THREE-WEEK INPATIENT ENERGY MANAGEMENT EDUCATION FOR PERSONS WITH MULTIPLE SCLEROSIS–RELATED FATIGUE. A RESEARCH PROJECT

Hersche Cupelli, Ruth and Weise, Andrea and Barbero, Marco and Kool, Jan (2017) THREE-WEEK INPATIENT ENERGY MANAGEMENT EDUCATION FOR PERSONS WITH MULTIPLE SCLEROSIS–RELATED FATIGUE. A RESEARCH PROJECT. In: MS Meeting, 9.6.17, Paris.

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Abstract

Background: Fatigue is considered to be one of the main causes of impaired quality of life among persons with multiple sclerosis (pwMS) independent from depression or disability 1. The current body of evidence, shows moderate to strong evidence in favor of energy management education in groups and in outpatient settings over six weeks, managed by trained occupational therapists (OT)2,3. Despite good efficacy, these courses could not be implemented in Switzerland, because they do not fit the needs of pwMS and the organization of healthcare here. Until now, no program has focused on treating inpatients in dynamic group compositions over a short period (three weeks) but with higher frequency. Only a group education program with a circular structure that allow participants to begin and end at any day of the week has the chance to be implemented with success in the Swiss rehabilitation context. Aim: The aim is to promote the implementation of evidence based education for pwMS-related fatigue by the adaptation of a treatment program (part 1) and the conduction of a feasibility study to verify a study protocol of a future randomized clinical trial (part 2). Methods part 1: The development of the materials has included several steps using a mixed-methods approach. After the training of three OTs, a test-treatment of 10-15 pwMS, and the evaluation of this experiences in two focus groups has been conducted to improve the program and the materials. Materials and Content: The IEME program consists of one individual and six group sessions The OT use the IEME manual and the participants the patient workbook created by the researchers. Every lesson has one theme: Energy account, break management, occupational balance, efficient use of body & environment, simplifying activities, effective communication and my goals. Between every session the participants are motivated to complete assignments. IEME group sessions are delivered with a circular order in two fixed days the week and integrated in the individual rehabilitation program of each participants. The underlying concepts of IEME are patient education & empowerment, energy conservation strategies, cognitive behavior therapy, self-efficacy and stage of change. Methods part 2: A small-scale RCT (40 participants) will be conducted to examine the feasibility in terms of process, resources, management, and scientific metrics for a larger-scale RCT. Potential participants will be recruited at Rehabilitation Centre Valens. Inclusion criteria: Persons with MS, >18 years, confirmed diagnosis of MS, fatigue severity scale score >4, EDSS ≤6.5, literacy in German. Exclusion criteria: Score of ≥21 on the telephone mini-mental state examination, or Beck depression inventory fast screen score >4. Intervention: All participants follow the rehabilitation program as usual and are randomly collocated to the IEME sessions or to progressive muscle relaxation group sessions (control intervention). Outcome measurements: Modified fatigue impact scale, SF 36, Occupational Self-Assessment, Self-efficacy Scale MS Version, Assessment of Self-Efficacy for Performing Energy Conservation Strategies. Results part 2: May 2018 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. 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. Archives of Physical Medicine and Rehabilitation, 94(7), 1360–1376. 3. 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 Acknowledgements: Swiss MS-Society, Stiftung für Ergotherapie Zürich, ErgotherapeutInnen-Verband Schweiz

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