Chronic Fatigue Syndrome: An Evaluation of an Occupational Therapy Inpatient Intervention

Abstract

It has been stated that, although most chronic fatigue syndrome (CFS) patients can be treated in primary care and that cognitive behaviour therapy and prescribed, graded aerobic exercise appear to be promising in outpatient management, a minority of patients will require inpatient care (Royal Colleges of Physicians, General Practitioners and Psychiatrists 1996). To date, little has been written on the need for and impact of an inpatient approach for patients with CFS. This study builds on previous work to show how patients with complex CFS responded to a specifically designed occupational therapy inpatient programme, using the principles of cognitive behaviour therapy and graded activity. A quasi-experimental study was carried out using current inpatients with those on the waiting list as a comparison. At 6 months following discharge, a significant difference between the groups in terms of symptoms and level of ability was not demonstrated. However, a significant effect was shown in patients' perceived health, length of time tired and management of the illness. Thirty-one (72%) of the inpatient group, compared with 10 (53%) of the comparison group, stated that they felt better than the previous year. Thirty-one (72%) of the inpatient group, compared with 7 (37%) of the comparison group, indicated better management of their illness. These findings give some evidence of the need for an inpatient CFS management programme for specific patients with complex CFS.

Activity Pacing Self-Management in Chronic Fatigue Syndrome: A Randomized Controlled Trial

“…Participants who were trained in activity pacing self-management seemed to have learned superior coping strategies for dealing with limitations in daily life activities or their illness in general compared with control participants, findings that are consistent with those of a similar study (Cox, 2002). Experimental group participants may have reappraised their daily life activities, altering the value they placed on those activities, in turn resulting in improved satisfaction with performance of desired activities (Persson, Andersson, & Eklund, 2011).…”

“…The rationale for activity pacing can be found in several strategies observed in people with CFS: reduced activity levels resulting from and in anticipation of fatigue (Nijs et al, 2011;Vercoulen et al, 1997), lowered activity peaks followed by very long rest periods (van der Werf, Prins, Vercoulen, van der Meer, & Bleijenberg, 2000), and ability to perform short periods of light to moderate activity without exacerbating symptoms (Clapp et al, 1999;Cook et al, 2005). Several randomized controlled trials (RCTs) have shown positive effects of treatment programs based on activity pacing for people with CFS (Cox, 2002;Crawley et al, 2013;Goudsmit et al, 2012;Jason et al, 2013;Pemberton & Cox, 2014;Taylor, 2004). The findings of these studies are in line with those of a pilot study in which several of the current authors participated (Nijs et al, 2009).…”

“…APSM, in contrast, encourages both reintroduction of and increases in activity. Studies of diverse methodological quality have found decreased fatigue levels and somatic symptoms and increased self-efficacy and quality of life after activity pacing as part of a multicomponent program for CFS (Cox, 2002;Crawley et al, 2013;Goudsmit, Ho-Yen, & Dancey, 2009;Taylor, 2004).…”

Quality and acceptability of patient-reported outcome measures used in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review

“…Limited evidence supports the responsiveness of the IMQ following a lifestyle management programme [40], but suggests that the CFS-APQ and CFS-SL are not responsive to change in health following exercise programmes [41,42]. Where reported, the statistical significance of score change or between groups difference was described; no study reported the clinical significance of score change or specifically evaluated PROM responsiveness or interpretation of score change.…”

Chronisch-vermoeidheidssyndroom

“…Other types of modified CBT, with occupational therapy/rehabilitation aspects, were examined in one RCT 97 of high quality evidence and two controlled trials in adults 98,99 of low quality evidence. These three studies found significant differences between groups for symptoms (one RCT, one controlled trial), emotional distress (one controlled trial) and global health/ quality of life (3 controlled trials).…”