The Clinical Challenges of Fatigue
2nd December 2020
Written by Olivia Fretwell.
I had the opportunity to speak with Fran Hill who is the Founder and Director of South Coast Fatigue. They are an independent specialist fatigue management service. She provided a very insightful overview of what they offer, who and how they treat clients, as well as how they have been impacted by Covid-19.
Brief background.
Fran Hill established South Coast Fatigue (SCF) in 2009. Fran and the team have worked with clients who have had fatigue for many years, working both within the NHS and now fully in independent practice.
What is the most common condition that you see?
The practice specialises in working with clients who have fatigue and not specific to any particular diagnosis. The majority of the people South Coast Fatigue see have CFS/ME as the clinic has NHS contracts to provide intervention for this client group for the whole of Hampshire. Some of SCF’s other clients are referred from other routes and may have sustained a brain injury, others have had Covid-19 whilst others require support specifically with sleep. The practice also takes referrals for vocational rehabilitation specifically for fatigue clients and can run sleep programmes as all staff are CBTI trained.
What are the sources of your referrals?
GPs are the predominant referrer, due to the NHS contracts. SCF also receive referrals from rehabilitation Case Managers, working as part of a multi-disciplinary team; often where fatigue is disrupting a client’s rehabilitation progress i.e. impeding them reaching their goals. This may involve working with other specialists such as physiotherapists or occupational therapists. Focus tends to be upon establishing a bespoke rest and activity programme with specific sleep advice to ensure clients have the best chance of managing their energy for their rehabilitation programmes and limiting payback afterwards. SCF also work with employers and offer vocational rehabilitation, helping clients to return to work as well as supporting them to remain well at work. Individuals may also self refer.
How do you approach intervention and what approaches are used?
A holistic approach is taken, with SCF offering and creating a bespoke programme for each individual to suit their specific needs. This approach focuses on key areas of fatigue management such as patterns of the fatigue, dysregulation within their bodily systems, sleep using CBTI, pacing and building up tolerance to activity. SCF also uses the AHP Health and Work Report as a tool for facilitating the implementation of reasonable adjustments in clients’ work place where appropriate.
How long does treatment last?
SCF typically work with clients for 6-9 months although this can be flexible depending upon the nature of the referral.
What is the age range of SCF’s clients?
SCF is an adult practice and as such takes referrals for clients aged from 16.
Treatment outcome – effective management as vs. symptom improvement/reduction as outcomes?
Both outcomes are met. SCF have a standardised set of assessments that are sent to clients at the beginning of their intervention and at the end along with patient reported outcome measures. Many aspects are looked at for example symptoms, pre and post levels of function, fatigue, pain, mood and work. One question individuals are asked is how often they would need to see their GP going forward, with the hope and intent of it being less than before; this is to try to reduce the burden on primary care. SCF’s recent Practice Analysis found that 92% of clients showed improvement and reported increased confidence and 72% of clients over the last 5 years said that they wouldn’t need to see their GP going forward; very positive figures.
Do you treat individuals with Functional Neurological Disorder?
SCF therapists will always assess each client comprehensively prior to commencing a programme. The team can work with clients with a diagnosis of Functional Neurological Disorder, however each individual suffering from FND is different. For some people their fatigue management programmes work really well and are effective, however, sometimes they may need more specialist support and an onward referral.
In your opinion, what is the most difficult symptom to treat?
Pain can be associated with a lot of conditions and needs to be well managed prior to commencing a fatigue management programme as it uses a lot of energy.
What does success look like for you?
SCF work with individuals for around 6-9 months. By the time clients leave, they are at the stage of the programme where they are working slowly on increasing their activity levels bit by bit, in a flexible way. Success to the team, is when clients have managed to regain aspects of their lives, are reporting better sleep and are able to engage in meaningful activity again.
Do you get any clients re-referred to you?
Some clients are re-referred however this is quite a small percentage. This may be due to a change in their circumstances which means they are now more able to complete the programme, the time is right, the situation’s easier. This enables them to engage more readily than before. They may only need to revisit a small part of the programme in order to help them re-stabilise and move forward.
How do clients typically respond to treatment initially?
Most clients SCF help are really eager to engage as it’s often taken some time to get a diagnosis; or to get to the point where they feel able or ready to engage. The comprehensive assessment prior to intervention allows clients the opportunity to tell their story and build rapport with their therapist.
How has the impact of Covid-19 affected your business, your workload, your clients? Have you been able to adapt to the changing environments?
For SCF, little has changed as the practice used tele-rehab tools for a large proportion of their work. The first consultation is now done remotely, which normally would be face to face, however the follow-ups continue to be delivered over the phone. Clients have found it helpful to have their consultation and appointments done at home, as this saves energy and avoids travel. The practice haven’t seen a change in the therapeutic relationship or clients’ progression through the programme. Initially referrals were lower due to very few clients going to their GP, however are now back to normal, if not higher. The practice is also seeing a significant number of post covid clients and have developed a new programme called The Essential Fatigue Management Programme. This programme consists of a comprehensive assessment and runs over 3-4 months covering all the essential elements how to manage energy.
Follow the link to their website here for further information about what they offer and to get in touch.
If you would like to comment or share experiences of working clinically with clients’ fatigue, please do get in touch via our social media platforms Twitter, Linkedin and Facebook, and we would love to hear what you have to say!
