Development and Preliminary Evaluation of a 3-Week Inpatient Energy Management Education Program for People with Multiple Sclerosis–Related Fatigue

Abstract

Background: Energy conservation strategies and cognitive behavioral therapy techniques are valid parts of outpatient fatigue management education in people with multiple sclerosis (MS). In many European countries, multidisciplinary rehabilitation for people with MS is chiefly delivered in specialized rehabilitation centers, where they benefit from short intensive inpatient rehabilitation annually. However, no evidence-based and standardized fatigue management education program compatible with the inpatient setting is available. Methods: Based on a literature search and the expertise of occupational therapists (OTs), a manualized group-based Inpatient Energy Management Education (IEME) program for use during 3-week inpatient rehabilitation that incorporates energy conservation and cognitive behavioral management approaches was developed. An IEME pilot program operated by trained OTs included 13 people with MS-related fatigue. The experiences of the IEME users and OTs were collected during focus groups to refine the program's materials and verify its feasibility in the inpatient setting. Results: The program was feasible in an inpatient setting and met the needs of the people with MS. Targeted behaviors were taught to all participants in a clinical context. In-charge OTs were able to effect behavioral change through IEME. Conclusions: Users evaluated the evidence-based IEME program positively. The topics, supporting materials, and self-training tasks are useful for the promotion and facilitation of behavioral change. The next step is a clinical trial to investigate the efficacy of IEME and to evaluate relevant changes in self-efficacy, fatigue impact, and quality of life after patients return home.

High-intensity interval training and energy management education, compared with moderate continuous training and progressive muscle relaxation, for improving health-related quality of life in persons with multiple sclerosis: study protocol of a randomized controlled superiority trial with six months’ follow-up

“…Before discharge from the clinic, the sessions conclude with an individual lecture (0.5 h), in which participants set goals concerning implementation of the learned strategies at home. The IEME-program integrates the principles of patient education, the trans-theoretical model of behaviour change, social cognitive theory, energy conservation strategies and cognitive behavioural techniques, as previously described by Hersche et al [ 15 ]. All sessions are conducted by independent and trained occupational therapists.…”

“…Two systematic reviews report that educational programs and approaches based on cognitive behavioural principles reduce patient-reported fatigue [ 12 , 14 ], but the relevance for patients’ functioning and HRQoL remain unclear. Recently, a three-week inpatient energy management education (IEME) program for inpatient rehabilitation was developed [ 15 ] that integrates the principles of patient education, the trans-theoretical model of behaviour change, social cognitive theory, energy conservation strategies and cognitive behavioural techniques. In a randomized controlled feasibility trial [ 16 ] IEME was compared with progressive muscle relaxation (PMR) that, in previous research, improved HRQoL in PwMS [ 17 ].…”

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

“…Through participation in FMIs, people with multiple sclerosis engaged in active problem-solving to adapt fatigue management strategies to their own lives (Akbar et al, 2018;Barlow et al, 2009;Hersche et al, 2019;Holberg & Finlayson, 2007). Furthermore, many individuals reported positive impacts of FMIs on addressing loss of ability associated with various symptoms of multiple sclerosis (Akbar et al, 2018;Clarke & Coote, 2015;Flensner & Lindencrona, 2002).…”

“…Most people expressed a preference for group interventions over individualised training (García-Jalón et al, 2013;Twomey & Robinson, 2010;Wendebourg et al, 2016). The group setting brought about friendships, support and feedback, reduced isolation among members and boosted morale among people with multiple sclerosis (Hersche et al, 2019;Mathiowetz & Busch, 2006;Mulligan et al, 2016;Thomas et al, 2010). Peer support also motivated people with multiple sclerosis to continue with the intervention and keep up with assigned work (Barlow et al, 2009).…”

“…Following completion of FMIs, people with multiple sclerosis described a wide range of strategies they had learned which enhanced their control over fatigue, such as managing energy, balancing a schedule, planning and pacing activities, breathing exercises, regular exercise and realistic goal-setting (Barlow et al, 2009;Mathiowetz & Busch, 2006;Thomas et al, 2010;Twomey & Robinson, 2010). Participating in FMIs was described by people with multiple sclerosis as beneficial in enabling them to reflect on their own routines and develop an individualised approach to implementing fatigue management strategies and lifestyle changes (Hersche et al, 2019;Moss-Morris et al, 2012).…”