Insights from healthcare professionals on enhancing fatigue management in chronic conditions: a qualitative study 2025 Hettinga et al

Andy

Andy

Retired committee member
Abstract

Purpose
Activity pacing is multidimensional and promising for fatigue management and quality of life in chronic conditions. There is a need to develop activity pacing interventions involving healthcare professionals’ views on fatigue management and activity pacing. This study explored healthcare professionals’ perspectives on activity pacing and its role in fatigue management for individuals with chronic conditions.

Materials and methods
Three focus groups and two semi-structured interviews were conducted with ten healthcare professionals. They were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic inductive analysis.

Results
Participants described activity pacing as complex. They highlighted barriers experienced by adults with chronic conditions, including fear of overexertion, reluctance disclosing their condition, and lack of understanding their fatigue. Participants underscored the importance of a tailored, holistic activity pacing approach. They viewed activity pacing as essential for improving the quality of life in chronic conditions and discussed physical activity engagement as a strategy to enhance fatigue management.

Conclusion
Findings from this study underscore the complexities of activity pacing in chronic conditions and offer insights to inform the development of more effective interventions. Healthcare professionals’ perspectives highlight the need to address both practical and psychological aspects of fatigue management through individualized and holistic approaches.

IMPLICATIONS FOR REHABILITATION

  • Rehabilitation programs may incorporate personalized physical activity and pacing strategies as core components of fatigue management for chronic conditions.

  • Understanding and addressing psychological barriers and environmental limitations related to activity pacing might be essential for successful fatigue management.

  • Collaborative care from various healthcare professionals might be crucial to create individualized plans that could help individuals with chronic conditions in managing their fatigue and improve overall quality of life.
Open access
 
abstract said:
There is a need to develop activity pacing interventions involving healthcare professionals’ views on fatigue management and activity pacing.
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Why?
Surely efficacy is more important than 'views'. The whole abstract is a sales pitch full of buzz words for rehab. specialists to claim they are essential to managing fatigue.
 
So, they asked people who don't know what they're doing and it turns out they don't know what they're doing and don't understand the problem with that, are still stuck with a failed paradigm where they, still, confuse difficulty with complexity, and have zero chance of achieving a single thing out of it. Also they choose their own, contrarian, meaning to common words, like pacing, by which they mean the opposite of what the word means in this context.

Aside from serious biomedical research, when it comes to chronic health problems, almost every study feels like this to me:

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JemPD said:
you may as well say we need more of the views of men who have no uterus, on how best to handle menstrual cramps
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I am about 100% certain that there are at least a couple of such studies, and 99.9% that there probably are more than a handful.

Root causes. They never focus on root causes, because they are the primary root cause.
 
Here, the confusion, in all its glory:
One participant remarked that “pacing sounds a very simple concept, but actually it can be very difficult to do in practice and I think there are some patients who believe they are pacing or believe they understand what proper pacing looks like, but actually really they don’t.umm.and this can be quite hard to communicate to them.” (P5.1), echoing the opinions of another who also stated “we have to be careful because although pacing sounds simple, it’s often not… you can set people up to feel that this is yet another thing they’re not doing well, and in some way, it feels like a personal failure” (P4.1). Additionally, pacing was characterized as “an integrated part of managing fatigue” (P3.2), underscoring its inseparability from the overall complexity of fatigue management. Complexity of pacing could be the reason that “I’ve never come across someone who does pacing, you know, 90% of the time, I think it’s very variable…I think people make pacing their own and they use it in their own way” (P4.1) as it is a complex approach.
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It is simple. It is in fact very simple. And it is difficult, which makes its simplicity moot. Simplicity/complexity is an independent dimension from difficulty. It's very simple to fix a broken watch wearing boxing gloves, but it's also impossible. Simple can be impossible. And complex can be easy, with the right tools and circumstances. Plus the difficulty has nothing to do with communication here. Go ahead and try to feed a family of four for a month using a single small bag of flour. There's no amount of communication that can make this realistic.
One participant provided extensive insight into these psychological barriers, stating "people have fear barriers that they’re worried they might damage themselves or they get into a cycle of going from reasonable to doing too much to crashing and then do it again" (P3.2), and adding, "It may be that their drive to achieve or the drive that pushes them is something that’s difficult to manage" (P3.2)
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They never question why that 'fear' appears to exist. Which is simple experience. The same kind of experience where any competent health care professional would expect diabetics to watch what they eat, and learn from the experience of failing to do so. Hell, it's pretty much the most common frustration that health care professionals express: "why won't they just stop smoking/drinking/doing the thing that harms them?"

But they can't apply this thinking here, because without an understanding of the biology at play, they can't do anything, they have no coherent models for this. What's absurd is that they understand the individual bits of difficulty (it's there all over the paper), but simply cannot put them together into a coherent, holistic, model. While claiming to be holistic. Which is maddening.

This reminded me of a video I watched last night from Pete Judo (who made a good and devastating breakdown of PACE). It's about tuberculosis, how it's a mostly treatable disease with a standard protocol, but still over 1M die from it each year. You take the drugs every day for several months, and most will be fine. Simple. Very simple. 4 pills, daily. That's about it.

And yet over 1 million people die from it each year. Not because it's complex, but because it's hard. Because barriers to getting the treatment are everywhere in poor countries. Barriers such as having to go to a clinic or hospital in person each day to get the pills. If they even stock them. For some people this could be hours back and forth, every day. Barriers such as some people experiencing intense hunger from it, which combined with low access to food, leads a lot of people to simply stop taking them because the hunger pains are unbearable.

From a system perspective, in the eyes of professionals working in that system, the barriers are complex. This is probably why they confuse difficulty with complexity here. But from the individual's perspective, it's all very simple, it's just impossible hard. Which, IMO, is the true valid application of a coherent biopsychosocial model of health. But this is not the model medicine uses. Instead it's 99.99% making all problems be about either depression or anxiety or both. Or fear. Or whatever. Anything but how reality actually works, because they refuse to acknowledge it.
 
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