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Jun.19.2020View related content

Energy Conservation (Rehabilitation Therapy)

ALERT

Continually assess the patient’s current cognitive and physical status, postoperative or nonoperative precautions, and ability and willingness to cooperate in energy conservation activities.

OVERVIEW

Energy conservation is a nonpharmacologic treatment approach used to manage the impact of fatigue when completing basic activities of daily living (ADL) and instrumental activities of daily living (IADL). Energy conservation strategies allow patients to use task simplification techniques to maintain their independence for completion of activities they like to do and activities they have to do.1,4

Studies have indicated that the use of energy conservation as a treatment approach is beneficial for individuals with chronic and progressive diseases.5 There is also research that indicates that energy conservation is a useful intervention technique for patients with acute injuries and patients who are aging and want to continue to maintain their independence at home.3

When using energy conservation as a treatment intervention, determining the patient's and the caregiver’s willingness to participate is important. The patient has to determine which tasks he or she will have to complete at home and in the community and which tasks, if any, a caregiver can help complete.5 Detailed task analyses then can be completed to determine the level of energy required to perform daily tasks.2,6 Energy conservation education and training is vital for patients to regain and maintain their previous level of function and independence. It also offers vital strategies to improve safety and reduce risk of injury.

SUPPLIES

Click here for a list of supplies.

EDUCATION

  • Encourage the patient to report pain and fatigue during activity.
  • Instruct the patient and caregiver on energy conservation strategies for basic ADL task completion.
  • Instruct the patient and caregiver on energy conservation strategies for IADL task completion.
  • Encourage questions and answer them as they arise.

PROCEDURE

  1. Perform hand hygiene.
  2. Introduce yourself to the patient.
  3. Verify the correct patient using two identifiers.
  4. Explain the procedure to the patient and ensure that he or she agrees to treatment.
  5. Assess the patient for pain.
  6. Assess the patient’s strength, balance, and cognition for safety.
  7. Construct a list of the patient’s daily activities.
    1. Basic ADLs (e.g., dressing, bathing, toileting)
    2. IADLs (e.g., cooking, laundry, cleaning)
    3. Leisure (e.g., reading, shopping for pleasure)
    4. Social participation (e.g., community outings)
  8. Prioritize each task from most important to least important.
    Rationale: Prioritizing tasks allows the patient to plan out his or her day by completing or eliminating important tasks first and saving for later or delegating the least important tasks for later.
  9. Gather all the necessary items to complete each task, and take note of the absence of essential equipment.
  10. Ask the patient to complete each task. While he or she does so, identify and eliminate unsafe strategies and unnecessary steps.
  11. Teach the patient and caregiver strategies to conserve energy, simplify tasks, and adapt activities as needed.
    1. Spread activities throughout the day and week.
    2. Plan and prioritize activities.
    3. Set up the work area before completing the task (e.g., lay out clothing before dressing, getting out food items before cooking).
    4. Pace the tasks. Break up tasks into manageable steps.
    5. Use pursed-lip breathing or deep breathing techniques to maintain adequate respiration and relaxation (Figure 1)Figure 1.
    6. Sit while performing tasks whenever possible.
    7. Use assistive devices (e.g., reacher, sock aide, shower chair or tub bench, handheld shower head, long-handled sponge, electric kitchen tools, rolling laundry basket, rollator) to perform tasks comfortably.
    8. Use proper body mechanics. Avoid awkward postures such as excessive bending and reaching.
    9. Modify the home to maximize efficient energy use. For example, the patient may place a chair on a landing when climbing stairs or in a long hallway for a rest break.
    10. Take breaks when needed.
  12. Teach the patient energy conservation strategies to use to complete basic ADLs.
    1. Use long-handled dressing tools (e.g., long-handled reacher, sock aide, and dressing stick) to avoid excessive bending and reaching (Figure 2)Figure 2.
    2. Wear convenient clothing (e.g., loose-fitting tops, front-closure tops, pants with snaps, elastic shoelaces).
    3. Rest before and after bathing.
    4. Use a tub bench or shower chair with a back rest when bathing and drying off. If using a towel is taxing for the patient, use a terry robe instead (Figure 3)Figure 3.
    5. Use a handheld shower head and long-handled sponge to decrease leaning and reaching while bathing.
    6. Sit at the sink when grooming (e.g., face washing, toothbrushing, shaving, applying makeup).
    7. Use an elevated toilet seat (Figure 4)Figure 4.
    8. Wear comfortable, low-heeled, nonslip shoes.
  13. Teach the patient energy conservation strategies to use to complete IADLs.
    1. Schedule housekeeping tasks such as vacuuming, mopping, dusting, and laundry throughout the week. Do not attempt to complete these tasks in one day. Delegate child care when possible.
    2. Slide large objects (e.g., large boxes or hamper) rather than lifting them. Use a rolling basket or hamper for laundry.
    3. Complete housework (e.g., ironing, folding laundry, meal preparation) sitting down when possible. Position housework on an even surface in front of the patient rather than to the side.
    4. Plan all meals ahead and assemble all ingredients and utensils before beginning to prepare a dish.
    5. Use lightweight cookware and cooking utensils. Use paper or disposable plastic products to eliminate dishwashing. Use small electric appliances, such as can openers, blenders, and food processers as necessary. Use community-based meal services (e.g., Meals on Wheels), if applicable.
    6. When grocery shopping, use a rollator or grocery cart for support (Figure 5)Figure 5. Use a motorized scooter, if available.
  14. Teach the patient energy conservation strategies to use to complete leisure and social activities.
    1. Plan activities that meet the patient’s level of energy. For example, do not plan a trip to a shopping mall if unable to tolerate extensive walking or sitting.
    2. Plan for and select appropriate transportation for community outings.
    3. Attend community outings with a caregiver or companion.
    4. Balance activity with rest.
  15. Perform hand hygiene.
  16. Document the activities and education in the patient’s record.

MONITORING

  1. Observe the patient for signs and symptoms of pain. If pain is suspected, report it to the authorized practitioner.
  2. Observe the patient for signs of overexertion. Note the number of minutes the patient is able to perform tasks, and record the patient’s vital signs including heart rate, blood pressure, respirations, and oxygen saturation.

EXPECTED OUTCOMES

  • The patient returns demonstration of energy conservation strategies and use of assistive equipment.
  • The patient completes tasks without signs and symptoms of exertion.

UNEXPECTED OUTCOMES

  • Inability to assess patient
  • Patient is unable to return demonstration of energy conservation strategies
  • Caregiver is unable to return demonstration of energy conservation strategies

DOCUMENTATION

  • Education
  • Patient and caregiver statements concerning intervention strategies
  • Patient’s progress toward goals
  • Unexpected outcomes and related interventions

OLDER ADULT CONSIDERATIONS

  • Due to age-related physiological changes, older adults may experience decreased strength and activity tolerance. Older adults may also experience decreased short-term memory and display decreased safety awareness, impacting their ability to retain and consistently demonstrate energy conservation techniques.

REFERENCES

  1. Blikman, L.J.M. and others. (2017). Effectiveness of energy conservation management on fatigue and participation in multiple sclerosis: A randomized controlled trial. Multiple Sclerosis Journal, 23(11), 1527-1541. (Level II)
  2. Blikman, L.J.M. and others. (2019). Energy conservation management for people with multiple sclerosis–related fatigue: Who benefits? American Journal of Occupational Therapy, 73(4), 7304205040p1-7304205040p9. doi:10.5014/ajot.2019.032474 (Level I)
  3. Chan, V., Xiong, C., Colantonio, A. (2015). Patients with brain tumors: Who receives postacute occupational therapy services? American Journal of Occupational Therapy, 69(2), 6902290010p1-6902290010p.6. doi:10.5014/ajot.2015.014639 (Level V)
  4. Pergolotti, M. and others. (2016). Occupational therapy for adults with cancer: Why it matters. The Oncologist, 21(3), 314-319.
  5. Siebert, C., Smallfield, S., Stark, S. (2014). Occupational therapy practice guidelines for home modifications. Bethesda, MD: AOTA Press. (classic reference)* (Level VII)
  6. Van Heest, K.N.L., Mogush, A.R., Mathiowetz, V.G. (2017). Effects of a one-to-one fatigue management course for people with chronic conditions and fatigue. American Journal of Occupational Therapy, 71(4), 7104100020p1-7104100020p9. doi:10.5014/ajot.2017.023440 (Level V)

*In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice.

Elsevier Skills Levels of Evidence

  • Level I - Systematic review of all relevant randomized controlled trials
  • Level II - At least one well-designed randomized controlled trial
  • Level III - Well-designed controlled trials without randomization
  • Level IV - Well-designed case-controlled or cohort studies
  • Level V - Descriptive or qualitative studies
  • Level VI - Single descriptive or qualitative study
  • Level VII - Authority opinion or expert committee reports