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Managing Long COVID: The Important Role of Occupational Therapy

by Alison Wright

Alison is one of The OT Practice’s expert Occupational Therapists who specialises in Fatigue Management. Here, Alison discusses how Long COVID is affecting our clients and shares some practical guidance for recovery and long-term fatigue management.

Alison Wright It has been over a year since the first COVID-19 cases were confirmed in the UK and the strain on patients’ health has brought the role of Occupational Therapy into the spotlight. As we are now becoming aware, this virus is leaving many people with ongoing and debilitating symptoms know as post-COVID-19 syndrome or ‘Long COVID’. The National Institute for Health and Care Excellence (NICE) lists a wide range of symptoms affecting most bodily systems. Most significantly for Occupational Therapists are the effects on patients’ respiratory symptoms and chronic fatigue. In this article, I will focus on the role of the Occupational Therapist in helping the client manage chronic fatigue.

Long COVID

There is still much to learn about the long-term effects of COVID-19. In December 2020, data released by the Office for National Statistics showed that 1 in 10 people infected with Coronavirus experience symptoms that last for 3 months or longer. As of February 2021, there have been over 3.8 million confirmed cases in the UK. This means that a lot of people will be dealing with symptoms of Long COVID in varying severity.

NICE released guidance on managing the long-term effects of COVID-19 in December 2020. As Occupational Therapists, we have a very important rehabilitative role in helping our clients manage their fatigue and recover from Long COVID.

The role of the Occupational Therapist in helping the client self-manage symptoms of Long COVID Fatigue

Understanding Chronic Fatigue

Chronic fatigue can be described as extreme tiredness which is overwhelming and not relieved by sleep or rest. It becomes a struggle to cope with daily life and further symptoms can develop as the body attempts to ‘keep going’ when in fact it needs to stop and rest.

It is common for clients to repeatedly ignore the body’s signals, citing that they have ‘too much to do,’ ‘feel guilty if they sit down’, or they believe others will think them lazy. It is important these beliefs are addressed at the start of therapy and the therapist reassures the client that treatment is a prescription to rest. By ignoring the signals, they will exacerbate their condition.

A fatigued body has a limited amount of energy available to it. Like an old mobile phone battery, the body loses energy quickly and it does not charge up very well. It is important to remember that the body needs to keep a reserve of energy to run its systems, fight infection and to aid recovery.

The level of fatigue experienced by COVID-19 patients, both during and after infection, will vary with some clients bedbound and unable to manage their personal care, while others can manage at home but are unable to make it to work. Repeatedly pushing beyond energy limits will further exacerbate the symptoms and the patient will ‘crash’ with physical and emotional symptoms such as pain, flu-like symptoms, nausea, upset stomach, sensory sensitivities and complete exhaustion. This often leads to days, or even weeks, bedbound or housebound.

In my experience, therapeutic interventions must encourage the client to remain within their ‘energy envelope’, and not push beyond their limits, especially in the early stages.

Occupational Therapy Treatment for Long COVID Fatigue

The overall aim of treatment is to repeatedly replenish energy and improve wellbeing through deep rest skills, pacing, good nutrition, good sleep and managing stress. Energy is used physically, cognitively and emotionally so all areas of a client’s lifestyle should be considered including daily tasks, relationships, work and education.

How to replenish energy and allow rest and recovery:

Rest
The deep rest skills of breathing, relaxation, meditation and restorative rest need to be established first. We know that deep rest aids recovery because the stress response is switched off and the body moves into ‘rest and digest’ mode. By practicing effective breathing and relaxation methods, the client can quickly master their own response to stress and teach the body and mind to rest deeply, allowing the body to heal and recover.

Pacing
The key to pacing for chronic fatigue is to stop and rest before feeling exhausted. This is tricky to get the hang of at first, so advising the client to take regular restorative rest breaks every 1-2 hours for 10-15 minutes will mean they will replenish their energy in a timely way.

Managing the mind
Learning how to cope with stress, anxiety and low mood, is an important element of fatigue management. Adopting a mindfulness approach of acceptance and self-compassion is a highly effective tool in managing energy and improving wellbeing.

Nutrition
Nourishing the body with healthy, regular meals, including breakfast, with a focus on proteins and a reduction of sugar and stimulants, will help replenish energy. Small frequent meals are preferable, as large meals take a greater amount of energy to digest.

Sleep
Good sleep hygiene includes a regular bedtime and get-up-time and taking rest breaks during the daytime. An after-lunch nap (or siesta), in my experience, is very acceptable and does, in fact, help night-time sleep if limited to 1.5 hours before 3pm.

Enjoyable activities
Carrying out and carefully pacing activities the client enjoys will help give a sense of wellbeing and regulate mood.

Building Activity levels
Only when the client is confident using rest breaks and pacing should they begin to build activity. Increasing activity levels can be carried out through daily occupation rather than exercise at this stage. It is essential to build activity very slowly, only once a week, by about 10-20%. This allows the body to slowly build its activity tolerance within the energy envelope, not pushing through into energy reserves. Deep rest breaks must continue alongside increasing activity levels.

Returning to work
A longer than usual phased return to work is advised. Slowly building work tolerance with continued rest breaks and reasonable adjustments will help reduce the risk of the exacerbation of symptoms.

If clients with Long COVID persist with symptoms of fatigue beyond 12 weeks, the GP may wish to refer them to the local ME/CFS team for diagnosis and specialist help.

To summarise the key points: - OTs have an excellent knowledge and skills base from which to treat clients with Long COVID fatigue symptoms. - An OT’s holistic approach is essential in effectively reducing energy usage and managing daily occupations, body and mind. - If Long COVID persists a diagnosis of ME/CFS may be made. - The impact of Long COVID can be lessened if the client receives prompt and timely fatigue management advice. - Pushing through or past energy limits exacerbates symptoms and hinders progress.

Finally, to successfully manage chronic fatigue it is best to resist the urge to push, fight or rush the body to health. Instead, have patience and allow the body and mind to recover in its own time. Provide it with the rest and nourishment it needs.

Further Reading

NICE Guidelines: Managing the Long-term Effects of COVID-19

NHS Guidance: Supporting Your Recovery after COVID-19

Royal College of Occupational Therapists Guidance: Quick Guide for OTs

BACME (The British Association for CFS/ME professionals) Post-Viral Fatigue

ME Association Post COVID-19 Management

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