Category: Management

Chronic fatigue syndrome: is there a role for occupational therapy?

Abstract:

Chronic Fatigue Syndrome (CFS) continues to evolve as a disabling phenomenon characterized by debilitating fatigue and consequential components that limit the functional ability of persons afflicted with the disease. A composite review of the current literature addresses a brief history, etiology, legitimacy, incidence and prevalence, prognosis, diagnosis, impact, and treatment of CFS. The primary focus illustrates available treatment strategies that have been incorporated into occupational therapy practice. As a profession that has made contributions to populations with chronic disease and symptoms similar to those suffering from CFS, the use of effective methods should reinforce the need for occupational therapy intervention with this population.

 

Source: Rubal E, Iwanenko W. Chronic fatigue syndrome: is there a role for occupational therapy? Occup Ther Health Care. 2004;18(3):33-45. doi: 10.1080/J003v18n03_03. http://www.ncbi.nlm.nih.gov/pubmed/23927616

 

An occupational therapy approach to persons with chronic fatigue syndrome: part two, assessment and intervention

Abstract:

Chronic Fatigue Syndrome (CFS) is a highly disabling condition that significantly interferes with occupational life. Occupational therapy services are very relevant for this population. Yet, information about the assessment and treatment of CFS is almost absent from occupational therapy literature. As a result, few occupational therapists possess expertise in evaluating and providing therapy for this complex condition. This paper describes an approach to evaluating and providing services for individuals with CFS according to the Model of Human Occupation. This model offers an integrative means of understanding the synergistic and evolving relationships between motivation, values, roles, habits, functional capabilities, and the environment as they influence individuals with CFS, and it provides a framework for the types of changes required in these different domains during the rehabilitation process. A case study illustrates recommended assessment and intervention approaches.

 

Source: Taylor RR, Kielhofner GW. An occupational therapy approach to persons with chronic fatigue syndrome: part two, assessment and intervention. Occup Ther Health Care. 2003;17(2):63-87. doi: 10.1080/J003v17n02_05. http://www.ncbi.nlm.nih.gov/pubmed/23944638

 

Interventions for the treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis

This article summarises the research evidence presented in a recent issue of Effective Health Care on interventions for the treatment and management of chronic fatigue syndrome/ myalgic encephalomyelitis (CFS/ME). It provides an overview of the evidence from a systematic review of randomised controlled trials commissioned by the Department of Health. The results of the systematic review were found to be similar to those of another systematic review carried out in the USA at the same time, and the two have been combined and published together in 2001.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743629/pdf/v011p00284.pdf

 

Source: Bagnall AM, Whiting P, Richardson R, Sowden AJ. Interventions for the treatment and management of chronic fatigue syndrome/myalgic encephalomyelitis. Qual Saf Health Care. 2002 Sep;11(3):284-8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743629/pdf/v011p00284.pdf (Full article)

 

The symptoms and management of myalgic encephalomyelitis

Abstract:

Myalgic encephalomyelitis (ME), which is also known as chronic fatigue syndrome, is a chronic, debilitating illness with varying symptoms and patterns of progression. Research has yet to establish its aetiology and pathogenesis, and there is no cure. A number of management strategies have proved effective, but these should always be tailored to the individual patient. Although no drug treatment has been developed specifically for ME, therapies used to manage the same symptoms in other conditions can provide some relief. Treatment and management should be planned in partnership with the patient.

 

Source: Richardson A.  The symptoms and management of myalgic encephalomyelitis. Nurs Times. 2002 May 7-13;98(19):32-5. http://www.ncbi.nlm.nih.gov/pubmed/12035392

 

Review: behavioural interventions show the most promise for chronic fatigue syndrome

Comment on: Interventions for the treatment and management of chronic fatigue syndrome: a systematic review. [JAMA. 2001]

 

QUESTION: In patients with chronic fatigue syndrome (CFS), what is the effectiveness of evaluated interventions?

Data sources: Published and unpublished studies in any language were identified by searching 19 databases, including Medline, EMBASE/Excerpta Medica, PsycLIT, ERIC, Current Contents, and the Cochrane Library (to 2000); the internet was searched using a meta-search engine; references of retrieved articles were scanned; and individuals and organisations were contacted through a website dedicated to this review and through members of 2 advisory panels.

Study selection: Studies were selected if they were randomised controlled trials (RCTs) or controlled clinical trials of any intervention used in the treatment or management of CFS in adults or children. Studies in which diagnoses were based on another syndrome with criteria similar to CFS, such as myalgic encephalomyelitis, chronic fatigue immune deficiency syndrome, or chronic Epstein-Barr virus infection, were included, but studies of fibromyalgia were not.

Data extraction: Data were extracted on study validity (randomisation and allocation concealment [RCTs], control group appropriateness and adjustment for confounders [controlled studies], baseline comparability of groups, blinding, follow up, drop outs, objectivity of outcome assessment, analysis, sample size, and cointerventions); intervention; diagnostic criteria; duration of follow up; and outcomes (psychological, physical, quality of life and health status, physiological, and resource use).

Main results: 44 studies (n=2801; age range 11–87 y, 71% women) were included (32 studies of adults, 1 of children, and 2 of adults and children; 9 studies did not give age information). 31 different interventions were grouped by type of intervention (behavioural, immunological, pharmacological, supplements, complementary or alternative, and other interventions). 36 studies were RCTs. 18 trials (41%) showed an overall beneficial effect of the intervention (≥1 clinical outcome improved). The results from the RCTs are shown in the table. Cognitive behavioural therapy (CBT) and graded exercise therapy (GET) had beneficial effects. Overall evidence from the other interventions was inconclusive.

 

Source: Kinsella P. Review: behavioural interventions show the most promise for chronic fatigue syndrome. Evid Based Nurs. 2002 Apr;5(2):46. http://ebn.bmj.com/content/5/2/46.long (Full article)

 

 

Recognising chronic fatigue is key to improving outcomes

Comment in: Caring for patients with chronic fatigue syndrome. Conclusions in CMO’s report are shaped by anecdote not evidence. [BMJ. 2002]

 

The government has finally issued its long awaited report on the management of chronic fatigue syndrome (also known as myalgic encephalomyelitis, or “ME”), after delaying publication earlier this month because several committee members resigned (5 January, p 7).

The report says that health professionals should recognise the condition as a chronic illness and that early recognition is key to improving outcomes.

Speaking at the launch, chief medical officer Professor Liam Donaldson acknowledged that the three years spent drawing up the report had been “enormously difficult, complex, and at some times controversial.”

“I’ve received a large amount of correspondence about this,” he said, admitting, “I’m a little surprised we have been able to get such a comprehensive and valuable report.”

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122065/

 

Source: Eaton L. Recognising chronic fatigue is key to improving outcomes. BMJ. 2002 Jan 19;324(7330):131. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122065/ (Full article)

 

Caring for patients with chronic fatigue syndrome. Conclusions in CMO’s report are shaped by anecdote not evidence

Comment on: Recognising chronic fatigue is key to improving outcomes. [BMJ. 2002]

 

In 1998, the chief medical officer of England and Wales commissioned a working group to advise on best practice guidelines to improve the quality of care and treatment for people with chronic fatigue syndrome/myalgic encephalomyelitis. Now issued, the group’s report reflects the good efforts of the scholars, practitioners, patients, and advocates who joined to address this complex matter.1

Given the controversies surrounding chronic fatigue syndrome, it is not surprising that the report admits to broad domains of disagreement among its members. If anything, it is remarkable that most of the original group weathered the undertaking, as there were resignations both among patients who deemed the evolving product insufficiently sympathetic and among academic practitioners who chafed at recommendations untempered by data.

The report identifies the sentinel issues that concern patients and practitioners alike: how one makes the diagnosis of chronic fatigue syndrome; the treatments to consider; and research that remains to be done. Unfortunately, despite more than 2000 relevant papers indexed on PubMed since chronic fatigue syndrome was first named in 1987, the group’s conclusions appear more shaped by anecdote than by evidence. In particular, major systematic reviews, including the recent one by Whiting et al, are not cited and do not seem to have significantly informed the guidelines.

You can read the rest of this comment here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122056/

 

Source: Straus SE. Caring for patients with chronic fatigue syndrome. Conclusions in CMO’s report are shaped by anecdote not evidence. BMJ. 2002 Jan 19;324(7330):124-5. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122056/ (Full article)

 

Chronic fatigue report delayed as row breaks out over content

The government’s long awaited report on the treatment of chronic fatigue syndrome could be in jeopardy after four key members resigned from the working group.

The move throws doubt on the validity of the report, which was due to be published in the first week of January. As the BMJ went to press, the chief medical officer, Liam Donaldson, had postponed its launch on 4 January 2002.

A total of 10 people from the original working group have resigned for various reasons since it was set up in 1998. The most recent resignations were highlighted in a written question by the Countess of Mar to health minister Lord Hunt on 17 December.

Two psychiatrists, a public health doctor, and a nurse therapist have resigned, saying that the report plays down the psychological and social aspects of the condition and concentrates on a medical model. Two patients are understood to have also resigned recently.

The group was set up to consider how best the NHS could care for people with the syndrome, also known as myalgic encephalomyelitis or “ME.”

But with so little still known about what causes the syndrome, how to diagnose it, and how best to treat it, it is understood that the report fails to provide the straightforward answers doctors may have hoped for.

You can read the rest of this article here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121974/

 

Source: Eaton L. Chronic fatigue report delayed as row breaks out over content. BMJ. 2002 Jan 5;324(7328):7. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1121974/ (Full article)

 

Interventions for the treatment and management of chronic fatigue syndrome: a systematic review

Erratum in: JAMA 2002 Mar 20;287(11):1401.

Abstract:

CONTEXT: A variety of interventions have been used in the treatment and management of chronic fatigue syndrome (CFS). Currently, debate exists among health care professionals and patients about appropriate strategies for management.

OBJECTIVE: To assess the effectiveness of all interventions that have been evaluated for use in the treatment or management of CFS in adults or children.

DATA SOURCES: Nineteen specialist databases were searched from inception to either January or July 2000 for published or unpublished studies in any language. The search was updated through October 2000 using PubMed. Other sources included scanning citations, Internet searching, contacting experts, and online requests for articles.

STUDY SELECTION: Controlled trials (randomized or nonrandomized) that evaluated interventions in patients diagnosed as having CFS according to any criteria were included. Study inclusion was assessed independently by 2 reviewers. Of 350 studies initially identified, 44 met inclusion criteria, including 36 randomized controlled trials and 8 controlled trials.

DATA EXTRACTION: Data extraction was conducted by 1 reviewer and checked by a second. Validity assessment was carried out by 2 reviewers with disagreements resolved by consensus. A qualitative synthesis was carried out and studies were grouped according to type of intervention and outcomes assessed.

DATA SYNTHESIS: The number of participants included in each trial ranged from 12 to 326, with a total of 2801 participants included in the 44 trials combined. Across the studies, 38 different outcomes were evaluated using about 130 different scales or types of measurement. Studies were grouped into 6 different categories. In the behavioral category, graded exercise therapy and cognitive behavioral therapy showed positive results and also scored highly on the validity assessment. In the immunological category, both immunoglobulin and hydrocortisone showed some limited effects but, overall, the evidence was inconclusive. There was insufficient evidence about effectiveness in the other 4 categories (pharmacological, supplements, complementary/alternative, and other interventions).

CONCLUSIONS: Overall, the interventions demonstrated mixed results in terms of effectiveness. All conclusions about effectiveness should be considered together with the methodological inadequacies of the studies. Interventions which have shown promising results include cognitive behavioral therapy and graded exercise therapy. Further research into these and other treatments is required using standardized outcome measures.

Comment in:

Measuring the quality of trials of treatments for chronic fatigue syndrome. [JAMA. 2001]

Chronic fatigue syndrome–trials and tribulations. [JAMA. 2001]

Review: behavioural interventions show the most promise for chronic fatigue syndrome. [Evid Based Nurs. 2002]

Review: behavioral interventions show the most promise for the chronic fatigue syndrome. [ACP J Club. 2002]

Review: cognitive behavioural therapy and graded exercise show the most promise for chronic fatigue syndrome. [Evid Based Ment Health. 2002]

 

Source: Whiting P, Bagnall AM, Sowden AJ, Cornell JE, Mulrow CD, Ramírez G. Interventions for the treatment and management of chronic fatigue syndrome: a systematic review. JAMA. 2001 Sep 19;286(11):1360-8. http://www.ncbi.nlm.nih.gov/pubmed/11560542

 

Approaches to coping with chronic fatigue syndrome (CFS)

Abstract:

The 1994 approach to the definition of Chronic Fatigue Syndrome (CFS) describes a severe disorder with unknown etiology and pathophysiology. It results in substantial reduction in previous levels of occupational, educational, social, or personal activities. Most patients cannot continue their usual lifestyle. No causal treatments or other therapies suitable for all patients exist so far.

Therefore it was intended to identify approaches to an effective disease management by the long time escort and observation of a CFS support group. CFS should be diagnosed according to the actual CDC guidelines. Conditions with similar symptoms explaining chronic fatigue have to be ruled out first. Then an individually shaped disease management comprising of different components plays a central role in the coping process. Medical long time care performed by a general practitioner and the membership in a suitable support group are integrated within this approach.

 

Source: Stark FM, Sobetzko HM. Approaches to coping with chronic fatigue syndrome (CFS). Zentralbl Hyg Umweltmed. 1999 Aug;202(2-4):179-90. http://www.ncbi.nlm.nih.gov/pubmed/10507127