An Internet-Based Self-Management Intervention to Reduce Fatigue Among People With Traumatic Brain Injury: A Pilot Randomized Controlled Trial

IMPORTANCE

Fatigue is a chronic and distressing sequela of traumatic brain injury (TBI). Little evidence exists for the efficacy of interventions that address post-TBI fatigue.

OBJECTIVE

To evaluate the preliminary efficacy of a self-management intervention (Maximizing Energy; MAX) for reducing the impact (primary outcome) and severity of fatigue on daily life, improving fatigue experience, and increasing participation compared with a health education (HE) intervention.

DESIGN

Pilot randomized controlled trial (RCT).

SETTING

Community.

PARTICIPANTS

Forty-one participants randomly assigned to the MAX (n = 20) or HE (n = 21) intervention.

INTERVENTIONS

The MAX intervention included problem-solving therapy with energy conservation education to teach participants fatigue management. The HE intervention included diet, exercise, and energy conservation education. Both interventions (30 min/day, 2 days/wk for 8 wk) were delivered online by occupational therapists.

OUTCOME AND MEASURES

The primary outcome was the modified Fatigue Impact Scale (mFIS). Outcome measures were collected at baseline, postintervention, and 4- and 8-wk postintervention.

RESULTS

At 8 wk postintervention, participants in the MAX group reported significantly lower levels of fatigue impact (mFIS) than those in the HE group, F(1, 107) = 29.54, p = .01; Cohen's d = 0.87; 95% confidence interval [0.18, 1.55].

CONCLUSIONS AND RELEVANCE

These findings provide preliminary evidence that the MAX intervention may decrease the impact of fatigue on daily life among people with post-TBI fatigue. What This Article Adds: An internet-based, self-management intervention combining occupational therapy- delivered energy conservation education with cognitive-behavioral therapy seems to reduce fatigue impact and severity among people with post-TBI fatigue. Future appropriately powered RCTs could positively contribute to the evidence available to occupational therapy practitioners for this chronic, debilitating, and often overlooked symptom.

Perceptions of fatigue and fatigue management interventions among people with multiple sclerosis: a systematic literature review and narrative synthesis

Background/Aims

Fatigue is the most common symptom of multiple sclerosis. Evidence supports the effectiveness of fatigue management interventions for people with multiple sclerosis. This review aimed to identify how people with multiple sclerosis experience fatigue and to examine their perceptions of fatigue management interventions.

Methods

The review was conducted systematically, searching the following electronic databases: AMED, CINAHL Complete, eBook Nursing Collection, ERIC, Health Source: Nursing/Academic Edition, MEDLINE, APA PsycArticles, and APA PsycInfo for original peer-reviewed empirical research published in English between January 2000 and June 2020. Qualitative and mixed-methods studies that captured the perspectives of people with multiple sclerosis on their fatigue and/or their perceptions of fatigue management interventions were included. A narrative synthesis was used to synthesise the findings.

Results

A total of 23 qualitative and eight mixed-methods studies were extracted comprising a total of 662 people with multiple sclerosis (relapsing remitting n=293; secondary progressive n=129; primary progressive n=73; relapsing progressive n=3; benign n=2; fulminant n=1; type of multiple sclerosis not reported n=161). Fatigue was perceived by people with multiple sclerosis as a debilitating symptom of the condition and which they felt impacted adversely on their lives. A lack of understanding from others about multiple sclerosis fatigue was challenging for people with multiple sclerosis. People with multiple sclerosis valued the physical and psychosocial-based content of fatigue management interventions and felt fatigue management interventions enabled them to legitimise their fatigue and feel more in control of their fatigue.

Conclusions

From the perspective of people with multiple sclerosis, fatigue is a central and debilitating feature of the everyday experience of living with multiple sclerosis. Research on the potential of fatigue management interventions to foster control for people with multiple sclerosis to help them manage their fatigue is warranted. Healthcare professionals should consider how they can empower people with multiple sclerosis to educate others about their fatigue. Some evidence being generated for practice might not be sufficiently contextualised to different forms of multiple sclerosis.

Making the most out of life: Exploring the contribution of attention restorative theory in developing a non-pharmacological intervention for fatigue

Objectives:

This study investigates an approach based on Kaplan's Attention Restorative Theory (ART) to develop a non-pharmacological intervention to help individuals manage the distressing effects of illness related fatigue. The study aims to: identify activities perceived as being enjoyable by individuals who have moderate to severe fatigue related to advanced illness; determine the core attributes of potentially beneficially interventions; analyse reported ‘enjoyable’ experiences within the ART framework by mapping emergent themes to attributes of attention restoration; and develop the prototype for a self-management intervention tool.

Methods:

A purposive sample of 25 individuals who experienced moderate to severe fatigue was selected from the local hospice and community. Focused semi-structured interviews probed the questions: What do you enjoying doing? What is it about the activity that you particularly enjoy? Framework analysis was used to manage responses.

Results:

Seventy-five ‘enjoyable experiences’ were identified, including artistic pursuits, voluntary work, socialising and learning. These activities were organised into four conceptual themes: Belonging, Expansive, Nurturing and Purposeful. When mapped against attributes of restorative activities specified in ART, there was some congruence and variation. It was clear that the participants expressed a great need to be safe and in a nurturing environment. Some participants placed a high value in and received great joy from contributing to the community; this was not noted in previous ART literature.

Significance of results:

This study has extended Kaplan's insightful work on restorative behaviours by revealing the value that purposeful, engaging and safe activities hold for people who live with fatigue. ART has inspired the research team to develop a self-management intervention tool to guide health care practitioners in promoting a non-pharmacological approach to manage fatigue through exploring, discovering and promoting experiences which engage, excite, nurture and challenge the person. Further research is needed to integrate this approach into clinical practice.