Evidence Based Practice Energy Conservation and MS

1
Evidence Based PracticeEnergy Conservation and MS
2
Mr. Jones

• Mr. Jones works for Lucent Technologies as a
  manager. He oversees completion of new software
  projects, which means keeping everyone on task
  and managing logistics of putting new software
  programs..

3
Mr. Jones

• At 37, Mr. Jones has three children and a very
  busy household. Six months ago, after noticing
  some visual problems and paresthesias in his R
  leg and L arm, he was diagnosed with MS. Since
  that time, he has experienced great fatigue, loss
  of strength, poor coordination, and difficulty
  with his memory.
• His doctor feels that Mr. Jones has developed so
  many problems and so many symptoms so quickly.
  Mr. Jones was referred to OT to assist in
  maintaining his functional abilities and his life
  style. He is interested in continuing to work,
  and of course, to participate in his family life
  as much as possible

4
Clinical Question

• Will energy conservation program as part of OT
  treatment decrease fatigue, increase overall
  function and quality of life to slow progression
  of the disease?

5
Literature Search Strategy

• CINAHL, EBSCO, MESH, MEDLINE, COCHRANE
  COLLECTION, PUBMED
• PICO TERMS
• P MS IFatigue prevention C no treatment,
  control group O decrease fatigue and increase
  QOL.
• Alternative terms
• Fatigue prevention, fatigue control, adults with
  MS, multiple sclerosis, fatigue, occupational
  therapy
• Energy conservation resulted in articles about
  power resources

6
Summary of Research Findings

• Elements of OT fatigue prevention or energy
  conservation program
• Research evidence for clinical question
• Recommendations for a fatigue prevention program

7
Article 1- Effects of an Energy Conservation
Course on Fatigue Impact for Persons with
Progressive Multiple Sclerosis

• Summary- 37 participants with progressive MS
  took part in an energy conservation course taught
  by an occupational therapist. The study was a
  crossover design, so both the control and
  experimental groups received the 8- week
  treatment. Fatigue impact was analyzed for both
  groups before and after treatment. The course was
  found to have a significant effect on the impact
  of fatigue and functioning in everyday life. This
  suggests that a course about managing fatigue can
  greatly improve outcomes for patients with
  moderate to severe symptoms of MS. The effects of
  this course were maintained when participants
  were tested 8-weeks post-course. This suggests
  that the effects could be long lasting. It was
  also indicated that the supportive group
  environment may have added to the reduced
  psychosocial fatigue impact.

8
Article 2-Efficacy of an energy conservation
course for persons with multiple sclerosis

• Summary- 54 self-volunteered individuals
  completed this 19-week study. It was of a
  crossover design and they were given a treatment
  of 6 weekly 2-hour sessions to complete an energy
  conservation course taught by occupational
  therapists. Results show significantly less
  fatigue impact after the energy conservation
  course, and no change in fatigue due to the
  control group sessions. The effects of the
  courses showed to be maintained for up to six
  weeks after the course.

9
Article 3- Randomized controlled trial of an
energy conservation course for persons with
multiple sclerosis

• Summary- 169 individuals were randomly assigned
  to the intermediate intervention and delayed
  control groups. The treatment was a 5-week EC
  course. A total of 20, 2-hour courses were
  implemented by trained OTs. Each class had 7-10
  participants per group. The control group
  received no treatment. Results show that fatigue
  impact was decreased and some aspects of quality
  of life were increased for participants in the EC
  course compared with those who did not
  participate. It also demonstrated a significant
  increase in self-efficacy for performing EC
  strategies post-course versus pre-course.

10
Research Findings

• Findings of all three studies indicate an energy
  conservation course significantly decreases
  fatigue and improves quality of life for
  individuals with progressive multiple sclerosis
• The supportive group may have served to motivate
  the clients

11
Research Findings

• Findings suggest the course may be even more
  beneficial for individuals with moderate to
  severe symptoms than for those with mild to
  moderate symptoms
• Findings show that the effects last over time

12
Elements of OT fatigue prevention or energy
conservation program

• The value of rest
• Budgeting and banking energy
• Incorporating rest periods throughout the day
• Learning to communicate personal needs to others
• Using good body mechanics and posture
• Using energy-efficient appliances and organizing
  stations of activity

• Separating fatiguing tasks into components
• Prioritizing and setting standards for activities
• Planning rest periods with self-care,
  productivity, and leisure activities so that a
  balance can be maintained
• Reviewing course principles and setting
  short-term and long-term goals

13
Did This Information Answer Our Clinical Question?

• Yes!
• Q- Will energy conservation program as part of OT
  treatment decrease fatigue, increase overall
  function and quality of life to slow progression
  of the disease?
• Every study we found supported a positive answer
  to this question and indicated that these effects
  last several weeks.

14
Did This Information Answer Our Clinical Question?

• Conversely, each study held its own limitations
  such as make up of the sample, size of the
  sample, and a general inability to blind
  administrators and participants.
• Overall the question was answered, but further
  and more strictly detailed studies could be done
  to verify the findings.

15
The Bottom Line

• Overall, there is significant research to
  indicate that implementing Energy Conservation
  courses for individuals with progressive Multiple
  Sclerosis is good Evidence Based Practice. Each
  study we analyzed indicated that as the number
  and frequency of Energy Conservation strategies
  increased, participants experienced a decrease in
  life impact of fatigue and improved quality of
  life.

16
Suggestions for Mr. Jones

• Participation in an energy conservation course is
  highly recommended for Mr. Jones because
• He meets all of the age and diagnostic criteria
  that were studied in our research
• He is interested in maintaining his current
  occupations. According to evidence from research,
  learning and implementing energy conservation
  techniques can greatly improve fatigue impact
  which will allow him to continue in his desired
  activities.
• Findings show that this can result in improved
  QOL of individuals with MS.
• Findings show that an EC course is much more
  beneficial than a standard support group alone.
• Findings suggest that there is an implied
  psychosocial benefit from taking this course in a
  supportive group environment
• There is no evidence of negative consequence as a
  result of taking an EC course from trained OTs.
• A 5-8 week energy conservation course modeling
  one of those used in this research is encouraged
  for consistency and to allow enough time for new
  strategies to be implemented, practiced, and
  discussed with feedback in group settings.

17
Bibliography

• Mathiowetz, V.G., Finlayson, M.L., Matuska, K.M.,
  Chen, H.Y., Luo, P. (2005). Randomized controlled
  trial of an energy conservation course for
  persons with multiple sclerosis. Multiple
  Sclerosis, 11, 592-601.
• Mathiowetz, V., Matuska, K.M., Murphy, M.E.
  (2001). Efficacy of an Energy Conservation Course
  for Persons with Multiple Sclerosis. Archives
  Physical Medicine and Rehabilitation, 82,
  449-456.
• Matuska, K., Mathiowetz, V., Finlayson, M.
  (2007). Use and Perceived Effectiveness of Energy
  Conservation Strategies for Managing Multiple
  Sclerosis Fatigue. American Journal of
  Occupational Therapy, 61(1), 62-69.
• Steultjens EMJ, Dekker J, Bouter LM, Cardol M,
  Van de Nes JCM, Van den Ende CHM. (2003).
  Occupational Therapy for Multiple Sclerosis.
  Cochrane Database of Systematic Reviews 2003, 3.
  Art. No. CD003608. DOI 10.1002/14651858.CD003608
  .
• Vanage, S., Gilbertson, K., Mathiowetz, V.
  (2003). Effects of an Energy Conservation Course
  on Fatigue Impact for Persons with Progressive
  Multiple Sclerosis. American Journal of
  Occupational Therapy, 57(3), 315-323.