The Effectiveness of an Intervention for Cardiac Arrest Survivors With Chronic Fatigue

The aim of this study was to examine the effectiveness of the Energy Conservation + Problem Solving Therapy (EC+PST) intervention provided remotely through telehealth (by telephone) in reducing the impact and severity of fatigue, improving perceived performance in daily activities, and increasing participation in daily activities in post–cardiac arrest (CA) adults.

Although fatigue was correlated with depression, physical and emotional health, and quality of life in other cardiac conditions, no interventions focusing on managing fatigue or improving functional abilities in post-CA adults with chronic fatigue are available. Therefore, an intervention that can be used to improve functional abilities, by means of fatigue management in post-CA adults, is urgently needed.

A prospective, experimental, pre–post design was used for this study.

Inclusion criteria were that participants (1) were ≥3 mo post-CA, (2) had a Fatigue Severity Scale score ≥ 4, (3) had access to a phone, (4) lived within 150 mi. of the research university, (5) had functional English fluency and literacy, and (6) were community residents. Exclusion criteria were that participants had cognitive impairment. Clinical staff referred potential participants from the emergency departments, follow-up clinics, inpatient and outpatient units, or rehabilitation centers.

All participants were assessed at pretest (in person) and posttest (by telephone). At pretest, demographic and medical information and descriptive (measuring cognitive impairment, depression symptoms, and health-related quality of life) and outcome measures (measuring fatigue impact and severity, perceived performance and participation in daily activity) were collected. The EC+PST intervention was administered by the occupational therapist remotely by telephone. Each EC+PST intervention session lasted approximately 45 min and occurred twice a week for ≥4 wk. During individualized sessions, participants solved their own fatigue-related problems with the assistance of the occupational therapist.

Hypotheses were tested using dependent t tests with the study outcome measures with an alpha level of p < .05. Effect sizes (rs) were calculated for all outcomes measures.

Eighteen participants completed all pretest and posttest measures, and there was a significant difference in the Modified Fatigue Impact Scale total scores (p < .001) between pre- and posttest, with participants reporting less fatigue at posttest. The EC+PST intervention was effective in (1) significantly reducing physical and cognitive fatigue impact to a small to moderate degree and reducing fatigue severity and overall fatigue to a small degree and (2) increasing participation in daily activities to a small degree.

Negligible changes in overall fatigue severity can be explained by the target of the intervention, which was to learn self-management of fatigue and not to ameliorate it. Negligible to small, nonsignificant changes in perceived performance and participation in daily activities can be explained by the lack of time to generalize the learned strategies to other problems and contexts and sensitivity of the assessments. Future studies should include a comparison group, use randomization to allocate participants to different groups, examine the effectiveness of the different numbers of sessions, and include more sensitive outcome measures to better address the high functioning level of this population.

This proposal is important to practice and science because it brings attention to the impact of CA survivors’ chronic fatigue on daily lives and individualized energy conservation intervention, and the evidence from study is the first of its kind to support occupational therapy practice for this population using telehealth.