Evaluation of a training programme to enable MSK physiotherapists to identify individuals with CFS symptoms post-COVID19, by J Breach, O Ledbetter, L Mould in Physiotherapy Vol 114, Suppl 1, p e178, Feb 1, 2022 [Part of special issue: Virtual Physiotherapy UK 2021 Conference]
Abstract:
Purpose
It is reported there are currently 1.1 million people suffering from long COVID symptoms, with 830,000 of these reporting that has an impact on their day to day life. One of the primary symptoms reported is fatigue. As part of our COVID rehabilitation programme, Nuffield Health physiotherapists were involved in triaging participants for suitability for the programme.
As previous research from the ME/CFS population indicates that exercise could be detrimental to individuals with fatigue by inducing post-exertional malaise, it was imperative they felt confident in being able to identify individuals with CFS-type symptoms to assess their suitability for the programme.
The aim of this project is to evaluate the effectiveness of the training programme in improving individual confidence in being able to identify individuals with chronic fatigue symptoms.
Methods
The training was devised following an extensive review of the current literature surrounding fatigue in both LongCovid and ME/CFS and delivered via a blended offering of online modules, webinars, interactive virtual classrooms, and discussion groups. It included being able to recognise signs of post viral fatigue, especially PEM as well as other symptoms such as cognitive issues, sleep disturbance and reduced functional capacity as detailed in the NICE draft guidelines for ME/CFS 2021.
The importance of this was emphasised by discussing evidence surrounding exercise and chronic fatigue and potential for harm if not managed appropriately by considering the symptom response to activity.
An Introduction to energy envelope theory for pacing was also presented. The effectiveness of the training was evaluated by an anonymised survey. Physiotherapists were asked to rate their levels of confidence before and after the training in regard to assessing participants for inclusion in the programme based on their fatigue symptoms, plus to provide comments on the training content.
Results
- Average confidence 8/10
- Improvement of 56% after training
Feedback
Positive: I felt confident to exclude all with CFS…
I think it is a case of getting on with it putting it into practice
Negative: I feel that as msk physios this is beyond the scope of what we should be doing…
As MSK physios we are not experts in many of the fields listed. i.e., CFS
Conclusion(s)
The training did result in good improvement in confidence in screening for CFS symptoms. However, the feedback did include some individuals feeling this is beyond their current scope of practice as msk physios, highlighting a need for ongoing support. This is understandable due to the evolving picture of Long Covid symptoms being different to the usual caseload of msk physiotherapists. However, to meet the growing need of rehabilitation for those suffering with Long Covid, it is imperative to support therapists in expanding their scope of practice to contribute to the recovery from the pandemic.
Impact
The findings will influence the ongoing support given to MSK physiotherapists to upskill in the area of chronic fatigue assessment and management to meet the demand Long Covid will be placing on rehabilitation. This is imperative to support individual therapists to expand their scope of practice beyond the usual MSK caseload.
