Inpatient fatigue-management education

Weise, Andrea and Barbero, Marco and Hersche Cupelli, Ruth and Kool, Jan and Gisela, Michel (2018) Inpatient fatigue-management education. UNSPECIFIED. In: 23rd Annual Conference of Rehabilitation in Mulitple Sclerosis (EuRims), 31.05.2018 -02.06.2018, Amsterdam.

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Background: Studies have shown the efficacy of outpatient fatigue management with energy conservation strategies in pwMS. However, these treatment protocols are not compatible with (bi)annual multidisciplinary inpatient rehabilitation, and knowledge transfer into practice has therefore not been completed. Aim: Development of an evidence-based inpatient energy management group education (IEME) protocol and materials, and user-evaluation of a test-run Methods: Based on a literature review of fatigue management education protocols and their scientific evaluation, the IEME framework, a manual for occupational therapists (OTs) and a workbook for pwMS were developed. Three occupational therapists (OTs) have been trained, followed by a 9-week test-run with totally 12 pwMS. The users’ experiences were evaluated by focus groups: OTs n=3, pwMS n=9. Results: IEME starts with an individual introductory lesson. Subsequently, participants enter into the first available group lesson. Group lessons are self-contained units with self-training assignments in between. IEME concludes with an individual goal-setting lesson. Patient empowerment and behavioural change strategies are incorporated in the 3-weeks protocol. During the test-run, OTs executed 24 individual and 15 group lessons with high treatment fidelity. Focus groups: Working in groups was seen as the decisive factor for success by pwMS and OTs. Exchanging experiences and strategies was reported by pwMS as motivating and enriching. They evaluate the individual and group tasks as realistic and meaningful. IEME-materials are experienced by both groups as multi-sided, oriented towards participants’ resources and understandable. OTs rate the training in IEME as useful and necessary, but more time for group moderation training is needed. Conclusion: IEME was implemented without problems in an inpatient rehabilitation setting. OTs and pwMS were satisfied with protocol and materials. No substantive changes are needed, but valuable improvements were implemented within the materials. A clinical trial is needed to establish the effect of IEME on self-efficacy and fatigue impact after discharge.

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