Hilary Stanek OTD, OTR/L, LRC (she/her/hers)

BACKGROUND: Fatigue is the subjective experience of insufficient energy that interferes with daily life participation. Fatigue is experienced by 75% to 90% of individuals with multiple sclerosis (MS), and 60% identify fatigue as their most difficult symptom to manage. Evidence proposes fatigue management interventions should be individualized, comprehensive, and systematic, and they should address the priorities of the individual, with behavior change interventions recommended as a frontline intervention. Fatigue management interventions delivered by occupational therapy practitioners (OTPs) facilitate learning strategies, techniques, and skills that reduce the impact of MS-related fatigue on daily activities. Lifestyle Redesign® (LR) is an intervention framework utilized by OTPs to address the needs of individuals living with chronic conditions through the promotion of awareness between occupational engagement and health and participation in occupations, habits, and routines to improve health and well-being. It involves the use of core techniques, including education, occupational self-analysis, autonomy-enhancing communication, and occupational orchestration and engagement. LR has been applied in a group format with people with MS with beneficial effects on occupational participation, quality of life, and fatigue.

OBJECTIVES: Describe the 1-to-1 delivery of fatigue management interventions through the LR intervention framework in patients with MS and provide a case study with clinical outcomes to demonstrate how these interventions can be integrated into an occupational therapy (OT) plan of care.

METHODS: The case study participant completed 13 OT sessions. Traditional fatigue management interventions (ie, fatigue management psychoeducation, and primary and secondary fatigue management training) were used in conjunction with the LR intervention framework to target daily habits and routines to improve occupational engagement. The Canadian Occupational Performance Measure (COPM) was administered before and after the intervention to capture perceived performance and satisfaction in areas of occupational performance deficit, including fatigue management. RESULTS: Clinically significant improvement occurred in the COPM performance (+5.0) and satisfaction (+4.0) scores for the fatigue management occupational performance domain. Additionally, the participant had clinically significant improvement in aggregate scores, with a 5.0-point increase in performance and a 5.6-point increase in satisfaction.

CONCLUSIONS: The results of this case study highlight the benefit of combining fatigue management interventions and the LR intervention framework delivered by OTPs. The study contributes to the literature supporting the need for and benefits of the use of fatigue self-management interventions in adults with MS.

Background. Although the number of college students with multiple sclerosis (MS) has not been reported, the increase in pediatric and young adult onset rates suggest that the number of college students with MS is likely rising (Hoffman et al., 2019). These young adults with MS face the unique challenge of learning how to manage their health while participating in higher education. Students with disabilities have identified that stigmatization exists within higher education, resulting in many being wary to seek and implement accommodations due to the disclosure process, particularly when their condition may be nonapparent (Helm et al., 2009; Smith et al., 2019; Timmerman & Mulvihill, 2015). To address these challenges, research suggests proactive support for students with disabilities transitioning to higher education, especially within the first year (Smith et al., 2019). Additionally, research calls for support for young adults recently diagnosed with MS to help them build a sense of identity and self-efficacy regarding daily living (Calandri et al., 2019). Occupational therapy practitioners (OTPs) can help meet the combined needs of college students with MS to create health-promoting habits and routines, develop self-management skills, and navigate disclosure and accommodations processes to support self-efficacy with daily living, as well as academic inclusion and success.

Objectives. Describe the delivery of interventions to support higher education participation in patients with MS and provide a case study with clinical outcomes to demonstrate how these interventions can be integrated into an occupational therapy (OT) plan of care.

Methods. The case study subject participated in 18 OT sessions. The following interventions were used to support higher education engagement: symptom management training, education regarding Americans with Disabilities Act protections, development of health-promoting habits and routines for daily living, self-advocacy training, school accommodations, and addressing concerns with symptom management in the education context. The Canadian Occupational Performance Measure (COPM) was administered before and after the intervention to capture perceived performance and satisfaction in areas of occupational performance deficit.

Results. Clinically significant improvement occurred on the COPM (+6.0) and satisfaction (+6.0) scores for the education domain. Additionally, the subject showed clinically significant improvement in aggregate scores, with a 4.25-point increase in performance and 4.75-point increase in satisfaction.

Conclusions. This case study highlights interventions OTPs can utilize to address higher education participation and contributes to the literature supporting the need for proactive intervention in college students with MS.

Keywords. Higher education in MS, Management of activities of daily living in MS