Managing fatigue transdiagnostically: a qualitative study among people with chronic conditions on optimizing daily activity, 2024, Hettinga et al

Andy

Andy

Retired committee member
Abstract

Purpose
To explore fatigue and physical activity behavior experiences and management, with an emphasis on activity pacing among adults with chronic conditions.

Materials and Methods
Semi-structured interviews were conducted with 15 adults with chronic conditions and the symptoms of chronic fatigue who had either received or not received fatigue management advice. Interviews were audio-recorded and transcribed verbatim, then analyzed using reflexive thematic analysis.

Results
Participants reported barriers to fatigue management such as overactivity, mental health issues, and workplace challenges. Additionally, they highlighted rest, restful activities, and supportive social environment as facilitators of effective fatigue management, along with the importance of nutrition and physical activity. In some cases, there were conflicting experiences with social environment and physical activity. Activity pacing was identified as a promising solution and participants recommended several strategies for future consideration.

Conclusions
Participants identified fatigue as a significant denominator in daily living and recognized the importance of activity pacing in fatigue management. Through reflective processes, they uncovered crucial factors for effective fatigue management, highlighting a multidimensional, interdisciplinary, and tailored approach to activity pacing as a promising solution. Further research should explore clinicians’ perspectives of a multidimensional fatigue management approach to further support optimal intervention design.

IMPLICATIONS FOR REHABILITATION

  • Fatigue was perceived commonly across various chronic conditions, extending beyond mere tiredness and diminishing individuals’ capacity to perform daily activities.

  • Rehabilitation professionals might incorporate activity pacing strategies tailored to each individual’s needs to effectively manage fatigue across chronic conditions.

  • A multidimensional approach, including physical, psychological, and social interventions, is suggested for comprehensive fatigue management in rehabilitation.

  • Facilitating rest and fostering a supportive social environment might be integral components of rehabilitation process to enhance the effectiveness of fatigue management
Open access, https://www.tandfonline.com/doi/full/10.1080/09638288.2024.2393798
 
They're trying to do something that could be described as active convalescence, taking the ideas of convalescence but making them worse by framing them as rehabilitative and as a solution to the problem. Still stuck on some belief that the right coaching and encouragement will do the trick, either oblivious or indifferent that the real problems are almost all economical, not social or psychological.

People need the resources to convalesce. It's not an active process. It's not a solution. But they want to feel like they're doing something, so they bastardize the whole thing around their own perspective. It ends up as useless as the CBT/GET stuff because it inevitably morphs into it.

In addition to fatigue being only one component of the whole. For people who talk a lot about multidisciplinary stuff and holistic everything, they're extremely narrow-focused.
 
Not sure I can add much to @rvallee's spot-on analysis.
Abstract said:
Activity pacing was identified as a promising solution and participants recommended several strategies for future consideration.
Click to expand...
But 'promising'? Pretty much everyone with a disease like ME/CFS works out a version of 'activity pacing' in the first 6 months. People give up things, often very important things, in order to reduce the activity they do. It's not news, and therapists can mark it for 'future consideration' if they like, but people with these conditions will go on doing it regardless.

Some marks for actually listening to people managing these conditions, some marks for recognising that 'fatigue' isn't just a sensation and has implications for activity.
Abstract said:
Further research should explore clinicians’ perspectives of a multidimensional fatigue management approach to further support optimal intervention design.
Click to expand...
But, there seems to be an implicit assumption that therapists need to endorse and improve approaches before they can be valid and effective, and that such approaches will lead to rehabilitation.
 
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