Description of a multifaceted intervention programme for fatigue after acquired brain injury: a pilot study

Abstract

The purpose of this pilot study was to describe and explore a group-based multifaceted intervention for patients with fatigue after acquired brain injury (ABI). We hypothesised that post-intervention changes would result in reduced fatigue, in addition to improved emotional health, sleep and attentional control. Eight subjects with traumatic brain injury (n = 3) and cerebrovascular insults (n = 5) were included. Inclusion was based upon the presence of fatigue complaints. The participants received 36 hours of intervention. Changes related to fatigue, emotional health and sleep was assessed with self-rating measures. Additionally, a neuropsychological test (Conners' Continuous Performance Test II) was included as a measure of attentional control. All subjects were assessed at baseline, post-intervention, and at 3 and 9 months follow-up. Findings indicated reduced fatigue levels (post-intervention and 3 months follow-up), anxiety (9 months follow-up), and daytime sleepiness (3 and 9 months follow-up). Pilot results suggest that multifaceted group-based interventions may have the potential to alleviate symptoms of fatigue, anxiety and sleepiness after ABI. At an individual level, a low load of psychological distress, insomnia symptoms, dysexecutive symptoms, in addition to a strong sense of self-efficacy, may be central in order to reduce levels of fatigue.

Occupational Therapy Interventions for Poststroke Fatigue: A Scoping Review

“…Indeed Skogestad et al reported 24 distinct self-report measures of PSF across 78 reviewed studies including three of the four measures discussed in this review the FSS, the MFS, and the CIS-f subscale. Given the plethora of measures available, we support the statement by Stubberud et al (2019) that researchers and clinicians may find it useful to use more than one measure to gain a full understanding of PSF in their clients. Skogestad et al were able to categorize the items in the measures they reviewed into four dimensions: quality of fatigue (e.g., weakness), severity of fatigue (e.g., tired every day), interference (e.g., prevents sustained function), and coping/management (e.g., pace activity).…”

“…In relation to participants, the vast majority had sustained their stroke more than 1 year prior to receiving an intervention for PSF and the majority lived in the community, either receiving the intervention as a community program or as an outpatient. The participant demographics across studies reflect those of the general stroke population with exceptions in three studies (Johansson, Bjuhr, Karlsson, et al, 2015; Johansson et al, 2012; Stubberud et al, 2019) in which the average age was younger, and the samples comprised of fewer males compared with a typical PSF population (Cumming et al, 2016). This suggests that the benefits found in the studies reviewed may extend to a broad population in relation to age and sex.…”

“…Psycho and PSF-education were included in most interventions. Several interventions drew on CBT and/or elements of CBT: Cognitive restructuring and problem-solving were used by Nguyen et al (2019), included in the cognitive treatment component of the COGRAT intervention in Zedlitz et al (2012), and in the emotional regulation component used by Stubberud et al (2019). Although MBSR was one of the three categories, elements of mindfulness were also used in other interventions, including the multicomponent interventions used by Stubberud et al (2019) and Pálsdóttir et al (2020).…”

“…Several interventions drew on CBT and/or elements of CBT: Cognitive restructuring and problem-solving were used by Nguyen et al (2019), included in the cognitive treatment component of the COGRAT intervention in Zedlitz et al (2012), and in the emotional regulation component used by Stubberud et al (2019). Although MBSR was one of the three categories, elements of mindfulness were also used in other interventions, including the multicomponent interventions used by Stubberud et al (2019) and Pálsdóttir et al (2020). Other commonalities across interventions included tailoring strategies to individual participants such that they could be implemented in participants' daily routines, and the use of homework tasks (e.g., home strategy practice) and assignments (e.g., maintaining a fatigue diary).…”

“…Another study considered multifaceted intervention including adaptive coping strategies, goal management training (GMT), and emotional regulation (Stubberud et al, 2019). Each session had the same general format including presentations, flipchart discussions, group activities, and homework.…”