Delivering Fatigue Management Education by Teleconference to People with Multiple Sclerosis

Abstract

Fatigue is one of the most common and disabling symptoms reported by people with multiple sclerosis (MS). Teaching people with MS how to self-manage their fatigue is an important role for occupational therapists (OTs). Typically, these strategies are taught face to face, either in groups or on a one-to-one basis. For some people with MS, traveling to a location for this education is difficult. Therefore, teleconference delivery can be a viable option.

The program broke things down into simple basic things that I could do to manage my fatigue—things I didn’t think about before the course.

Participant

Appendices

The Case Study of Karen: Supporting the Use of Fatigue Management Strategies

Keywords: Fatigue, Multiple sclerosis, Self-management

Introduction

The theme of this case study is enabling fatigue self-management through the selection and application of fatigue management strategies.

The Students’ Tasks Include Learning About

• MS (e.g., Cameron et al. 2013)

• Fatigue in MS (e.g., Finlayson et al. 2013a)

• Evidence supporting the use of fatigue management education in MS (e.g., Blikman et al. 2013)

• Self-management and self-management principles (e.g., Lorig and Holman 2003)

• Telehealth and the challenges of delivering interventions by telehealth (e.g., Dunleavy 2013)

As a starting point, students should use the following references to gather background information:

• 1. Cameron M, Finlayson M, Kesselring J (2013) In: Finlayson M (ed) Multiple sclerosis rehabilitation: from impairment to participation. CRC/Taylor Francis, Boca Raton, pp 9–34

• 2. Finlayson M, Johansson S, Kos D (2013) Fatigue. In: Finlayson M (ed) Multiple sclerosis rehabilitation: from impairment to participation. CRC/Taylor & Francis

• 3. Blikman LJ, Huisstede BM, Kooijmans H, Stam HJ, Bussmann JB, van Meeteren J (2013) Effectiveness of energy conservation treatment in reducing fatigue in multiple sclerosis: a systematic review and meta-analysis. Arch Phys Med Rehabil 94(7):1360–1376. doi: 10.1016/j.apmr.2013.01.025

• 4. Dunleavy L, Preissner K, Finlayson M (2013) Facilitating a teleconference-delivered fatigue management program: perspectives of occupational therapists. Can J Occup Ther

• 5. Butler J (2013) Self-efficacy. In: Gellman MD, Turner JR (eds) Encyclopedia of behavioral medicine, vol. 4 S-Z. Springer, New York, pp 1737–1739

Overview of the Content

Major Goals of the Actual Intervention

The major goals of fatigue management education are: (1) to reduce the impact of fatigue on daily life, (2) to enhance overall quality of life, and (3) to support development of self-management skills and self-efficacy to manage MS .

Learning Objectives

By the end of studying this chapter, the learner will be able to:

• 1. Appreciate the complexity of MS fatigue and its management

• 2. Identify when it is appropriate to offer fatigue management education to a person with MS.

• 3. Describe the overarching self-management skills that are developed through group-based fatigue management education

• 4. Summarize the evidence regarding fatigue management education for people with MS

The Background History of Karen

Personal Information

Karen is a 47-year-old female with relapsing remitting MS. She was diagnosed 12 years ago. She is married, has a 7-year-old daughter, and works part time as a sales clerk. She and her family live in a three-story town house in a large city.

Medical Information Including Prognosis

Over the past 2 years, Karen’s MS has progressed. She has experienced two relapses, both of which left her with residual mobility impairments and extreme fatigue. She tried the medication amantadine for her fatigue, but found it ineffective, so stopped taking it. She prefers not to use a cane because it makes her feel “old.” Her doctor has indicated that she is likely transitioning into a secondary progressive form of the disease.

Occupational Therapy Intervention

The initial interview with Karen uncovered that she is struggling to maintain employment because of her fatigue and mobility impairments . In order to cope, she has given up most of her social and leisure activities so that she has enough energy to take care of her home and child and get through her tasks at work. Some of her personal activities of daily living (ADL) habits have also suffered due to fatigue, and she has resorted to prepared meals and fast food because she is having difficulty in grocery shopping and making meals after a day at work. Karen reports that these changes make her feel bad about herself and her ability to be a good role model for her daughter. Karen wants to make adjustments to manage her fatigue more effectively and get back to doing the things that she values.

Karen completed the nine-item Fatigue Severity Scale (Krupp et al. 1989) and received a score of 6.8, which indicates that she is experiencing severe fatigue. Karen also completed the 14-item self-efficacy for Energy Conservation Questionnaire (Liepold and Mathiowetz 2006), which evaluates a person’s confidence to use 14 different fatigue management strategies. Overall, Karen’s confidence was low, with an average score of 4 out of 10.

The Student’s Report

The following guiding questions have been identified:

• What are some of the factors that may be contributing to Karen’s fatigue?

• Which of these factors are most likely to be amenable to fatigue management education?

• What are the key self-management skills that the occupational therapist will work to develop during the course of the fatigue management program?

• What is self-efficacy and why it is important for fatigue management?

• Based on Karen’s situation and the available literature, which fatigue management strategies would you focus on during your intervention and why?

• What outcome measures would you select to evaluate the effectiveness of a fatigue management education program for Karen and why?

• What are the potential benefits and limitations of a teleconference-delivered fatigue management program for Karen?