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Making Every Contact Count
Encouraging patients to have a healthy lifestyle, including diet, exercise and smoking/alcohol cessation, is a crucial part of the Make Every Contact Count initiative.
For patients with additional health conditions such as fatigue, this is even more important as they are more prone to the negative effects of wellbeing decisions.
Scope of Practice
While it is important to treat our patients in a holistic manner, it is essential that we only work within our scope of practice.
This means not overstepping boundaries of other professions, seeking support and making appropriate referrals when the patient's needs are outside of our knowledge and experience base.
For example, it may be appropriate for you to educate your patient about grading their existing occupation of walking or jogging, however it may not be appropriate to prescribe them an exercise programme unless you have had the appropriate training or experience to do this.
Similarly, it may be appropriate for you to encourage your patient to eat a balanced, nutritious diet instead of just a packet of crisps once per day as their entire daily food intake, however it would not be appropriate to recommend a specific diet regime.
Below are some extracts from RCOT regarding practicing within your scope of practice. The image is hyperlinked and will take you to the RCOT website where you can access the full, current guidelines.
Physical Activity
Using OT skills like grading, pacing and occupation as therapeutic activity can be useful when your patient wants to increase their level of physical activity.
Your patient may not be able to participate in the conventional idea of 'exercise', however appropriately increasing their level of physical activity to maintain wellbeing is important.
Remember the boom & bust cycle here - balancing activity with rest.
Never recommend to your patients to 'push through' their symptoms in conditions which include fatigue as a symptom (this is sometimes referred to as the 'lightning process') as this can and does make the symptoms worse.
Below is a link to the NICE guidelines for ME/CFS (Chronic Fatigue Syndrome - a specific condition, one of the main symptoms of which is fatigue) which contains a lot of further information around this. The guidance is similar for a lot of fatigue-related conditions, but you must check the relevant recommendations for specific conditions when treating patients.
An important note: Graded Exercise Therapy IS NOT the same as activity grading or pacing. The video below is an interesting conversation between specialists in the area specific to long COVID. This may be more complex watching than what you are used to, but you may find it interesting.
Grading:
Exercise may be beneficial to individuals with fatigue. An individual could increase the amount of exercise they are able to tolerate by grading this activity with the help of an occupational therapist (see the Grading page in Interventions). It is important to recognise the difference between activity grading (an OT specific skill) and Graded Exercise Therapy (described in the left-hand column).
Pacing:
Review the pacing page. How could a patient's exercise programme, previous favourite exercise or a new routine be developed using pacing? This may include only exercising for 1 minute before resting for 2 minutes. It could mean only exercising on days where your patient has not had to travel to an appointment. Every person will be different, it is important to consider exercise in view of their whole routine.
Occupation as therapeutic activity:
There is a wealth of research documenting the positive effects of exercise on wellbeing. However, it is important to recognise that certain conditions may affect someone's ability to engage in exercise or even be worsened by it. Consider what your patient is able to do, how much they are able to do and any appropriate adaptations to the activity. An activity analysis approach may be a good starting point.
Food & Drink
Different conditions which cause the symptom of fatigue require a different, individualised approach in terms of nutrition, as with all other aspects of therapy or treatment.
Much of the evidence base for specific diets, foods or supplements is mixed, unclear or limited in the study of fatigue.
It is essential to follow current guidelines, such as the NICE guidelines, in order to provide evidence based practice.
Click the image below to access the current NICE guidelines around nutrition.
The current recommendation for adults in the UK is known as the Eatwell Guide.
The crucial thing to remember here is your scope of practice.
As an Occupational Therapist, your role in nutrition may include:
Signposting
Dietician - to review the patient's nutritional needs
GP - to assess the patient's needs for further investigations
Speech and Language Therapist - in case of concerns around safe swallow
Specialised Psychology services - in case of concerns regarding eating disorders
Education
MECC - education about healthy lifestyle choices at the right moment
Eatwell Guide - education about healthy food and drink habits
Problem Solving
Is diet impacted by physical ability to make meals? E.g. unable to use arms due to injury, unable to access kitchen due to mobility impairment.
Is diet impacted by cognition? E.g. unable to remember if eaten today, lacking awareness of impact of water intake on wellbeing.
Evidence Based Practice
Why?
Occupational Therapy practice needs to be led by evidence.
This is a list of relevant scientific research and articles relevant to diet and exercise in fatigue management.
Please read the diet articles with caution - there is limited research and evidence in these areas, these are included for you to explore the evidence base in view of the NICE guidelines which guide our best practice.
Relevant articles
Relevant articles
Kim S, Xu Y, Dore K, Gewurtz R, Larivière N, Letts L. (2022) Fatigue self-management led by occupational therapists and/or physiotherapists for chronic conditions: A systematic review and meta-analysis. Chronic Illness.18(3):441-457. doi:10.1177/17423953211039783
Sathiaraj, E., Afshan, K., R, S., Jadoni, A., Murugan, K., Patil, S., & Naik, R. (2023). Effects of a Plant-Based High-Protein Diet on Fatigue in Breast Cancer Patients Undergoing Adjuvant Chemotherapy - a Randomized Controlled Trial. Nutrition and Cancer, 75(3), 846–856. https://doi.org/10.1080/01635581.2022.2159044
Chase, E., Chen, V., Martin, K., Lane, M., Wooliscroft, L., Adams, C., Rice, J., Silbermann, E., Hollen, C., Fryman, A., Purnell, J. Q., Vong, C., Orban, A., Horgan, A., Khan, A., Srikanth, P., & Yadav, V. (2023). A low-fat diet improves fatigue in multiple sclerosis: Results from a randomized controlled trial. Multiple Sclerosis, 29(13), 1659–1675. https://doi.org/10.1177/13524585231208330
Haß, U., Herpich, C., & Norman, K. (2019). Anti-inflammatory diets and fatigue. Nutrients, 11(10), 2315-. https://doi.org/10.3390/nu11102315
Ovcharova, E., Danovska, M., Marinova, D., Pendicheva-Duhlenska, D., Tonchev, P., Atanasova, M., Ruseva, A., Shepherd, N., & Tzveova, R. (2022). ADAPTED MEDITERRANEAN DIET IMPACT ON THE SYMPTOMS OF CHRONIC FATIGUE, SERUM LEVELS OF OMEGA-3 POLYUNSATURATED FATTY ACIDS (PUFAS) AND INTERLEUKIN 17 (IL-17) IN PATIENTS WITH RELAPSING-REMITTING MULTIPLE SCLEROSIS UNDERGOING DISEASE-MODIFYING THERAPY: A PILOT STUDY. Journal of IMAB, 28(1), 4297–4304. https://doi.org/10.5272/jimab.2022281.4297
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