REHABILITATION Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is commonly treated in the UK using activity modification. In this small qualitative study, patients expressed negative feelings and beliefs towards the concept of doing nothing and therefore sought to push their activity levels when this was available, leading to recurring cycles of symptoms and activity. Rehabilitation programmes need to consider how people with CFS/ME engaged with activity and inactivity before the condition and how this may impact upon engagement with activity-based rehabilitation programmes.
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Affiliation(s)
- Sue Pemberton
- Yorkshire Fatigue Clinic, Forsyth Business Centre , York, North Yorkshire , UK and
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Padilla R. Effectiveness of Interventions Designed to Modify the Activity Demands of the Occupations of Self-Care and Leisure for People With Alzheimer’s Disease and Related Dementias. Am J Occup Ther 2011; 65:523-31. [DOI: 10.5014/ajot.2011.002618] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
A systematic review of evidence for the effectiveness of modification of activity demands in the care of people with Alzheimer’s disease (AD) was conducted as part of the American Occupational Therapy Association’s Evidence-Based Literature Review Project. The review included 10 articles addressing occupations of self-care and leisure. No reports related to work and social participation were located. Results suggest that evidence for this intervention’s effectiveness is strong. Four practice principles were derived from this appraisal: (1) Occupational therapy programs should be individualized to elicit the person’s highest level of retained skill and interest, (2) cues used while assisting people with AD to complete tasks should be short and provide clear direction, (3) compensatory strategies in the form of environmental modifications and simple adaptive equipment should be specifically implemented on the basis of the unique needs of the person, and (4) caregiver training and involvement are essential in implementing individualized programs.
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Affiliation(s)
- René Padilla
- René Padilla, PhD, OTR/L, FAOTA, is Associate Dean for Academic and Student Affairs, Office of Academic and Student Affairs, Criss III Building, Suite 154, School of Pharmacy and Health Professions, Creighton University, 2500 California Plaza, Omaha, NE 68178;
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Haywood KL, Staniszewska S, Chapman S. Quality and acceptability of patient-reported outcome measures used in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review. Qual Life Res 2011; 21:35-52. [DOI: 10.1007/s11136-011-9921-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2011] [Indexed: 12/26/2022]
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Purcell A, Fleming J, Bennett S, Haines T. Development of an Educational Intervention for Cancer-Related Fatigue. Br J Occup Ther 2010. [DOI: 10.4276/030802210x12759925544425] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Fatigue is one of the most common and disabling symptoms experienced during cancer treatment. Educational interventions are used by health professionals, such as occupational therapists, to manage cancer-related fatigue; however, there is a lack of information about the content, format and effectiveness of educational interventions in managing fatigue. This paper presents the development and structure of CAN-FIT, a theoretically driven cancer-related fatigue educational intervention, and a preliminary study of the intervention's feasibility and acceptability. Preliminary evaluation: The CAN-FIT programme was piloted with two groups with a total of nine radiotherapy patients. Patients completed a confidential evaluation form and were asked qualitative questions to provide feedback about the programme. The results of the preliminary study indicated that the intervention was acceptable to and feasible for participants. The participants reported that they received a high level of new information and skills from the education sessions and would recommend the sessions to others. Small modifications to programme components were made based on participant feedback. Conclusion: The CAN-FIT programme provided a feasible structured educational intervention for the management of cancer-related fatigue, which was acceptable to the participant sample. A randomised controlled trial is required to provide evidence of its effectiveness among the wider radiotherapy population.
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Affiliation(s)
- Amanda Purcell
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Jenny Fleming
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Sally Bennett
- University of Queensland, Brisbane, Queensland, Australia
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Thomas S, Thomas PW, Nock A, Slingsby V, Galvin K, Baker R, Moffat N, Hillier C. Development and preliminary evaluation of a cognitive behavioural approach to fatigue management in people with multiple sclerosis. PATIENT EDUCATION AND COUNSELING 2010; 78:240-249. [PMID: 19665337 DOI: 10.1016/j.pec.2009.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2008] [Revised: 06/29/2009] [Accepted: 07/03/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVES (i) To develop a group-based intervention for the management of multiple sclerosis (MS) fatigue incorporating energy effectiveness and cognitive behavioural approaches and (ii) to undertake a process and preliminary evaluation. METHODS Drawing upon a literature search, a local model of good practice and the views of service users and health professionals, a manualised group-based fatigue management programme was developed, designed to be delivered by health professionals. A process and preliminary outcome evaluation was undertaken. Sixteen participants attended across two iterations. Participant feedback, obtained via a focus group and evaluation questionnaires, was used to refine the programme. Outcomes were collected pre- and post-programme (including fatigue severity, quality of life, self-efficacy). RESULTS Focus group feedback suggested the programme was well received, reflected in high attendance and positive ratings on evaluation questionnaires. At follow-up, despite the small sample size, there were significant improvements in perceived self-efficacy for managing fatigue. CONCLUSION An evidence-based fatigue management intervention has been developed and preliminary findings look promising. In the next phase we will examine whether the programme transfers satisfactorily to other centres and collect data in preparation for a randomised controlled trial (RCT). PRACTICE IMPLICATIONS Implications for practice will emerge when the results of our RCT are published.
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Affiliation(s)
- S Thomas
- Dorset Research and Development Support Unit, Poole Hospital NHS Foundation Trust, Poole, Dorset BH15 2JB, UK.
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Reynolds F, Vivat B, Prior S. Women's experiences of increasing subjective well-being in CFS/ME through leisure-based arts and crafts activities: A qualitative study. Disabil Rehabil 2009; 30:1279-88. [DOI: 10.1080/09638280701654518] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pureell A, Fleming J, Haines T, Bennett S. Cancer-Related Fatigue: A Review and a Conceptual Framework to Guide Therapists' Understanding. Br J Occup Ther 2009. [DOI: 10.1177/030802260907200205] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cancer-related fatigue is reported as the most common and distressing symptom experienced by people with cancer. There is limited research published to guide occupational therapists working with people with cancer to help address this distressing symptom. This article reviews literature on cancer-related fatigue and identifies several factors associated with the development of fatigue, including underlying medical factors and other factors. The underlying medical factors reported in the literature include biomedical mechanisms, such as anaemia, proinflammatory cytokines and specific cellular processes; disease-related factors; treatment-related factors; and comorbid conditions. Other factors reviewed include physical or behavioural factors, such as poor nutrition, decreased activity, sleep disturbance and pain; psychological factors, including anxiety and depression; and sociodemographic factors, such as social support, employment and education. The review identified a variety of factors associated with cancer-related fatigue, which must be considered by occupational therapists working with people with cancer. This presents a challenge to the clinical reasoning of occupational therapists attempting to treat such people. A framework of factors contributing to cancer-related fatigue is proposed in order to guide both the practice of occupational therapists working with adults with cancer and future research in this area.
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Affiliation(s)
- Amanda Pureell
- The University of Queensland, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
| | - Jennifer Fleming
- The University of Queensland, Brisbane, Australia
- Princess Alexandra Hospital, Brisbane, Australia
| | - Terry Haines
- Southern Health, Victoria, and Monash University, Victoria, Australia
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Hughes JL. Chronic Fatigue Syndrome and Occupational Disruption in Primary Care: Is There a Role for Occupational Therapy? Br J Occup Ther 2009. [DOI: 10.1177/030802260907200102] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper presents the findings of a postal survey that examined the experience of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) in the primary care setting. The views of 51 general practitioners (GPs) (response rate of 30%) and 51 people that had experienced CFS/ME (response rate of 61%) were collected in an attempt to describe both the occupational disruption experienced due to CFS/ME and the current management offered in primary care, and to investigate whether there was an early intervention role for occupational therapy. The greatest level of occupational disruption reported was in the performance of self-care and productivity tasks and the most helpful intervention reported was that of acknowledgement of the condition and its implications. The GPs rated the use of cognitive behavioural therapy and graded exercise therapy as more beneficial than medical care for CFS/ME and many offered advice on these interventions, but 57% of people with CFS/ME reported that they had received unhelpful advice and/or treatment from their GP. Currently, there is little research evidence to support any particular interventions for people with CFS/ME in primary care and the prevention of occupational dysfunction, as often seen in secondary and tertiary care, is a role that could be fulfilled by occupational therapists.
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Chambers D, Bagnall AM, Hempel S, Forbes C. Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review. J R Soc Med 2006; 99:506-20. [PMID: 17021301 PMCID: PMC1592057 DOI: 10.1177/014107680609901012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To determine whether any particular intervention or combination of interventions is effective in the treatment, management and rehabilitation of adults and children with a diagnosis of chronic fatigue syndrome / myalgic encephalomyelitis (CFS/ME). DESIGN Substantive update of a systematic review published in 2002. Randomized (RCTs) and non-randomized controlled trials of any intervention or combination of interventions were eligible for inclusion. Study participants could be adults or children with a diagnosis of CFS/ME based on any criteria. We searched eleven electronic databases, reference lists of articles and reviews, and textbooks on CFS/ME. Additional references were sought by contact with experts. RESULTS Seventy studies met the inclusion criteria. Studies on behavioural, immunological, pharmacological and complementary therapies, nutritional supplements and miscellaneous other interventions were identified. Graded exercise therapy and cognitive behaviour therapy appeared to reduce symptoms and improve function based on evidence from RCTs. For most other interventions, evidence of effectiveness was inconclusive and some interventions were associated with significant adverse effects. CONCLUSIONS Over the last five years, there has been a marked increase in the size and quality of the evidence base on interventions for CFS/ME. Some behavioural interventions have shown promising results in reducing the symptoms of CFS/ME and improving physical functioning. There is a need for research to define the characteristics of patients who would benefit from specific interventions and to develop clinically relevant objective outcome measures.
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Affiliation(s)
- Duncan Chambers
- Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK.
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