Alternative title: "Three-week inpatient energy management education (IEME) for persons with multiple sclerosis related fatigue: A research project

Barbero, Marco

Hersche, Ruth

Kool, Jan

Weise, Andrea

Alternative title: "Three-week inpatient energy management education (IEME) for persons with multiple sclerosis related fatigue : a research project

ZHAW Zürcher Hochschule für Angewandte Wissenschaften

Inpatient Energy Management Education (IEME) for persons with MS–related fatigue  Ruth Hersche1, Andrea Weise2, Marco Barbero1, Jan Kool2    1Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland 2Kliniken Valens, Rehabilitationszentrum Valens, Switzerland 2Ergotherapie Impulse, Vättis, Switzerland Results 1: Treatment protocol IEME  Individual lesson with OT 1h Energy account • Vicious fatigue circle • Principles of energy management • Energy profile                               S e l f t r a i n i n g  -  t a s k s  -- -- --  --->           5 Group lessons with OT 2-5 pwMS 1 h Break Management • Types of breaks and break rules • Daily schedule  Occupational balance • Activity patterns and priorities • Weekly schedule Use of body & environment • Ergonomic behaviour • Environmental adjustments Simplifying activities • Workload reduction • Energy costs and consumption Effective communication • Speaking about fatigue • Communication strategies Individual lesson with OT 0.5 h My goals • Revisit the course and the potential of change • Formulation of realistic and specific goals Total: 6.5 h Letter home Reinforce input for the behaviour change Background Fatigue is one of the most common symptoms in persons with multiple sclerosis(pwMS)¹. It limits participation in ADL’s, productivity and effects quality of life. Outpatient energy conservation education is a valid and effective intervention², but is not compatible with inpatient rehabilitation. Rehabilitation centers need a standardized protocol, feasible in inpatient setting which main the reinforcing effect of peers, principals of patient education, empowerment and change management.  Results 2: Feasibility of study protocol Methods: Part 2 • Small RCT with pwMS from the Rehabilitation Centre Valens.  • Randomization to IEME or to progressive muscle relaxation (PMR; control intervention) in addition to rehabilitation as usual. • Inclusion criteria: confirmed diagnosis of MS, 3 week inpatient rehabilitation, FSS (>4),   EDSS (≤6.5). Exclusion criteria: T-MMSE (<21), BDI-FS  (<4). • Outcome measurement at baseline, after 3-week inpatient rehabilitation (T1) and 4 month from baseline (T2). Assessments: MFIS, SF 36, OSA, Self-efficacy MS-Scale, Self-efficacy for performing energy conservation strategies assessment (SPECSA).  Methods: Part 1 • Development based on scientific literature and knowledge from OT experts.  • Training of 3 OT’s in IEME execution. •  Test run  with 13 pwMS. • Analysis of 3 focus group (participants and OTs) discussions after test-run.  • IEME optimization.  Aims Part 1: To develop an inpatient energy management education (IEME) protocol and materials, and user-evaluation of a test-run. Part 2: To evaluate the feasibility of a RCT study-protocol and to explore the effect of IEME on self-efficacy, fatigue and quality of life • Recruitment rate: 56.6 %. • Drop-out: 4.2 %. • Lost for follow up: 21.4 % • Follow up: 74.4 %  • Significant higher scores (p<0.10) in physical functioning (SF36) and self-efficacy for performing energy conservation strategies in IEME vs. PMR at T1 & T2. • No significant  differences in fatigue impact between the groups. • High treatment fidelity with 89% of all tasks completed. • Reduced need of individual OT sessions thanks IEME. • Participants have left the clinic with high motivation to follow their own goals. • They are in different stages of change. • Workload reduction and ergonomic behavior is  easier to implement. • Redesign of daily structure, roles and responsibilities seems more challenging.     Inpatient Energy Management Education (IEME) REFERENCES:  1. Krupp L. Fatigue is intrinsic to multiple sclerosis (MS) and is the most commonly reported symptom of the disease. Mult Scler. 2006, 12(4), 367-368. 2. Asano M., Finlayson ML. Meta-analysis of three different types of fatigue management interventions for people with multiple sclerosis: exercise, education, and medication. Mult Scler Int. 2014.1-12. Manual for OT and  workbook for participants  Conclusions 

Inpatient energy management education (IEME) for persons with MS-related fatigue

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Inpatient energy management education (IEME) for persons with MS-related fatigue

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