Effectiveness of One-to-One Fatigue Management Course on Fatigue,Self-Efficacy,and Quality of Life for Persons with Chronic Health Conditions

PURPOSE: To evaluate the effectiveness of a one-to-one fatigue management course on participants’ fatigue, self-efficacy, quality of life, and energy conservation behaviors

RATIONALE: Fatigue is a serious problem that does interfere with daily functioning and quality of life for individuals with chronic conditions. The Managing Fatigue program, a 6-wk fatigue management course developed by Packer, Brink, and Sauriol, has demonstrated high effectiveness in the group format. Because the group format was not always feasible for clinical use, Stout developed the One-to-One Fatigue Management, but its effectiveness has yet to be established. The one-to-one course consists of five educational, self-learning modules, plus appendices pertaining to cognitive and secondary fatigue. Modules were designed to be reviewed with clients over four to six sessions and included homework assignments to be discussed at the next session. The main focus of the course involved fatigue education and teaching strategies to help manage fatigue.

DESIGN: This quasi-experimental study used a one-group, pretest–posttest, follow-up design.

PARTICIPANTS: Participants were recruited via the Midwest Chapter of National Multiple Sclerosis Society, churches, community centers, and an outpatient rehabilitation center. Participants needed to be diagnosed with a chronic disease (e.g., multiple sclerosis, chronic fatigue, or fibromyalgia), be ≥18 yr old, be literate in English, and have moderate to severe fatigue. Participants were excluded if they scored <18 on the Montreal Cognitive Assessment.

METHOD: FACIT–Fatigue scale was used to measure fatigue, Self-Efficacy for Performing Energy Conservation Strategies Assessment was used to measure self-efficacy, and FACT–G was used to measure quality of life. These scales were completed by participants at pretest, posttest, and 6-wk follow-up. The Energy Conservation Strategies Survey was used to measure energy conservation behaviors at the 6-wk follow-up.

ANALYSIS: A one-way analysis of variance with repeated measures and a post hoc, paired-data t test was used to compare pretest, posttest (n = 49), and follow-up (n = 38) data. Energy Conservation Strategies Survey was analyzed descriptively.

RESULTS: Participants showed significant reductions in fatigue and significant increases in self-efficacy and quality of life, physical well-being, emotional well-being, and functional well-being at posttest. These beneficial effects were maintained at follow-up. Social well-being was the only outcome that did not change significantly. Participants implemented 58%–85% of the energy conservations behaviors that were taught, and when the behaviors were adopted they were rated as highly effective.

DISCUSSION: This study provides evidence that the one-on-one fatigue management course was a beneficial intervention for people with chronic conditions in outpatient and community-based settings. Possible reasons for the beneficial effects of this format were that it was likely easier for participants to share their unique challenges, which enabled a more client-centered intervention than the group format. The major limitation of this study was the lack of a control group.

IMPACT STATEMENT: This is the first study that demonstrated the effectiveness of the One-to-One Fatigue Management course on fatigue, self-efficacy, and quality of life. This is critical scientific evidence to support occupational therapy practitioners’ use of the one-to-one format and has the potential to positively change practice.