Q&A WITH DR. THOMAS HARRELL
Dr. Thomas Harrell, director of the Fatigue Management Institute at Florida Tech, has developed community-based programs for chronic fatigue management .
CENTRAL FLORIDA, USA – Chronic fatigue is one of the least understood afflictions Americans face every day, but a new research and treatment program at Florida Tech University in Melbourne may offer hope for those who are suffering from the illness.
Dr. Thomas Harrell, director of the Fatigue Management Institute at Florida Tech, has developed community-based programs for chronic fatigue management .
Dr. Thomas Harrell, director of the Fatigue Management Institute at Florida Tech, has developed community-based programs for fatigue management for those with rheumatoid arthritis and for cancer survivors.
It is a research-based intervention that has been demonstrated to reduce fatigue levels and the impact of fatigue on daily living, as well as increasing the belief among participants that they can manage their fatigue. Chronic illness-related fatigue can be debilitating and may continue for weeks at a time, he said.
Harrell’s brief self-management program not only reduces fatigue levels, but also teaches self-management strategies to patients coping with severe illness and improves their ability to function more effectively on a day-to-day basis.
Using a four-hour program conducted over three weekly sessions, Harrell and his graduate students have created a community-based program with research findings that have been presented at two national professional meetings.
They also conducted an online national survey of fatigue in individuals with chronic medical conditions and it was the first large-scale examination of fatigue across a range of chronic illnesses with more than 1,500 participants.
“We are just beginning to analyze the data obtained from the survey, but we hope to establish a picture of the primary parameters of fatigue in chronic illness, its impact on areas of daily life, and the effectiveness of medical, psychological, and patient-generated interventions in reducing and then managing fatigue,” Harrell said.
We are delighted to welcome Dr. Harrell to address questions related to this misunderstood condition, which is a threat to the health, happiness and productivity of many.
CENTRAL FLORIDA MEDICINE: How did you become interested in the subject of fatigue?
DR. HARRELL: I began research in this area because of my general interest in the impact of chronic illness on functional ability and quality of life. Individuals with widely differing responses to health-related limitations have always fascinated me. I focused on fatigue because it is such a prominent symptom across so many chronic medical conditions and because of my belief that individuals could learn better strategies for managing their fatigue if they were made aware of what works and what doesn’t. We have studied the effectiveness of our program and our findings indicate participation results in decreased fatigue and depression six months after the program is completed.
CENTRAL FLORIDA MEDICINE: How big is this problem?
DR. HARRELL: More than 12 percent of working-age adults in America have a chronic illness that impairs their ability to function. The percentage is much greater among older adults with more than 32 percent experiencing functional impairment associated with chronic illness. Of these individuals, how many who experience disabling fatigue is unknown. Studies of fatigue in individuals with rheumatoid arthritis suggest that 42 to 80 percent are living with a degree of fatigue that significantly reduces their quality of life. A study of breast cancer survivors also found that 67 percent of patients reported high levels of fatigue six months after treatment. Considering the extensive effects of fatigue across chronic illnesses, fatigue should be viewed as an important concern for all health care professionals involved in the development, planning and implementation of individualized treatment interventions for individuals with chronic medical conditions.
DR. HARRELL: Normal fatigue is predictable following periods of increased physical activity, exercise, or prolonged periods of normal activity without sleep and is responsive to adequate sleep. Normal fatigue can typically be avoided or controlled by reducing exertion and/or increasing sleep. Chronic illness related fatigue is typically unearned or not preceded by increased activity or exertion or decreased sleep. It is unpredictable in onset, duration, and severity. It is recurrent and does not decline following rest. It significantly interferes with daily life activities and is perceived as unavoidable and uncontrollable. Chronic illness-related fatigue also is more likely to be debilitating in severity and may continue for weeks at a time.
CENTRAL FLORIDA MEDICINE:What are some common errors individuals make in dealing with fatigue?
DR. HARRELL: The most common errors include avoiding making future plans. It does not reduce fatigue levels and leaves the individual with nothing to look forward to, which increases depressive feelings. They also spend more time in bed or take long naps, which also does not reduce fatigue because fatigue related to chronic illnesses is not alleviated by additional sleep or rest and which often makes individuals feel unproductive and think they will be viewed by others as lazy. People also limit pleasurable and valued activities due to fatigue, which again does not reduce fatigue, but does increase depressive feelings because the individual is reducing their life to what they have to do.
CENTRAL FLORIDA MEDICINE: What is the biggest obstacle for medical professionals to overcome when treating fatigue?
DR. HARRELL: Chronic illness-related fatigue is a difficult symptom for medical professionals to address due the need to rule out other medical conditions that could be the basis of, or contributing to, the patient’s fatigue, as well as the limited medication options available for treating fatigue in chronic illness. Extended patient education programs such as ours are often difficult to implement within medical practices, although this is beginning to change. I believe it’s important for medical professionals not to be discouraged by patient reports of fatigue, because research indicates fatigue can be managed in ways that reduce its impact on patient quality of life even when it can’t be eliminated.
CENTRAL FLORIDA MEDICINE: Are there any new treatments for those suffering from fatigue coming in the near future?
DR. HARRELL:Promising treatments include the continuing effort to develop medications that specifically address fatigue and the emerging research findings indicating that fatigue management training is effective in reducing fatigue and decreasing depression. The challenge with regard to patient education and fatigue management training is making it available within existing healthcare systems.
CENTRAL FLORIDA MEDICINE: Why hasn’t anyone studied this subject before and what do you feel will be the lasting result of this project?
DR. HARRELL: Self-management training has been widely investigated with regard to its effectiveness in helping individuals with disorders such as Type II diabetes comply with medical recommendations. I have simply focused this approach to patient education and training on the management of fatigue. One reason there has been limited research in this specific area is that the focus of research funding has been on developing treatments for illness, rather than the consequences of medical conditions that at present cannot be cured. This focus is just beginning to change, because more adults are aging with one or more chronic diseases. Our program is quite unique and is available in very few settings across the country. My team and I sincerely hope more individuals will take advantage of the program.
For information about Florida Tech’s Fatigue Management Institute or to participate in a fatigue program, call 321-674-8104 or email tharrell@fit.edu.
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