Energy Conservation (Rehabilitation Therapy)

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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.^{undefined#ref4">4}

Studies have indicated that the use of energy conservation as a treatment approach is beneficial for individuals with chronic and progressive diseases.³ 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.¹

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 the patient will have to complete at home and in the community and which tasks, if any, a caregiver can help complete.³ Detailed task analyses then can be completed to determine the level of energy required to perform daily tasks.² Energy conservation education and training are vital for patients to regain and maintain their previous level of function and independence. Energy conservation education and training also offer vital strategies to improve safety and reduce risk of injury.

SUPPLIES

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EDUCATION

• Give developmentally and culturally appropriate education based on the desire for knowledge, readiness to learn, preferred learning style, and overall neurologic and psychosocial state.
• Encourage the patient to report pain and fatigue during activity.
• Teach the patient and caregiver about energy conservation strategies for basic ADL task completion.
• Teach the patient and caregiver about energy conservation strategies for IADL task completion.
• Encourage questions and answer them as they arise.

PROCEDURE

1. Clean hands and don appropriate personal protective equipment (PPE) based on the risk of exposure to bodily fluids or infection precautions.
2. Explain the procedure and be sure that the patient agrees to treatment.
3. Assess the patient for pain.
4. Assess the patient’s strength, balance, and cognition for safety.
5. 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)
6. Prioritize each task from most important to least important.

   Rationale: Prioritizing tasks allows the patient to plan out the day by completing or eliminating important tasks first and saving or delegating the least important tasks for later.

7. Gather all the necessary items to complete each task, and take note of the absence of essential equipment.
8. Ask the patient to complete each task. While the patient does so, identify and eliminate unsafe strategies and unnecessary steps.
9. 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, get 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).
   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.
10. 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).
    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).
    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).
    8. Wear comfortable, low-heeled, nonslip shoes.
11. 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 childcare 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). Use a motorized scooter, if available.
12. 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.

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

• Therapist is unable 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. Engels, C. and others. (2021). Leisure and productivity in older adults with cancer: A systematic review. Occupational Therapy International, 2021, Art. No.: 8886193. doi:10.1155/2021/8886193
2. Omura K.M. and others. (2022). Energy conservation, minimum steps, and adaptations when needed: A scoping review. Hong Kong Journal of Occupational Therapy, 35(2), 125-136. doi:10.1177/15691861221137223
3. Siebert, C., Smallfield, S., Stark, S. (2014). Occupational therapy practice guidelines for home modifications. Bethesda, MD: AOTA Press.
4. Wingårdh, A.S.L. and others. (2020). Effectiveness of energy conservation techniques in patients with COPD. Respiration, 99(5), 409-416. doi:10.1159/000506816

Clinical Review: Meghan Jackson, OTR/L

Published: October 2024