A Novel Multidisciplinary Approach to Fatigue in Multiple Sclerosis

Background: Up to 90 percent of patients diagnosed with Multiple Sclerosis (MS) endorse fatigue at some point in their disease course. Fatigue can occur at any stage of the disease with significant impact on quality of life, social interactions and employability. Despite its high prevalence and devastating consequences, its underlying mechanism, clinical characterization, and relationship with various interventions is poorly understood. This is further complicated by the lack of tools available to understand the multiple domains of fatigue and the variables that affect response to various interventions. Therefore, implementation of a multidisciplinary patient-centered therapeutic interventions is necessary.

Objectives: To demonstrate the benefits of a multidisciplinary approach in addressing fatigue among patients with MS while administering assessments and providing interventions aimed at quantifying and managing MS-related fatigue. 

Methods: The University of Florida’s comprehensive MS center created a multidisciplinary fatigue clinic providing physical, occupational, and speech therapy services. The Fatigue Severity Scale (FSS), Modified Fatigue Impact Scale (MFIS), Godin Leisure Activity Questionnaire, and 6 minute walk test are administered to obtain subjective and objective assessments of fatigue and establish baseline. Compensatory and restorative approaches to address physical, cognitive, visual, and respiratory fatigue are addressed by the respective disciplines. When appropriate, patients are referred to outpatient clinics closer to home.  Follow up visits at our clinic are arranged within 1-6 month intervals to track outcomes and provide further treatment. 

Results: Nearly all MS patients from our clinic present with high levels of fatigue, as measured by the FSS and MFIS. Per the Godin Leisure Activity Questionnaire, few of these patients exercise regularly. Many also lack strategies to effectively conserve energy. Through education on fatigue management strategies, including exercise and energy conservation, patients are gaining control over their daily life. A detailed description of the outcomes including number of patients, demographics and results of standardized testing will be provided at the time of the presentation. 

Conclusions: Through subjective and objective measurements, we are building evidence that a multidisciplinary approach will improve patient care by providing MS patients with the tools to manage the different aspects of fatigue that impact quality of life.