Occupational Therapy News OTnews May 2020

FATIGUE FEATURE G iven the high transmission rates of COVID-19, many occupational therapists will work with people who have had the disease. Fatigue has been reported as a common symptom of COVID-19 infection, so it is likely that some people will continue to experience fatigue for some time after the infection has cleared. Therefore, health professionals need to be prepared to support others in managing and recovering from post-viral fatigue where possible. Post-viral fatigue is when you have an extended period of feeling unwell and fatigued after a viral infection without other cause. Fatigue can present in physical and cognitive forms and may affect all aspects of function. It can take several months, and for some a year or more, to feel recovered from post-viral fatigue. Reducing the chance of post-viral fatigue Online resources and apps are accessible and useful. Encourage experimentation to find approaches that suit the individual to enhance engagement. Sensory approaches are also useful to help support quality rest. Give practical and easy examples, such as favourite relaxing music, fragrances, heat, and use sensory checklists for ideas. Rest needs to implemented throughout recovery and not only in the acute phase. Explaining the value and need for rest, even for short periods, in in this situation will support engagement. I will often establish an idea of frequency for this – for example, three times a day. It may be more depending on level of fatigue. This can be a surprise to people, but given specific guidance many people will implement it. Scheduling rest times can also be helpful when rest gets forgotten. This frequency and focus also underlines the need and value of rest. The COVID-19 pandemic has changed our work, home, leisure and social lives, with many areas of increased demand and stress Approach to occupational activity influenced by our circumstances and the strategies we have available to cope. How individuals respond to post-viral fatigue may influence recovery and consequently prevent longer term ill-health, and occupational therapists are ideally qualified to provide the necessary advice and intervention to support people in reducing and managing post-viral fatigue. We have skills in holistic consideration of the mind and body, adjusting approaches to occupations and routines to support health, and examining the intersection of occupations with the physical and social environment. Using our experience of working with people with post-viral fatigue, the team of occupational therapists and a GP with special interest at the Yorkshire Fatigue Clinic recognised a need for information in managing post-viral fatigue. Consequently, we developed and published guidance for people to use in recovery, sharing this through social media, with positive feedback from people recovering, patient groups, and health professionals. RCOT is currently looking to adapt this information for publication for use by health professionals and the general public. As occupational therapists, we can use this resource and provide more in-depth guidance on the most important – but in my experience potentially the most difficult – elements to apply. Rest Rest is paramount during an acute immune activation, allowing the body to focus on fighting off infection. It is important that people understand the difference between rest and leisure, and physically not moving and relaxation, which also addresses the busy mind. In this context rest means resting both the body and the mind, so doing very little – not television, telephones or internet browsing. Occupational therapists have many skills and experience in quality relaxation techniques, and we need to be confident in sharing these skills, even in acute phases of ill health. In partnership with rest is occupational activity. In the acute phase of illness an individual needs to keep their activity levels low, allowing the maximum amount of energy available to be used in immune responses. However, this is likely an area where education may be needed. In my experience of working with people with fatigue, activity is often overlooked. Many people believe they are ‘doing nothing’ and consequently do not understand their lack of energy. This can occur when engaging with tasks mindlessly, engaging in activities that are not meaningful, or not recognising the demands of an activity – particularly enjoyable, social or cognitive occupations. Education around the demands of activities helps people to make decisions about energy expenditure. Guidance may be needed to identify leisure occupations that are low energy to do for short periods to help relieve boredom and support mental health. With invisible symptoms, such as fatigue, people can feel less justified in making decisions about not working. People may need encouragement and permission to stay off work to allow the body to focus on fighting infection. Once the acute phase of illness recedes, people can gradually begin to return to daily life. However, this often needs to be much more gradual than expected. As occupational therapists we are experienced in analysing occupations and activity and can help to break down the complexities of everyday tasks into their components and demands, then, using this information, gradually to support people in building up their activity tolerance. When trying to identify a baseline level of activity that is tolerable, it can help to suggest that people start at a level below what they predict they can do, to allow for over-expectation and hopefully enable success and a level that is regularly sustainable. I encourage a gentle approach as I find people tend to be more eager to get going, rather than fearful of activity. Caution against overdoing it and recognise that increased fatigue is possible. OTnews May 2020 53

Occupational Therapy News OTnews May 2020 | Page 53