Date Presented 4/20/2018
Preliminary findings of a randomized controlled trial on interventions for people with heart failure and fatigue are discussed. This topic advances occupational therapy practitioners’ knowledge on individualized interventions to reduce fatigue impact in people with heart failure and fatigue.
Primary Author and Speaker: Young Joo Kim
Additional Authors and Speakers: Jennifer Radloff, Jenny Chiariello, Nicole Faust, Madison Wilcox
PURPOSE: The aim of this study was to compare the effectiveness of an energy conservation + problem-solving therapy intervention (EC+PST) to health education (HE) in reducing fatigue impact and increasing participation in instrumental activities of daily living in people with heart failure and fatigue. The prevalence of people with heart failure is projected to increase to 25% of the U.S. population by 2030 (Go et al., 2013), and fatigue is one of its main chronic symptoms (Tang & Francis, 2016). Despite the negative impact of heart failure and fatigue on daily activities (Hägglund et al., 2008), the evidence for rehabilitation interventions addressing fatigue management in this population is scarce.
METHOD: A randomized controlled trial design with two groups (EC+PST and HE) was used. Inclusion criteria were 6 mo post heart failure diagnosis and 3 mo post hospitalization, moderate to severe fatigue (Fatigue Severity Scale score ≥4), and intact or questionable cognition (Short Blessed Test score <9). Participants were referred by clinicians at inpatient, outpatient, and rehabilitation units in Greenville, NC.
After random assignment, a pretest (descriptive and outcome measures) was conducted in participants’ home. Then participants received a 6-wk intervention, and a posttest (outcome measures) was conducted in participants’ home. Outcome measures were the Fatigue Impact Scale, which assesses the impact of fatigue on daily activities, and the Activity Card Sort, which assesses participation level in instrumental activities. Participants received the interventions via a video conferencing system using a tablet. The EC+PST group learned how to manage their fatigue and problem solve daily fatigue challenges, whereas the HE group learned about health-related topics relevant to heart failure.
IBM SPSS Statistics Version 24 (IBM Corp., Armonk, NY) was used for the data analyses. Mixed analysis of variance with an alpha level of p < .05 was used to analyze the outcomes followed by post hoc tests with Bonferroni corrections. In addition, effect sizes (d) were calculated for all outcome measures.
RESULTS: In this ongoing study, eight participants had completed study participation (four in the EC+PST group and four in the HE group). We are aiming to recruit a total of 52 people with heart failure and fatigue. In the EC+PST group, mean Fatigue Impact Scale total scores were 69.8 (SD = 25.5) at pretest and 65.8 (SD = 23.0) at posttest. In the HE group, mean Fatigue Impact Scale total scores were 58.3 (SD = 37.9) at pretest and 42.3 (SD = 25.4) at posttest. In the EC+PST group, mean Activity Card Sort total retention rate was 76.3 (SD = 16.3) at pretest and 71.9 (SD = 6.2) at posttest. In the HE group, mean Activity Card Sort total retention rate was 65.4 (SD = 31.2) at pretest and 82.1 (SD = 26.1) at posttest.
CONCLUSION: We are collecting more data to examine statistical significance and degrees of difference between the groups. Future studies should include participants from multiple sites, long-term follow-up, and an objective outcome measure, such as physical activity level.
IMPACT STATEMENT: This study advances the knowledge on intervention options for people with chronic illnesses and fatigue. The interventions used in this study may provide a better opportunity for people who live in rural areas or do not have adequate access to rehabilitation services. We are examining the effectiveness of the interventions, which can be used by occupational therapy practitioners to improve participation in daily activities. Supporting evidence for occupational therapy practice for people with heart failure is currently scarce.
References
Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Blaha, M. . . . Turner, M. B. (2013). Heart disease and stroke statistics: 2014 update. Circulation, 129, e28–e292. https://doi.org/10.1161/01.cir.0000441139.02102.80
Hägglund, L., Boman, K., & Lundman, B. (2008). The experience of fatigue among elderly women with chronic heart failure. European Journal of Cardiovascular Nursing, 7, 290–295. https://doi.org/10.1016/j.ejcnurse.2007.12.004
Tang, W. H. W., & Francis, G. S. (2016). Clinical evaluation of heart failure. In D. L. Mann & G. M. Felker (Eds.), Heart failure: A companion to Braunwald’s heart disease (3rd ed., pp. 421–437). Philadelphia: Elsevier.
