Feasibility and effectiveness of e-therapy on fatigue management in home-based older adults with congestive heart failure
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Fatigue, one of the most severe and distressing symptoms of Congestive heart failure (CHF), is often overlooked by clinicians. Traditional fatigue management programs in community-based settings require patients to travel posing a great physical challenge for persons experiencing fatigue. The purpose of the study was to test the feasibility and effectiveness of an 18-week e-therapy program, an internet-based fatigue management program, in older adults with CHF. A quasi-experimental design using a pretest-posttest with control group design was employed. A total of 29 participants including 14 treatment group and 15 control group participants were recruited. Participants in the e-therapy group accessed the online education materials on fatigue management, and recorded activity level and their use of energy conservation strategies on a secure web-based daily log. In addition, they joined an online support group. Throughout the 18-week intervention period, the principal investigator monitored the daily logs, and led the online support group discussion. Both daily logs and the outcome measures were collected in participants' home three times over the 18-week intervention period: initially, at 12th week and at 18th week. Descriptive statistics, ANCOVA, and repeated measures ANOVA with contrast were used for data analysis. The study results showed that all e-therapy participants used at least one feature of the e-therapy program and reported satisfaction with the program. In comparison to the control group, e-therapy participants had lower Global Fatigue Index scores at 18th week, higher overall activity levels at 12th week, and better physical functioning at 12th and 18th week. After the interventions, e-therapy participants showed significant gains in knowledge of fatigue management, and diminished fatigue impact on daily activities. During the 18 week intervention, e-therapy participants remained stable with respect to fatigue symptoms, overall activity levels and qualify of life; while the control group experienced significant increases in fatigue severity and impacts, and significant decreases in activity levels, vitality, and mental health. This study suggested that the e-therapy program is feasible and is likely to be effective in reducing the impact of fatigue on daily activities, in addition to maintaining the health and quality of life of older adults with CHF.