Applying The Stages Of Change Model With MS Fatigue Management

Background: Due to the onslaught of services being limited at this time through capitation of coverage for rehabilitative services its imperative that clients are given the tools to assume greater responsibility in managing their symptoms and overall health care needs.  The stages of change model provide unique opportunities to address common secondary factors that contribute to MS related fatigue.  MI techniques offer strategies to assist clients in taking more responsibility in such areas as sleep, hygiene, weight management and exercise.  Interdisciplinary interventions need to be provided in a more cost effective manner with the consumer taking more responsibility for achieving their personal goals.  This workshop will provide clinicians with an alternative model of intervention in which the client’s readiness and motivation to change is an essential part of the assessment and the goal setting process. Empowerment of the client at the onset of the intervention stresses the client’s willingness to work on what they perceive to be their immediate treatment needs. The likelihood of positive clinical outcomes is greater and of shorter duration when the client directs the care.

Objectives:

1. Participants will be able to identify 8 secondary contributing factors to MS related fatigue.

2.  Participants will be able to identify the stages of change and recognize behaviors in each stage.

3. Participants will be able to identify at least three motivational interviewing techniques appropriate for use in developing fatigue management strategies for clients with MS.

4.  Through group experiential activities participants will demonstrate the understanding of how to apply the model of change and motivational interviewing techniques in their assessment and treatment of MS related fatigue.

5.  Participants will demonstrate increased awareness of client perspectives on therapeutic empowerment, self motivation and ongoing support needs form observed client interviews.

Methods: Baseline assessment of fatigue using the COPM, modified fatigue impact scale. Sleep assessment, activity diary, readiness and motivation to change rulers along with goal and priority setting and baseline assessment of physical skills and cognitive screen.

Results: More efficient goal directed care of shorter duration with interdisciplinary team management of fatigue. Improved scores on modified fatigue impact scale, life satisfaction and routine physical and cognitive screens.  Improved patient satisfaction with functional outcomes and strategies for applying the change model to other areas of symptom management.

Conclusions: Clients, who assume responsibility for making life style changes with the support of clinicians familiar with the stages of change model and motivational interviewing, achieve greater and longer lasting positive outcomes then those clients who don't take ownership of their therapeutic treatment program.