Theoretical foundation of the Activity Calculator – a method for fatigue management 2025 Pinxsterhuis et al

Andy

Andy

Senior Member (Voting rights)

Abstract​

Background​

Chronic fatigue impacts individuals’ ability to engage in daily activities and their quality of life. The Activity Calculator is a method for fatigue management in relation to occupational participation that aims to: 1. Help patients to find a balance between what they want to do and what they are able to do. 2. Help patients to obtain congruence between occupational participation and their values and personal meaning.

Aims​

Elaborate on a theoretical foundation for the Activity Calculator by addressing three concepts: occupational adaptation, patterns of daily occupational, and occupational balance.

Results​

The three concepts are presented, and it is discussed how the concepts may serve as a theoretical foundation for the Activity Calculator when used in an occupational therapy intervention. The concept occupational adaptation is discussed as a transactional process, but also as an outcome as expressed by the two aims of the Activity Calculator.

Conclusion​

The three addressed concepts seem to serve as a suitable theoretical foundation of the Activity Calculator.

Significance​

The developed theoretical foundation makes it possible to evaluate the effects of the Activity Calculator in future research.

Open access
 

Introduction​

Chronic fatigue can be defined as a subjective experience of prolonged or recurrent tiredness and reduced capacity for mental and/or physical activity [Citation1]. People with chronic fatigue have trouble starting or maintaining an activity even if they are motivated and want to be active [Citation1]. This entails, among other things, a significantly reduced activity level, limited work capacity, a restricted social life, and reduced quality of life [Citation1]. The economic costs generated by chronic fatigue are high due to lost employment, and the need for formal services and informal care [Citation2]. Chronic fatigue occurs in approximately 20% of the general population [Citation3], but especially in people with chronic conditions such as chronic fatigue syndrome (CFS/ME) [Citation4], long Covid [Citation5], rheumatic diseases [Citation6], multiple sclerosis (M.S.) [Citation7], chronic obstructive pulmonary disease (COPD) [Citation8] and cancer [Citation9], as well as after traumatic brain injury [Citation1,Citation10] and stroke [Citation1,Citation11]. Women have a higher incidence of chronic fatigue than men [Citation3].
 
However, the Activity Calculator may be criticized for lacking and presenting a solid theoretical foundation. According to Skivington et al. [Citation31] is it necessary to develop programme theory that describes how an intervention is expected to lead to its effects and under what conditions, before evaluating it. A programme theory outlines the essential elements of an intervention and how they interact. It explains the intervention’s mechanisms, identifies contextual factors that may impact these mechanisms, and describes how the mechanisms might, in turn, affect the context [Citation31].
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Therefore, the aim of this paper is to elaborate on a theoretical foundation of the Activity Calculator by addressing three relevant concepts within occupational therapy and occupational science: occupational adaptation, patterns of daily occupational, and occupational balance.
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I don’t think the authors understood the task..

The Activity Calculator has been criticised for lacking a theoretical explanation of why it might help someone with fatigue, but their paper doesn’t say anything about the mechanisms that will actually affect the level of fatigue.

They seem to just take it for granted that doing the same, but «right» amount of activity every day is good. And that micromanaging your days is good.

They also seem to take for granted that the internal logic of the calculator is valid.
 
It's not terribly wrong and can have its uses in some cases but this is not a theory, it's just a model. There is no theoretical framework here, nothing to back this up, it's a rule-of-thumb thing but about a way of doing things that usually doesn't work. In people with a fixed energy level it can make sense, but trying to strictly following something that, at best, is a rule-of-thumb thing gets in the way quickly and is then likely to be abandoned.

In ME/CFS it completely falls apart because of PEM, and in conditions that tend to flare up and down, like MS and Lupus, it will also too often become necessary to just ignore it for extended periods of time, which usually will lead to not being picked up again.

What's annoying is that this is clearly thought out in a similar way as budgeting within a poverty budget. Except in poverty there are usually ways to trade off lack of wealth by borrowing from health, taking time and energy to make up gaps in budgets. This gives the illusion that there are ways around the strict limitations that fatigue imposes, which, unlike how the paper defines it, is not tiredness even in the context of chronic fatigue.

It's not a bad idea, but this has been tried and failed the same way for decades in dozens of tiny variations of the same theme. What we expect of professionals is not to get stuck doing the same things that have always failed, and this is just the same old same old.
 
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