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Fatigue Management Patient Information
Occupational Therapy DepartmentHighland Rheumatology Unit Ross Memorial HospitalFerry RoadDingwallIV15 9QTTel : 01349 868 766
Occupational Therapy Service
The people who work for NHS Highland are committed to improvingthe quality of care to patients, their relatives and their carers.
ContentsIntroduction AbouttheFatigueManagementFile WhatisFatigue? Howcommonisit? Symptoms Whatcausesit? Impactoffatigue Howisitmanaged? Howdoesenergyenterthebody? /Whatdoesthebodyuseforfuel?
Fatigue Management Toolbox FatigueImpactScale Energyconservation Movement,exerciseandrest Talking Education Mentalexhaustion Relaxation Adaptthinking Rewarding Relationships 4Ps:Prioritising,Planning,Pacing,Positioning Self Management for fatigue ActivityCycle.Boomorbust Wheeloflife CopingwithsetbacksUnhelpful thinking
Tools to help Prioritisingtool Planningandpacing Howtosetagoal Weeklydiary
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Introduction : About the Fatigue Management FileThe file provides information to enable you to understand more about what fatigue is, why it happens and suggests ways in which to manage it.
• Anoverwhelmingsenseofexhaustionwithdecreasedcapacityforphysicalandmentalworkthatissustainedandnotrelievedbyrest.
(Carpenito 1993)
Introduction : What is Fatigue?
Fatigueisacommon,butpoorlyunderstood,symptomininflammatoryarthritis.Between40-80%ofpatientswhoattendhospitaloutpatientshavesignificantlevelsoffatigue.Fatigueisshowntobestronglyassociatedwithpain,butcanalsobelinkedtodiseaseactivity,depression,fibromyalgiaandsomemedications.
Prolongedandrecurringfatiguecanmakeitdifficulttomaintaindailyactivities.Itcanalsocauseirritabilityandeffectconcentration.
How common is it?• Morecommoninwomenthanmen.• Morecommoninthosewhohaveexperiencedfatigueoranxiety/
depressioninthepast.• 90%ofindividualswithLupus(SLE)andmanypeoplewithRAreport
symptomsoffatigue.• ClassicsymptomofFibromyalgia.
• Reducedappetite• Poorconcentration • Needforfrequentrest • Physicaldiscomfort • Havingtopushselftodothings• Weariness,weakness,lackofenergy,• exhaustion,difficultycarryingoutusualactivities• Moodchanges• Irritability• Disinterest• Increasedneedforrest
Symptoms: The most frequently reported symptoms of fatigue are:
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Impact of Fatigue
Physical-anaemia;poorsleep;“deconditioning”;overdoingthings;overusingjoints,reducedenergylevels,needtoslowdownnormalpace,generalsenseofsluggishness,increasedneedforsleepandrest.
Sensory - increased pain due to muscle stiffness, increased pain due toimmobilityandlackofexercise. Thoughts / Cognitive-difficultyconcentrating,difficultyfocusingattentiononthings,difficultyrememberingthings,feeling“overloaded”.
Feelings / Emotions:stress;worry;“negativethoughts”;depressionorfeelinglow;hidingillnessfromothers;workpressures,frustration, irritation, lackofmotivation,feelingsofneverbeing“normal”again,feelinglikepeopledonottrulyunderstand,moodchanges. Behavioural-avoidinggoingout,avoidingusualactivities,seeinglessoffriends/family,acceptingfewerresponsibilitiesatwork,reducingworkhours,takingextradaysoffwork. Environmental: noise, too high/low temperatures; awkward workenvironments;uncomfortablefurniture;trafficandqueues!! Severity - changes from day to day, may feel more fatigued after certainactivities, tiredness may last for days, may experience peaks and troughs,severitymaybeinresponsetosymptoms(e.g.pain,nauseaandvomiting,etc.) Dimensionsreference:Cox(2001)
• Primary fatigue–thediseaseprocessitself.• Secondary fatigue–anxiety,fear,frustration,depression,
de-conditioning,drugsideeffects,exertion,environmente.g.heat,cold,sleepdisturbance,orbeingoverweight.
What causes it?Thecausesoffatiguearemanyandvariedbutcanbecategorisedby:
Everyone feels fatigued as some stage but when this persistently affects daily activities it can then become a problem.
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How is Fatigue Managed?
• IfFatigueisongoingalwaysdiscusswithyourGPorSpecialistNurse/Consultantsoothermedicalreasonsforfatiguecanbeeliminated
• Self-Managementcopingstrategies
How does energy enter the body? What does the body use for fuel?
• Areyougettingenoughrestfulsleepatnight,7-9hrsisrecommended.Areyouabletohavearestafterlunchtore-chargeyourbatteries,30mins–60mins.Avoidtoomanynapsduringthedayasthiscouldimpactonyoursleepquality.
• Keepadiaryofyourfoodintake,isitsufficient?AhealthybalancedietakintotheMediterraneandietiswhatisadvocated.
• Hydration-areyoudrinkingenoughfluidinadayapprox2pintsoffluidadayforwomenand3pintsformeniswhatisrecommended.
Imagine your body is your car, if the wrong fuel or oil goes into it the car doesn’t work properly.
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Fatigue Management ToolboxThe fatigue management toolbox gives you self-assessment, information and self-management activities to help you manage your fatigue.
Fatigue Impact Scale• Completescaleandusetohighlightsituationswhichmaycausean
increaseinfatigue.
Energy Conservation
• Understandinghowenergyorfuelgetsintothebodyi.e.Diet,HydrationandSleep/Rest.Behonestwithyourselfandkeepadiaryforaweekofallyoueat,drinkandrest/sleep.Understandhowallphysicaloremotionaldailyactivitiesneedenergytobeundertakene.g.gettingdressedorworryingaboutpayingbills.UseEnergyConservationtechniquestobecomemoreenergyconsciousandenergyefficientenablingyourbodytoretainmoreenergyandhelpyoubettercope
withcarryingoutyourdailyactivitiesespeciallythoseimportanttoyou.
• Canyousavetimeandenergywhilstdoingtasksi.e.washing/dressing,foodpreparation.
• Mobilisingathomeareyoustrugglingusingmoreenergythanneededgettingoffchair,bedortoiletgoodheightscansaveenergy.
• Ifyousittopreparemealsthiscansaveenergy.
• Dressing/kitchenequipmentcanfacilitateenergyconservation.
• Acertainamountofexerciseisproventoincreaseenergylevelsandreducefatigue;helpscombatthe‘deconditioning’ofthemuscles.Increasingmovementathomeandnotsittingorlyingdownforlongspellscanbeviewedasexercise.
• Experimentwithdifferenttypesofexercise,durationandtimeofday.Thiswillhelpyouestablishwhatworksbestforyou.
Movement, Exercise and Rest
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Talking•Shareproblems.•Makeothersawareofthedifficultieshelpthemtounderstand.•Talkingcanmakethesituation“normal”andhelpyourealiseyou arenotalone.•Writedownquestionstoaskyourdoctor/therapist/nurse.
• Stretchfrequentlyincreasingoxygenintothebody.
• 30-60minsrestorrelaxationintheafternooncanre-chargeenergybatteries.
• Stopbeforebecomingovertiredi.e.ifyouarefatiguedafter20minutes,exercisefor15minutesthenrest.
Education• Increasedknowledgeandunderstandingoftheconditioncan
helptodecreaseanxietyandworryaboutthefuture,usingup lessenergyworryingaboutaproblemcanhelpreducefatigue.
Mental Exhaustion•Beawareofyourlimitations.•Informotherswhenyoufeeloverwhelmedor“overloaded”.•Minimisedistractionsinyourenvironmentwhentryingto concentrateonatask.•Keepadiarytohelpyourememberyourplanfortheday/week.•Gaincontrol–askpeopletorepeatinformationorgivemessages moreslowly.
Relaxation•Seerelaxationasan“investment”.•Mayhelppaincausedbymuscletensionresultinginincreasedfatigue.•Allowsyoutoachievegreaterself-esteem.•Increasesconfidence.•Givespeaceofmind.•Canreducefatiguelevels.
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Adapt thinking
•Commonforpeopletoplaceunrealisticandunfairexpectations onthemselves.•Peoplethink“Ishould”,“ought”or“must”.•Trytoreplacewiththoughtprocessesthatgivemorecontrolsuch as“Ichoose”.
Rewarding Self/Treats
•Acknowledgeeffortsandpraiseself.•Taketimeandrewardselfspendingtimedoingsomethingthatyou enjoyaftercompletingtasks.•Timeoutinvolvesbeingphysicallyandmentallyremovedfrom sourcesofstress.•Reflectuponpreviousexperiencestohelporganise,planand prepareforfutureactivities.
Relationships
•Planyourdaytoconserveyourenergysothatyoucanspend qualitytimewithyourpartner/family/friends.•Fatiguemayaffectyoursexualrelationship,forexample:anxiety surroundingsexsuchaspainduringintercourse.Yourbodyimage maybealtered.Talktoyourpartnerandmakeaplanfortimetogether.
Prioritising
•Prioritisethoseactivitieswhichareimportanttoyoueitheron practicaltermsoremotionally.•Organiseyourdayorweekontheseterms.•Considerwhichtimesofthedayarebestforyou.•Considertheimportanceofsocialandleisureactivitieswhichareoftenforgottenorstopped.
The 4 P’s
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Planning•Organiseyourdayandweek.•Considerwhichtimesofthedayarebestforyou.•Avoidunnecessaryexertion(e.g.goingup/downstairs10timesaday).•Trytospaceactivitiesoutduringtheweekandnotconcentrateall activitiesintooneday.•Recognisehowsomeactivitiescouldbe‘heavier’foryoutoundertake,soplantomixinheavierandlighteractivitiesonadailybasis.
Pacing•Doatimedactivityandhaveashortrestuntiltaskiscomplete,keeppacingwithinyourplan,don’tkeepgoinguntilyou’reexhaustedas thisrepeats‘BoomandBust’.•Itisbettertotakealittleextratimetocompleteonetaskand beabletocontinue,thantofinishonetaskquicklyandfeeltootiredtocontinue.•Ifyoucompletelydrainyour‘batteries’youhavetowaitalongtimeforthemtorecharge,bettermakingregular‘topups’,pacinghelps youdothat.•Overaperiodoftime,whenyouarepacing,youshouldbeableto increaseyouroverallactivitylevelswithoutilleffects.Somepeoplecallthisincreaseinactivity‘gradedactivity’butformanypeople thiswillhappennaturallyasyougetbetteratpacing.•Pacinggivesyouawarenessofyourownlimitations,whichenables youtopositivelyplanthewaythatyouuseyourenergy,maximisingwhatyoucandowithit.
Positioning• Useagoodposturewhenstandingandsitting–asuprightas
possible.Tryandavoidyourneck‘pokedforward’asyouread orworkatatable/desk.Keepyourbackasstraightasyoucan.
Havegoodsupportiveseating.• Becomemoreawareofhowyousit,standandwalk.Poor
postureusesupmoreenergyandcanincreasefatigueanpain.• Avoidstayinginonepositionforalongtime–thisusesmoreenergy
changepositionregularlyandgiveyourselfregularstretch• Analysethebodypositionsyouusewhendoingactivities–couldyoubemoreefficient?
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TheFatigueImpactScalewasdevelopedtomeasuretheeffectoffatigueonlife‘measuringtheeffectoffatigueonactivities…ismoresensitivethansimplyaskingpeopletoratetheirfatigue’(Fisk et al 1994a).
TheFatigueImpactScaleassessesperceivedfatigueimpactonthinking/cognitivefunctioning(10items),physicalfunctioning(10items)andpsychologicalfunctioning(20items).
Itratestheextenttowhichfatiguehascausedproblems0-noproblem,4-extremeproblem,withamaximumFISscoreof160.
Youthenreviewareaswithhighscorestoidentifyareastoworkonorareasofstrength.
Fatigue Impact Scale
1Ifeellessalert
2IfeelthatIammoreisolatedfromsocialcontact
3Ihavetoreducemyworkloadorresponsibilities
4Iammoremoody
5Ihavedifficultypayingattentionforalongperiodoftime
6IfeellikeIcannotthinkclearly
NO. QUESTION Rating
8Ihavetorelymoreonotherstohelpmeordothingsforme9Ihavedifficultyplanningactivitiesaheadoftimebecausemyfatiguemayinterferewiththem10Iammoreclumsyanduncoordinated11IfindthatIammoreforgetful12Iammoreirritableandmoreeasilyangered13Ihavetobecarefulaboutpacingmyphysicalactivities
14Iamlessmotivatedtodoanythingthatrequiresphysicaleffort
7 Iworklesseffectively.(Thisappliestoworkinsideoroutsidethehome)
0 No Problem1 Small Problem2 Moderate Problem3 Big Problem4 Extreme Problem
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16Fatiguelimitsmyabilitytotraveloutsidemyhome
17Ihavetroublemaintainingphysicaleffortforlongperiods
18Ifinditdifficulttomakedecisions
19Ihavefewsocialcontactsoutsideofmyownhome
20Normalday-to-dayeventsarestressfulforme
21Iamlessmotivatedtodoanythingthatrequiresthinking
22Iavoidsituationsthatarestressfulforme
23Mymusclesfeelmuchweakerthantheyshould
24Myphysicaldiscomfortisincreased
25Ihavedifficultydealingwithanythingnew
26Iamlessabletofinishtasksthatrequirethinking
27Ifeelunabletomeetthedemandsthatpeopleplaceonme
28Iamlessabletoprovidefinancialsupportformyselfandmyfamily
29Iengageinlesssexualactivity
30IfinditdifficulttoorganisemythoughtswhenIamdoingthingsathomeoratwork31Iamlessabletocompletetasksthatrequirephysicaleffort32IworryabouthowIlooktootherpeople33Iamlessabletodealwithemotionalissues34Ifeelsloweddowninmythinking35Ifindithardtoconcentrate36Ihavedifficultyparticipatingfullyinfamilyactivities37Ihavetolimitmyphysicalactivities38Irequiremorefrequentorlongerperiodsofrest
NO. QUESTION Rating15Iamlessmotivatedtoengageinsocialactivities
39IamnotabletoprovideasmuchemotionalsupporttomyfamilyasIshould40Minordifficultiesseemlikemajordifficulties
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Self-Management for Fatigue: Activity Cycle / Boom or Bust
Oftenpeoplewithfatiguedescribeashavingvaryingamountsofenergyfromonedaytoanotherorevenwithinthesameday.Thislackofenergymayleadpeopletoattempttodotoomuchonabetterdayandthenspendseveraldaysrecoveringfromit.ThisisreferredtoastheBoom and BustapproachorActivity Cycle:
Good day
Over-activity
Prolonged Rest
Increased Fatigue
Theproblemofstayinginthisactivity cycle is that everytimeyouoverdo it, you aremore likely to avoid doingtheseactivitiesinthefuture.
• Thereisworkthat“hastobedone”andtryandcraminasmuchactivityaspossibleinaperiodoftheday.• You’reblinkeredtogettingthejobdone.• Oftenfeelguiltyaboutoverloadingothers.• Trytoignoreorbeatthelossofenergy.
What are the negative consequences of the Activity Cycle?
• Setbacks,recurringfatigue.• Moretemptingtoavoidactivities.• Hardertomakelongertermprogresswithactivity.• Fatiguedecideshowmuchyoudo,notyou.• Feelingsoffrustrationandfailure.
People stay in the Activity Cycle because
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How can this ‘boom and bust’ approach to activity be changed?
• Acknowledgethatthisishowyoutendtoapproachactivity.• Starttoanalysehowmuchofanactivityyoucandoonagood
dayandabadday,theaimbeingtosustainthesameamounteach day. In practice this will normallymean that you set abaseline of activity, which is initially lower than you wouldnormallyattemptonagoodday.
• Keepanactivitydiary,payingattention towhichactivitiesarehighonenergyrequirement.
• Usethe4PsPrioritise,Plan,PaceandPositioning.• Setrealisticgoalsensuretheyareachievableasitsbetternotto
setselfuptofail.
Ask yourself the ‘Readiness Ruler’ questions
• HowImportantisitformetomakeachange?And• HowconfidentdoIfeelthatIcanmakechangestomylifestyle?
Set realistic and timely goals to help bring about change.
Taking a balanced, steady approach to activity counteracts the common tendency to swing from one extreme to another.
It avoids the inevitable ill effects that follow, so you can start the process towards recovery.
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Forourhealthandwellbeingthereisaneedtoretainabalancebetweenthedifferentareasofourlives.Thiscanbechallenging.Attimes,oneareamaytakeupmoreofourtimeandenergyandthisistobeexpected,however,iftheimbalancecontinuesforasustainedperiodoftimethenotherareascanmissout.Thewheeloflifehelpsyoulookatthebalancebetweenyourareasoflife,andhelpyouprioritiseactivitieswhichyouwouldliketoparticipateinagain.Thisisadynamicprocess,willbeeverchangingsoyoucanrepeatthisexerciseatdifferenttimes.
Self-Management for Fatigue: The Wheel of Life
Scoreeachsegmentofthecircleoutof10forhowsatisfiedyouarewiththatarea0=leastsatisfied,10=mostsatisfied.Lookatthesegmentsthatscoredthelowerandask: • Whatwould10outof10feel,lookandsoundliketoyou?
• Isthatunrealistic?• Howwouldyourlifebedifferentifyouscored10outof10inthatarea?• WhatcanyoudotomoveyourscoreupjustONEpoint?• Usethespacebelowtowritesomenotesinanswertothesequestions.
Leisure & Social Friends & Family
Financ e
Wor
k(p
aid
or u
npaid
)
Pers
onal
Relati o
nshi
ps
Spiritual life
/Well-being
Health
Learning
Notes:
To complete the wheel of life:
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Self-Management for Fatigue: Coping with SetbacksMostpeoplewithfatiguewillexperiencesetbacks;timeswhensymptomsworsenforaperiodoftime.Itcanbedifficulttomaintainyourlevelsofactivityduringthesetimes.Differentthingswillprovokesetbacks,andtheymaylastforvaryinglengthsoftime.Eachpersonwillhavedifferentwaysofdealingwithasetback.Thepurposeofthishandoutistoencourageyoutobecomeawareofthosethingsthatprovokeasetbackforyou,andtodevelopaplanforcopingwithasetbackwhenithappens.
What provokes a setback?Setbacksdon’talwayshaveclear-cutcauses,butthereareanumberofthingswhichcancontributetoone.
Overdoing it–Thismaybetheresultoftakingontoomuch,orsimplyasaresultofdoingoneactivityfortoolong.Setbackscanbestartedifyoufailtopaceyourselfproperly,orifyoufailtoplan,prepareandprioritise.
Stress–Aperiodofstressinyourlifemayprovokeasetback.Beawareofthosethingsthatupsetyouandspotthesignsthatyouarebecomingundulystressed.Stressmanagementmaybeespeciallyhelpfulatthesetimes.
Periods of illness–Followingaflare-upofyourconditionyoumaybemorepronetoasetback.Remembertorestartactivitiesandexercisegraduallybypacingyourself.
Low mood/seasonal factors–manypeoplefindthatthereisaninteractionbetweentheirframeofmindandtheirenergylevels.
Notallthesefactorsapplytoeveryone.Itisworthrecognisingasmanysignsandcharacteristicsfromyourownexperienceofsetbackstohelpyounexttime.Usethespacebelowtolistthosewarningsignswhichyouhavenoticedbefore,andaddanynewonesasyoubecomeawareofthem.
Warning signs:
Evenwiththebestofplanning,itmaybeimpossibletoavoidasetback.However,ifyoudohaveone,couldyouuseitasawaytolearn?Didyouignorethesigns?Whatcouldyouhavedonedifferently?
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Compromise:Areyouaskingtoomuchofyourselfatpresent?Don‘tbeafraidtostepbackandreconsideryourexpectationsduringasetback.Remembertorecognisewhatyouareachieving!
Socialise:Ifyou’reverytired,it’seasytofeellikeisolatingyourself.Rememberthatbeingintouchwithsomeonecanbehelpful,sowhataboutgivingsomeonearing,orinvitingafriendround?
Pamper:Ifthegoingistough,paceyourselfandgiveyourselfabreak.Ifamassageorrelaxingshowerorbathhelps,whynot?Decidenowhowyouwillindulgeyourselfasakindofcompensationnexttimeasetbackoccurs.
Thinking: Rememberthewaywethinkinfluenceshowwefeel.Inthemidstofasetbackitiseasytoslipintobadhabitsanddwellonthenegatives.Trytobeawareofthis,andtryoutdifferentwaysofthinking.
Setback Management using your coping strategies
Animportantpartoflearningtomanageyourfatigueislearningtomanagesetbacksasbestyoucan.Thismeansthatyouwillbeabletogetoveryoursetbackmorequickly,andfeelmoreconfidentinthewayyouhandlesetbacks.Duringtheprogrammewehavediscussedanumberofideasformanagingthem,andherearesomereminders:-
Relaxation:remembertheimportanceofproper,recuperatingrelaxation?Trytouseyourfavouriterelaxationtechnique.
Planned rest: whathaveyoufoundoutaboutthemosteffectiveuseofrest?Isitplanned,timelimitedandenjoyable?
Exercise: It’stemptingtostopcompletelywhenyouarefatigued–don’t.Rememberwhatyouhavelearnt,andadjustyourbaselineaccordingly.
Prioritise: Putyourenergyintothemostimportantareasofyourlifefirst.
Notallthesestrategieswillapplytoyou,andyoumayhavedevelopedsomeadditionalideasforsuccessfullymanagingorreducingthelengthofaset-back.Writedownthoseideasthatyouhaveformanagingyourownsetback,andaddanynewonesthatmayhelp.
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Unhelpful ways of thinkingUnhelpful ways of thinking
Description Example
Jumping to negativeconclusions
Over generalisation
All-or-nothing thinking/black-and-white thinking
Lookingatasituationastwoextremesonly.Therearenoin-betweensorshadesofgrey.
“IfIdon’tsucceedatdoingallthehouseworkthenI’matotalfailure.”
Makinganegativeassumption;becausesome-thinghasgonewrongonceortwice,itwillalwaysdoso.
“WhenItriedtodoexercisebeforemypainincreased,somypainisboundtoincreaseifIexerciseagain”.
‘Should’ and ‘must’statements
Fixedexpectationsonhowyouthinkyouorothersshouldbehave.
“Ishouldbeabletovacuumthehouseinonego;Imusttryharder.”
Catastrophising Thinkingabouteventsasiftheyarealotmorenegativethantheyare.
“Mypainisreallybadtoday,Imustbedoingpermanentdamagetomybody.”
Emotionalreasoning
Takingafeelingasbeingevidenceoffact.
“Ifeelanxious,Iknow somethingdangerousisgoingtohappen.”
Labelling Attachingalabeltoyourselforotherswithoutconsideringevidencethatdoesnotsupportit.
“I’museless.”“Theyaresoinconsiderate.”
Mind-reading Believingthatyouknowwhatothersarethinking.
“MyfriendsmustthinkI’mareallyboringpersonandtheydon’treallywanttobeherewithme.”
Personalisation Blamingyourselfforanythingunpleasantandtakingtoomuchresponsibilityforthingsthatarenotunderyourcontrol.
“It’smyfaultthat.............”
Tunnel vision Focusingsolelyonthenegativeaspectsofasituation.Thewholepictureiscolouredbywhatmaybeasinglenegativedetail.
“I’minasmuchpainasIwas2monthsago;Ihaven’timprovedatall.”
Drawinganegativeconclusionwhenthereisnoevidencetosupportit.
“Theywon’tlikeme,sowhyeventrytojoinin?”
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Listactivitiesortasksyouneedtodofortheweek.Whenyouhavelistedalltasks,prioritisetheseintowhatyouconsidertobehigh,mediumandlowpriorities(i.e.putthetasksmostimportanttoyouinthehighprioritycategory).
Tool for PrioritisingMediumPriority
HighPriority
LowPriority
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20
Identifyhigh,mediumandlowenergyactivities.Fromthelistofweeklytaskstodo,planwhenyouaregoingtocarryouteachtask,usingpacingtocarryitthrough
Tool for Planning and PacingM
onda
yTu
esda
yW
edne
sday
Thur
sday
Frid
aySa
turd
aySu
nday
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Step1-whatwouldyouliketochange?Yourgoal
Step2-whatchangeswouldhelpyoutoachievethischange?
Step3-whatsmallchangescanyoumaketohelpyouachieveyourgoal?
Step4-howcanyousustainthischangeandexpanditintootheraspectsofyourlife?
Example
Step1-returningtoapreviouslyenjoyedactivity–baking–yourpriority
Step2-usingpre-packedbakingingredients,allocatingtimetocarryoutenjoyableactivity–yourplan
Step3-buyinprepackedingredientstocarryoutbakingwhenfeeling physicallyable,allocatingtimetoundertakeactivitywithrest spellsatendpointsofactivityandusingaseattohelpconserve energywhilstcarryingoutactivity–pacingandpositioning
Step4-prioritisingthisactivityasenjoyableandprovidingasenseof achievement,identifyanothergoalandusesimilarquestions
How to set a goal using the 4 Ps?
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Out
com
e
DIDITW
ORK
?YES/NO.
PRAC
TICE
(setgoa
ls)Selectagain…..
Askforh
elp/doless?
3 St
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hiev
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Goa
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Da
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Mon
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Tues
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Wed
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Satu
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Sund
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Fatig
ue sc
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(1-1
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teAftereachday,listdowntheactivitiescarriedoutduringthedayandthenrateyourleveloffatigueonascaleof1-10with1beingnottiredatalland10beingextremelytired.
Weekly Diary
• Itisbelievedthatpersonaldiariesthatrecordvaryinglevelsofenergy/fatigueduringthedaycanhelpwithplanningandpacing.• Itisalsorecommendedtorecordmoodlevelsthroughouttheday.
Thisleafletisavailableindifferentformatsonrequest.Theseincludelargefont,audiotypeanddifferentlanguages
Issue No. 2 Date of issue : March 2018 Review date : March 2020
Devised by Amanda Trafford & Val Little, Occupational Therapy (2014)
Reviewed by Val Little and Toria Macdonald, Occupational Therapy (2018)
March2018.NC17-00363
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