Fatigue is one of the most burdensome and disabling symptoms in numerous acute and chronic conditions and is associated with reduced participation in all aspects of daily life, for example, parenting, employment, and socialization. Historically, occupational practitioners played key roles in fatigue management by creating and implementing interventions. The American Occupational Therapy Foundation convened a Planning Grant Collective workshop with the goal to develop collaborative research ideas and proposals to advance the understanding and management of fatigue. Participants from occupational therapy and other disciplines, with expertise with fatigue or who were conducting research on fatigue, participated in a 3-day virtual workshop. Four main topics emerged: implementation science, treatment taxonomy, trial design and comparative effectiveness, and phenotyping. This white paper describes the proceedings, summarizes the discussions, and outlines recommendations from the PGC workshop on fatigue.
AlizadehN.PackerT. L.SturkenboomI.EskesG.WarnerG. (2022). Managing fatigue in Parkinson’s disease: Protocol for a pilot randomized controlled trial. Canadian Journal of Occupational Therapy, 89(2), 180–189. https://doi.org/10.1177/00084174221085449
AvlundK.MehlsenM. Y.ThomsenD. K.ViidikA.ZachariaeR. (2008). Physical functioning and use of health services in a young and old sample. Danish Medical Bulletin, 55(3), 147–151.
4.
BillonesR.LiwangJ. K.ButlerK.GravesL.SaliganL. N. (2021). Dissecting the fatigue experience: A scoping review of fatigue definitions, dimensions, and measures in non-oncologic medical conditions. Brain, Behavior, & Immunity-Health, 15, Article 100266. https://doi.org/10.1016/j.bbih.2021.100266
5.
BowerJ. E. (2019). The role of neuro-immune interactions in cancer-related fatigue: Biobehavioral risk factors and mechanisms. Cancer, 125(3), 353–364. https://doi.org/10.1002/cncr.31790
6.
CarandangK.PooleJ. L.ConnollyD. (2022). Fatigue and activity management education for individuals with systemic sclerosis: Adaptation and feasibility study of an intervention for a rare disease. Musculoskeletal Care, 20(3), 593–604. https://doi.org/10.1002/msc.1617
7.
CarandangK.VigenC. L. P.OrtizE.PyatakE. A. (2020). Re-conceptualizing functional status through experiences of young adults with inflammatory arthritis. Rheumatology International, 40(2), 273–282. https://doi.org/10.1007/s00296-019-04368-8
8.
CashionA. K.GillJ.HawesR.HendersonW. A.SaliganL. (2016). National Institutes of Health Symptom Science Model sheds light on patient symptoms. Nursing Outlook, 64(5), 499–506. https://doi.org/10.1016/j.outlook.2016.05.008
9.
DaviesK.DuresE.NgW. F. (2021). Fatigue in inflammatory rheumatic diseases: Current knowledge and areas for future research. Nature Reviews Rheumatology, 17(11), 651–664.
10.
DürM.UngerJ.StofferM.DrăgoiR.Kautzky-WillerA.Fialka-MoserV.SmolenJ.StammT. (2015). Definitions of occupational balance and their coverage by instruments. British Journal of Occupational Therapy, 78(1), 4–15. https://doi.org/10.1177/0308022614561235
11.
ElbersR. G.RietbergM. B.van WegenE. E.VerhoefJ.KramerS. F.TerweeC. B.KwakkelG. (2012). Self-report fatigue questionnaires in multiple sclerosis, Parkinson’s disease and stroke: A systematic review of measurement properties. Quality of Life Research, 21(6), 925–944. https://doi.org/10.1007/s11136-011-0009-2
Fernández-de-Las-PeñasC.Palacios-CeñaD.Gómez-MayordomoV.Palacios-CeñaM.Rodríguez-JiménezJ.de-la-Llave RincónA. I.Velasco-ArribasM.Fuensalida-NovoS.Ambite-QuesadaS.GuijarroC.CuadradoM. L.FlorencioL. L.Arias-NavalónJ. A.Ortega-SantiagoR.Elvira-MartínezC. M.Molina-TriguerosL. J.Torres-MachoJ.Sebastián-VianaT.Canto-DiezM. G.. . . Arendt-NielsenL. (2022). Fatigue and dyspnoea as main persistent post-covid-19 symptoms in previously hospitalized patients: Related functional limitations and disability. Respiration, 101(2), 132–141. https://doi.org/10.1159/000518854
14.
FinstererJ.MahjoubS. Z. (2014). Fatigue in healthy and diseased individuals. American Journal of Hospice and Palliative Medicine, 31(5), 562–575. https://doi.org/10.1177/1049909113494748
15.
FurstG. P.GerberL. H.SmithC. C.FisherS.ShulmanB. (1987). A program for improving energy conservation behaviors in adults with rheumatoid arthritis. American Journal of Occupational Therapy, 41(2), 102–111. https://doi.org/10.5014/ajot.41.2.102
16.
GoodfellowM.SchoenhalsA.SleightA. (2021). Cancer-related fatigue protocol using a personalized self-management program. Archives of Physical Medicine and Rehabilitation, 102(10), e73–e74. https://doi.org/10.1016/j.apmr.2021.07.690
17.
HardyS. E.StudenskiS. A. (2010). Qualities of fatigue and associated chronic conditions among older adults. Journal of Pain and Symptom Management, 39(6), 1033–1042. https://doi.org/10.1016/j.jpainsymman.2009.09.026
18.
HewlettS.AlmeidaC.AmblerN.BlairP. S.ChoyE. H.DuresE.HammondA.HollingworthW.KadirB.KirwanJ. R.PlummerZ.RookeC.ThornJ.TurnerN.PollockJ. (2019). Reducing arthritis fatigue impact: Two-year randomised controlled trial of cognitive behavioural approaches by rheumatology teams (RAFT). Annals of the Rheumatic Diseases, 78(4), 465–472. https://doi.org/10.1136/bmjopen-2015-009061
19.
JaremkaL. M.FagundesC. P.GlaserR.BennettJ. M.MalarkeyW. B.Kiecolt-GlaserJ. K. (2013). Loneliness predicts pain, depression, and fatigue: Understanding the role of immune dysregulation. Psychoneuroendocrinology, 38(8), 1310–1317. https://doi.org/10.1016/j.psyneuen.2012.11.016
20.
JimH. S.SmallB.FaulL. A.FranzenJ.ApteS.JacobsenP. B. (2011). Fatigue, depression, sleep, and activity during chemotherapy: Daily and intraday variation and relationships among symptom changes. Annals of Behavioral Medicine, 42(3), 321–33. https://doi.org/10.1007/s12160-011-9294-9
21.
KarshikoffB.SundelinT.LasselinJ. (2017). Role of inflammation in human fatigue: Relevance of multidimensional assessments and potential neuronal mechanisms. Frontiers in Immunology, 8, Article 21. https://doi.org/10.3389/fimmu.2017.00021
KlugerB. M.KruppL. B.EnokaR. M. (2013). Fatigue and fatigability in neurologic illnesses: Proposal for a unified taxonomy. Neurology, 80(4), 409–416. https://doi.org/10.1212/WNL.0b013e31827f07be
24.
KratzA. L.MurphyS. L.BraleyT. J. (2017). Ecological momentary assessment of pain, fatigue, depressive, and cognitive symptoms reveals significant daily variability in multiple sclerosis. Archives of Physical Medicine and Rehabilitation, 98(11), 2142–2150. https://doi.org/10.1016/j.apmr.2017.07.002
25.
LeH. H.Ken-OpurumJ.LaPradeA.MaculaitisM. C.SheehanJ. J. (2022). Assessment of economic burden of fatigue in adults with multiple sclerosis: An analysis of U.S. National Health and Wellness Survey data. Multiple Sclerosis and Related Disorders, 65, Article 103971.
26.
MarrelliK.ChengA. J.BrophyJ. D.PowerG. A. (2018). Perceived versus performance fatigability in patients with rheumatoid arthritis. Frontiers in Physiology, 9, Article 1395. https://doi.org/10.3389/fphys.2018.01395
MurphyS. L.NiemiecS. S. (2014). Aging, fatigue, and fatigability: Implications for occupational and physical therapists. Current Geriatric Reports, 3(3). https://doi.org/10.1007/s13670-014-0093-6
OmuraK. M.Augusto de Araujo Costa FolhaO.MoreiraP. S.da Silva BittencourtE.SeabraA. D.CardosoM. M. (2022). Energy conservation, minimum steps, and adaptations when needed: A scoping review. Hong Kong Journal of Occupational Therapy, 35(2), 125–136. https://doi.org/10.1177/15691861221137223
31.
O’RiordanR.DoranM.ConnollyD. (2017). Fatigue and activity management education for individuals with systemic lupus erythematosus. Occupational Therapy International, 2017, Article 4530104. https://doi.org/10.1155/2017/4530104
32.
PackerT. L.LehmanM. J.BrinkN.SauriolA. (2022). Therapist manual: Packer managing fatigue—A Six-Week Self-Management Group Program (2nd ed.). Think Self-Management. https://www.thinkselfmanagement.ca
33.
PennerI. K.PaulF. (2017). Fatigue as a symptom or comorbidity of neurological diseases. Nature Reviews Neurology, 13(11), 662–675. https://doi.org/10.1038/nrneurol.2017.117
34.
PlowM.GunzlerD. D. (2022). Disentangling self-reported fatigue, depression, and cognitive impairment in people with multiple sclerosis. Multiple Sclerosis and Related Disorders, 61, 103736. https://doi.org/10.1016/j.msard.2022.103736
35.
PlowM.GunzlerD. D.ChangJ. L. (2023). Characterizing fatigue phenotypes with other symptoms and clinically relevant outcomes among people with multiple sclerosis. Quality of Life Research, 32, 151–160. https://doi.org/10.1007/s11136-022-03204-0
36.
PlowM.PackerT.MathiowetzV. G.PreissnerK.GhahariS.SattarA.BethouxF.FinlaysonM. (2020). REFRESH protocol: A non-inferiority randomised clinical trial comparing internet and teleconference to in-person “managing fatigue” interventions on the impact of fatigue among persons with multiple sclerosis. British Medical Journal Open, 10(8), Article e035470.
37.
ProffittR.CasonJ.LittleL.PickettK. A. (2021). Stimulating research to advance evidence-based applications of telehealth in occupational therapy. OTJR: Occupation, Participation and Health, 41(3), 153–162. https://doi.org/10.1177/15394492211011433
38.
ShadickN. A.ZibitM. J.IannacconeC. K.ThrowerR.SowellN. F.WeinblattM. E.SolomonD. H.CuiJ. (2018). A development and feasibility study of a peer support telephone program in rheumatoid arthritis. Journal of Clinical Rheumatology, 24(6), 346–349. https://doi.org/10.1097/RHU.0000000000000661
39.
SkivingtonK.SimpsonS. A.CraigP.BlazebyJ. M.CraigN.McIntoshE.Rycroft-MaloneJ. (2021). A new framework for developing and evaluating complex interventions: Update of Medical Research Council guidance. British Medical Journal, 374, Article n2061. https://doi.org/10.1136/bmj.n2061
40.
SleightA. G.CrowderS. L.SkarbinskiJ.CoenP.ParkerN. H.HooglandA. I.GonzalezB. D.PlaydonM. C.ColeS.OseJ.MurayamaY.SiegelE. M.FigueiredoJ. C.JimH. S. L. (2022). A new approach to understanding cancer-related fatigue: Leveraging the 3P model to facilitate risk prediction and clinical care. Cancers, 14(8), Article 1982. https://doi.org/10.3390/cancers14081982
41.
StoneA. A.ShiffmanS. (2002). Capturing momentary, self-report data: A proposal for reporting guidelines. Annals of Behavioral Medicine, 24(3), 236–243. https://doi.org/10.1207/S15324796ABM2403_09
42.
StrandV.ShahR.AtzingerC.ZhouJ.ClewellJ.GanguliA.TundiaN. (2020). Economic burden of fatigue or morning stiffness among patients with rheumatoid arthritis: A retrospective analysis from real-world data. Current Medical Research and Opinion, 36(1), 161–168. https://doi.org/10.1080/03007995.2019.1658974
43.
VeenhuizenY.CupE. H. C.JonkerM. A.VoetN. B. M.van KeulenB. J.MaasD. M.HeerenA.GroothuisJ. T.van EngelenB. G.GeurtsA. C. H. (2019). Self-management program improves participation in patients with neuromuscular disease: A randomized controlled trial. Neurology, 93(18), e1720–e1731. https://doi.org/10.1212/WNL.0000000000008393
44.
ZielinskiM. R.SystromD. M.RoseN. R. (2019). Fatigue, sleep, and autoimmune and related disorders. Frontiers in Immunology, 10, Article 1827. https://doi.org/10.3389/fimmu.2019.01827
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
