Energy management education and occupation-related outcomes in adults with chronic diseases: a scoping review, by Janine F Farragher , Sarbjit V Jassal, Sara McEwen, Helene J Polatajko in Brit J Occ Ther, April 10, 2020 [doi.org/10.1177/0308022620904327]
Article abstract:
Introduction:
Fatigue is a pervasive symptom of chronic disease that often interferes with occupational performance. Our objective was to describe what is known about energy management education and occupation-related outcomes in adults with chronic diseases.
Methods:
Seven electronic databases were searched for relevant literature published before August 2019. Eligible articles were full-text, available in English, and studied energy management education in adults with a chronic disease. The first author assessed article eligibility with validation from a second reviewer, extracted characteristics of included studies, and described them using descriptive statistics. A narrative synthesis of findings was conducted for each chronic disease population.
Results:
Forty-four studies addressed eight different chronic disease populations. The most common program delivery format was face-to-face in a group setting (42%), 39% of programs were informed by a learning theory, and their median cumulative length was 8 hours. Positive outcomes were associated with a specific, group-based energy management program in people with multiple sclerosis. The evidence on other energy management programs and in other chronic disease populations was more limited and inconclusive.
Conclusions:
Further research is needed to understand the impact of energy management education in chronic disease populations beyond multiple sclerosis, and its impact on occupational performance.
Extract from Discussion:
Our study is the first to comprehensively identify and describe the literature on EME and occupational performance or related outcomes in adults with chronic diseases. EME has been studied in eight different chronic disease populations, including MS, cancer, CFS, cardiac disease, arthritis, acquired brain injury, fibromyalgia and post-polio syndrome.
The literature was most extensive on the six-session, group-based “Managing Fatigue” program (Packer et al., 1995) in MS, where studies including RCTs suggested positive impacts on outcomes related to occupational performance, such as fatigue impact and self-efficacy…
However, the evidence on EME for other programs and chronic disease populations was found to be more limited, and often described mixed or inconclusive findings. There were also few studies that directly investigated the effects of EME on occupational performance.
The lack of robust research on EME outside of MS is surprising, given the prevalence of fatigue in many chronic diseases populations and the need for evidence-based interventions to improve fatigue management. In some populations (for example arthritis, post-polio, cardiac disease), although preliminary findings appeared to be promising, a lack of RCTs limits the conclusions that can be drawn about the efficacy of the approach.
In other populations (for example cancer and CFS), although large RCTs have been conducted, they had potential methodological limitations that might minimize their validity. For example, in cancer, an RCT that reported EME had limited effects on fatigue and physical function (Barsevick et al., 2004) used a very brief EME program, which might have provided insufficient education to achieve positive outcomes. In CFS, a large RCT showed no effect of an extensive, individually delivered EME program on occupational performance, fatigue, physical performance, or mental health (White et al., 2011), but the validity of this trial and its conclusions have been questioned due to several methodological concerns since its publication (Jason, 2017; Wilshire et al., 2017), including concerns with the activity pacing intervention (Jason, 2017).
We also found no studies (preliminary or other) on EME in other chronic disease populations known to have a high burden of fatigue, such as chronic kidney disease (Murtagh et al., 2007) and chronic obstructive pulmonary disease (Baltzan et al., 2011).
Collectively, this review highlights the need for more well-designed primary studies about EME in adults with chronic diseases, to support occupational therapists seeking to engage in evidence-based practice in this area
