Occupational Therapy News OTnews May 2020 | Page 54

FEATURE FATIGUE
If fatigue increases, but resolves with a short
amount of rest, it is an indicator of reasonable amount
of activity. If it is taking a long time to recover, then
the increase in activity may be too much, or other
demands are having an effect.
At this point reminders about cognitive activity
being demanding of energy are also likely to be
required. As people come out of the acute phase
of illness and start to be able to do a little more,
worry and guilt can become prominent. This needs
to be recognised and addressed as this can also
be a significant drain on energy or drive people to
overreach their energy levels. Positive emotions, such
as excitement, are also energy demanding.
Once a
sustainable baseline
of activity has been
established then
‘‘
activities prior to considering return to work and then
replicating a work-like pattern and activity demand at
home can help build tolerance.
This will increase the success of a planned
return to work. Phased returns with the support of
occupational health may be required and may need to
be prolonged.
Routines
Initially, daily routines may not have been retained, with
sleep and eating happening as needed, and activity
reduced. But as recovery occurs, re-stabilising routine
becomes important to support internal regulation for
quality of sleep and regular appetite.
Routine also allows a sense of normality and
relieves regular everyday decision making.
If previous routines are not achievable,
initially start with what is most
activity levels can
achievable and realistic to be
Fatigue has been
gradually be increased.
consistent.
reported
as
a
common
Using the same
Over time, this can
principles of
be gradually adjusted
symptom of COVID-19
activity analysis
depending on the
infection, so it is likely that
and methods
individual’s situation and
some people will continue to
for measuring
ability. Directing people
each activity,
towards
sleep management
experience fatigue for some
small incremental
programmes and information
time after the infection
changes can be
may be necessary.
has cleared.
trialled.
The most common
Specialist input
issue encountered here
Many people will gradually see an
is increasing activity levels too
improvement from post-viral fatigue and
quickly and causing setbacks, so
can, therefore, continue to progress back to
encourage a slow steady approach. When working
their normal. However, if someone is not improving,
with people with long-term fatigue we might only
or is deteriorating, then further medical input should
increase one activity every couple of weeks. This slow
be sought and investigations to assess for possible
pace may not be required, but it may provide a useful
contributing factors.
indication.
Referral to specialist chronic fatigue services may
Trying to ‘push through’ fatigue is normally
be available through local referral options.
unhelpful. Gradually, activity tolerance can be built
These principles of management may seem simple
until able to engage more in occupations. The pace
and even instinctive to occupational therapists as
and level of progress will vary between individuals so
they focus on our core skills and particularly consider
management of expectations may be helpful.
approaches to occupational activity. However, to many
As activity tolerance increases, in my experience
people they will be unknown and valuable gems of
people will tend to focus on purposeful and practical
information that may support them in recovery and
tasks and will need encouragement to also include
prevention of development of long-term ill health.
leisure activities in the mix. This is particularly
important to support ongoing wellbeing if recovery is
Joseph Bradley is a clinical specialist occupational
protracted.
therapist at the Yorkshire Fatigue Clinic specialising
While return to work is a priority for most, for
in the assessment and treatment of fatigue disorders
multiple reasons, returning to work too soon could
and particularly ME/CFS. Follow: @joetheOT, visit:
increase the risk of extended recovery and long-term
www.yorkshirefatigueclinic.co.uk or email joe@
fatigue issues. Being able to complete other everyday
yorkshirefatigueclinic.co.uk
54 OTnews May 2020