Case study: Virtual fatigue management group

Provided by Anneka Morrish, Occupational Therapist, Neurological Rehabilitation, Cornwall Partnership NHS Foundation Trust


This is a fatigue management programme over 6 weekly session for patients with a diagnosis of stroke or neurological disorder. We originally planned to run the group face-to-face, but due to the pandemic we were unable to do this so planned to start it virtually. The format of the group is on Microsoft Teams as this was recommended by the Trust and we were unable to use our Attend Anywhere platform for group therapy. We needed to adapt resources to enable us to use them virtually and ensure patients had the required technology available.



  • To run a 6 week virtual fatigue management programme for patients with stroke or neurological diagnosis;
  • To compare pre and post group outcomes measures including the Modified Fatigue Impact Scale (MFIS) and the Fatigue Severity Scale (FSS);
  • To determine if this is a feasible method of delivery for fatigue management and whether it improves timely discharge from the service.


  • It will be feasible to run a fatigue management programme virtually using Microsoft Teams and embed it into future practice;
  • We predict that we will be able to discharge 90% of patients who attend the course within 1 month post completion;
  • Patients’ fatigue will be reduced and they will improve their skills in self-management of fatigue.



Suitable patient target group:

  • People with a diagnosis of a stroke or neurological condition in which fatigue is a limiting factor to engagement in occupation;
  • Considered able to cope with and willing to engage in a 6 week programme and participate in homework based exercises;
  • Able to travel and attend group setting with or without carer OR able to participate in video consultations or virtual group;
  • Proficient English;
  • Able to read PowerPoint display.

Exclusion criteria:

  • Those with cognitive and language difficulties that would be unable to engage in the group setting, using resources or would be disruptive in the group situation (in this situation consider if use of resources on a 1:1 basis is appropriate);
  • People with visual impairments where resources cannot be adapted to suit needs.


A 6 week fatigue management programme completed virtually. The content is as follows:

Session 1: Introduction and what is fatigue

  • Aims and objectives of programme
  • General introduction & types of fatigue
  • Information gathering including outcome measures
  • Action before next session: Issuing fatigue diaries and energy measure

Session 2: Your energy levels

  • Review of activity diaries and identification or fatigue triggers
  • Introduction to fatigue management toolbox
  • Sleep, sleep questionnaire and sleep hygiene
  • Relaxation
  • Prioritisation
  • Homework: prioritisation and relaxation practice

Session 3: Managing energy levels

  • Review of prioritisation worksheet and relaxation
  • Understanding energy levels
  • Energy conservation strategies: prioritisation/organisation/pacing
  • Rest
  • Homework: sleep/activity/rest planner

Session 4: Lifestyle management

  • Review of sleep/activity/rest planner
  • Ergonomic principles and posture
  • Adapting Activities of Daily Living to conserve energy
  • Exercise
  • Diet and nutrition
  • Local resources
  • Goal setting
  • Homework: goal setting worksheet

Session 5: Psychological impact of fatigue

  • Review goal setting worksheet
  • Stress
  • Thinking styles
  • Challenging unhelpful thoughts
  • Homework: thought record sheet

Session 6: Action planning and long-term self-management

  • Summary
  • Recap of sessions
  • Review goals
  • Create action plan
  • Repeat outcome measures and feedback questionnaires


Two staff members run the virtual group, with a maximum of five patients. Duration of each session is 60-90 minutes with a screen break in the middle. Patients were sent a link to the session in advance, taking care not to share e-mail addresses to protect confidentiality.


Microsoft Teams


Weekly sessions. Aim to run this run this programme regularly in the future.

Data Collection

Complete outcome measures via a virtual call 1 week prior to programme and 1 week post.

  • MFIS
  • FSS


Currently running the group therefore outcome results not gained yet. Had run the programme on a 1:1 basis and a pilot group with a small number. Patients gave very positive feedback.

Observed benefits of virtual compared with face-to-face:

  • Reduced travel time- Particularly vital for Cornwall as we could include people from across the county in one session rather than people being excluded if we could only find a venue far away. Reduced travel is particularly important for people with fatigue.
  • Some patients felt more able to share experiences virtually as they could choose to keep the camera off or write in the chat box.
  • Patients report they are less likely to miss sessions due to reduced time commitments.

The structure and workbook we used helped people to reflect on their progress between sessions. They may have been more likely to complete the activities set and refocus on the fatigue issues they needed to address.

The peer support element was vital - people really like this side of it and said it was good to hear other people that do understand as often friends/family/employers don’t. People were more likely to take on board the strategies if their peers reported trying it and finding it useful.

Carer involvement - one patient had carer support to help him to access the group virtually. His carer found it extremely useful as she didn’t understand tiredness vs fatigue and often got frustrated that he wasn’t pushing himself. It helped her to hear other patients explain what fatigue is.