Document Type : Original Article
- Hamid Reza Fateh 1
- Reihaneh Askary-Kachoosangy 2
- Niloofar Shirzad 2
- Alireza Akbarzadeh-Baghban 3
- Farzad Fatehi 4
1 Department of Physical Medicine and Rehabilitation, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Occupational Therapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Proteomics Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Background: Fatigue is one of the most frequent complaints in patients with motor neuron diseases (MNDs), with a significant impact on the quality of life (QOL). Current pharmacological or non-pharmacological treatments of fatigue in this population lack enough evidence to be applied in the clinical setting. Energy conservation strategies are one of the key interventions for fatigue management in chronic diseases. In the present study, we aimed to investigate the effect of applying these techniques in the fatigue management of patients with MND.
Methods: This randomized controlled trial (RCT) study was carried out on 28 patients with MND. Participants were randomly assigned to either the intervention or control group. In addition to routine treatment, patients in the intervention group participated in 3 weekly 1-hour energy conservation programs provided by an experienced occupational therapist. The Fatigue Severity Scale (FSS) score, 36-Item Short Form Survey (SF-36), and Canadian Occupational Performance Measure (COPM) were measured at baseline, immediately after the last intervention session, and one month later.
Results: FSS and COPM significantly changed after the course in the intervention group (P < 0.001 and P = 0.001, respectively). Both FSS and COPM improved significantly toward the final assessment only in the intervention group. The SF-36 changes were not significant in either intervention or control group.
Conclusion: According to the findings of the present study, using energy conservation strategies could lead to better mid-term fatigue management and occupational performance improvement, but it did not improve QOL in patients with MND.
- Dal Bello-Haas V, Florence JM. Therapeutic exercise for people with amyotrophic lateral sclerosis or motor neuron disease. Cochrane Database Syst Rev 2013; (5): CD005229.
- van Groenestijn AC, van de Port IG, Schroder CD, Post MW, Grupstra HF, Kruitwagen ET, et al. Effects of aerobic exercise therapy and cognitive behavioural therapy on functioning and quality of life in amyotrophic lateral sclerosis: Protocol of the FACTS-2-ALS trial. BMC Neurol 2011; 11: 70.
- Arbesman M, Sheard K. Systematic review of the effectiveness of occupational therapy-related interventions for people with amyotrophic lateral sclerosis. Am J Occup Ther 2014; 68(1): 20-6.
- Gibbons C, Pagnini F, Friede T, Young CA. Treatment of fatigue in amyotrophic lateral sclerosis/motor neuron disease. Cochrane Database Syst Rev 2018; 1: CD011005.
- Ng L, Khan F, Young CA, Galea M. Symptomatic treatments for amyotrophic lateral sclerosis/motor neuron disease. Cochrane Database Syst Rev 2017; 1: CD011776.
- Cifu DX. Braddom's physical medicine and rehabilitation. Philadelphia, PA: Elsevier Health Sciences; 2015.
- Ingre C, Roos PM, Piehl F, Kamel F, Fang F. Risk factors for amyotrophic lateral sclerosis. Clin Epidemiol 2015; 7: 181-93.
- Dumitru D, Amato A. Disorders affecting motor neurons. Elextrodiagnostic Medicine. 2002. p. 581-651.
- Lou JS, Reeves A, Benice T, Sexton G. Fatigue and depression are associated with poor quality of life in ALS. Neurology 2003; 60(1): 122-3.
- Ramirez C, Piemonte ME, Callegaro D, Da Silva HC. Fatigue in amyotrophic lateral sclerosis: frequency and associated factors. Amyotroph Lateral Scler 2008; 9(2): 75-80.
- Gibbons CJ, Thornton EW, Young CA. The patient experience of fatigue in motor neurone disease. Front Psychol 2013; 4: 788.
- Hardiman O, Al-Chalabi A, Chio A, Corr EM, Logroscino G, Robberecht W, et al. Amyotrophic lateral sclerosis. Nat Rev Dis Primers 2017; 3: 17085.
- Lo Coco D, La Bella V. Fatigue, sleep, and nocturnal complaints in patients with amyotrophic lateral sclerosis. Eur J Neurol 2012; 19(5): 760-3.
- Gordon PH. Amyotrophic lateral sclerosis: Pathophysiology, diagnosis and management. CNS Drugs 2011; 25(1): 1-15.
- Jackson CE, Rosenfeld J. Symptomatic pharmacotherapy: Bulbar and constitutional symptoms. In: Mitsumoto H, Przedborski S, Gordon PH, editors. Amyotrophic Lateral Sclerosis. Boca Raton, Fl: CRC Press; 2006. p. 649.664.
- Feinberg J, Trombly CA. Arthritis. In: Trombly CA, editor. Occupational therapy for physical dysfunction. Baltimore, MD: Lippincot Williams & Wilkins; 2010. p 815-30.
- Kos D, Duportail M, Meirte J, Meeus M, D'hooghe MB, Nagels G, et al. The effectiveness of a self-management
occupational therapy intervention on activity performance in individuals with multiple sclerosis-related fatigue: A randomized-controlled trial. Int J Rehabil Res 2016; 39(3): 255-62.
- Blikman LJ, Huisstede BM, Kooijmans H, Stam HJ, Bussmann JB, van Meeteren J. Effectiveness of energy conservation treatment in reducing fatigue in multiple sclerosis: A systematic review and meta-analysis. Arch Phys Med Rehabil 2013; 94(7): 1360-76.
- Sandstedt P, Littorin S, Johansson S, Gottberg K, Ytterberg C, Kierkegaard M. Disability and contextual factors in patients with amyotrophic lateral sclerosis - a three-year observational study. J Neuromuscul Dis 2018; 5(4): 439-49.
- Costa J, Swash M, de Carvalho M. Awaji criteria for the diagnosis of amyotrophic lateral sclerosis:a systematic review. Arch Neurol 2012; 69(11): 1410-6.
- Vanage SM, Gilbertson KK, Mathiowetz V. Effects of an energy conservation course on fatigue impact for persons with progressive multiple sclerosis. Am J Occup Ther 2003; 57(3): 315-23.
- Mathiowetz V, Matuska KM, Murphy ME. Efficacy of an energy conservation course for persons with multiple sclerosis. Arch Phys Med Rehabil 2001; 82(4): 449-56.
- Mathiowetz VG, Matuska KM, Finlayson ML, Luo P, Chen HY. One-year follow-up to a randomized controlled trial of an energy conservation course for persons with multiple sclerosis. Int J Rehabil Res 2007; 30(4): 305-13.
- Ghotbi N, Nakhosin Ansari N, Fertosi S, Shamili A, Choobsaz H, Montazaeri H. Fatigue in Iranian patients with neurological conditions: An assessment with Persian Fatigue Severity Scale. Health Science Journal 2013; 7(4): 395-402.
- Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): Translation and validation study of the Iranian version. Qual Life Res 2005; 14(3): 875-82.
- Law M, Baptiste S, McColl M, Opzoomer A, Polatajko H, Pollock N. The Canadian occupational performance measure: an outcome measure for occupational therapy. Can J Occup Ther 1990; 57(2): 82-7.
- Dehghan L, Dalvand H, Pourshahbaz A. Translation of Canadian Occupational Performance Measure and testing Persian version validity and reliability among Iranian mothers of children with cerebral palsy. J Mod Rehabil 2015; 9(4): 25-31. [In Persian].
- Kitano K, Asakawa T, Kamide N, Yorimoto K, Yoneda M, Kikuchi Y, et al. Effectiveness of home-based exercises without supervision by physical therapists for patients with early-stage amyotrophic lateral sclerosis: A pilot study. Arch Phys Med Rehabil 2018; 99(10): 2114-7.
- Pinto AC, Alves M, Nogueira A, Evangelista T, Carvalho J, Coelho A, et al. Can amyotrophic lateral sclerosis patients with respiratory insufficiency exercise? J Neurol Sci 1999; 169(1-2): 69-75.
- Eidenberger M, Nowotny S. Inspiratory muscle training in patients with Amyotrophic Lateral Sclerosis: A systematic review. NeuroRehabilitation 2014; 35(3): 349-61.
- Veenhuizen Y, Cup EHC, Jonker MA, Voet NBM, van Keulen BJ, Maas DM, et al. Self-management program improves participation in patients with neuromuscular disease: A randomized controlled trial. Neurology 2019; 93(18): e1720-e1731.
- Lewis M, Rushanan S. The role of physical therapy and occupational therapy in the treatment of amyotrophic lateral sclerosis. NeuroRehabilitation 2007; 22(6): 451-61.
- Hersche R, Weise A, Michel G, Kesselring J, Bella SD, Barbero M, et al. Three-week inpatient energy management education (IEME) for persons with multiple sclerosis-related fatigue: Feasibility of a randomized clinical trial. Mult Scler Relat Disord 2019; 35: 26-33.
- Young GR. Energy conservation, occupational therapy, and the treatment of post-polio sequelae. Orthopedics 1991; 14(11): 1233-9.
- Voet N, Bleijenberg G, Hendriks J, de Groot I, Padberg G, van Engelen B, et al. Both aerobic exercise and cognitive-behavioral therapy reduce chronic fatigue in FSHD: an RCT. Neurology 2014; 83(21): 1914-22.
- Okkersen K, Jimenez-Moreno C, Wenninger S, Daidj F, Glennon J, Cumming S, et al. Cognitive behavioural therapy with optional graded exercise therapy in patients with severe fatigue with myotonic dystrophy type 1: A multicentre, single-blind, randomised trial. Lancet Neurol 2018; 17(8): 671-80.
- Menting J, Tack CJ, Bleijenberg G, Donders R, Droogleever Fortuyn HA, Fransen J, et al. Is fatigue a disease-specific or generic symptom in chronic medical conditions? Health Psychol 2018; 37(6): 530-43.