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Sweerts L1, Hoogeboom T1, Nijhuis-van der Sanden R1
1Radboud University Medical Centre, IQ Healthcare, Nijmegen, Netherlands
Background: Q-fever is a zoonosis caused by the intracellular bacterium Coxiella burnetii. Fifty-three Q-fever epidemics worldwide have been described in the period 1981 to 2011. Between 2007 and 2011, the Netherlands was confronted with a large outbreak of Q-fever, resulting in more than 4,000 patients with acute Q-fever; making it the largest outbreak in the word. Approximately 20-30% of these patients developed the chronic Q-fever fatigue syndrome (QFS) which is characterized by severe fatigue causing significant disabilities in daily practice and reduced quality of life. The pathophysiology of QFS remains to be elucidated, which hampers treatment based on etiology. Because of the similarities between QFS and chronic fatigue syndrome, a physical therapy intervention is offered to improve physical activity and reduce fatigue severity, since this intervention is found effective in patients with chronic fatigue syndrome.
Purpose: The primary objective of this study was to assess the efficacy of physical therapy in reducing fatigue severity and improve physical activity in patients with QFS. The secondary objective was to determine whether individualized physical therapy is superior to group-based physical therapy.
Methods: Fifteen patients with QFS (nine patients) or persistent experienced fatigue after acute Q-fever (six patients) were included in this randomized non-concurrent multiple-baseline single-case study design. Seven patients were randomized to a group intervention focusing on cardio and strength exercises in a physical therapy practice, with a duration of thirteen weeks. Eight patients were randomized to an individualized physical therapy intervention tailored to the patients' individual needs and level of physical fitness. The duration of this intervention varied, but the maximum duration was thirteen weeks. Primary outcomes were physical activity, determined daily with an activity tracker (Fitbit zip), and fatigue severity, determined by an online survey in which patients fulfilled a VAS score about experienced fatigue, three times per week. In this online survey also VAS scores about self-management, illness perception, coping and the Patient Specific Complaints are determined. Before and after thirteen, weeks fatigue severity was also determined with the Multidimensional Fatigue Inventory.
Results: Four males and eleven women participated (mean age 51, range: 25 and 68 years). Visual inspection of the repeated measures data, by celeration lines and 2-SD band method, and randomization testing according Tyrell et al. 2013 demonstrated no effects for physical activity (p=0.131) and fatigue severity (p=0.337) between baseline phase and intervention phase. Likewise, other repeated measures and before and after analysis showed no effect of both interventions on used parameters. Some individuals showed small improvement in experienced fatigue and physical activity and other participants could maintain their functioning.
Conclusion(s): No effect was found for both physical therapy interventions in improving physical activity and reducing fatigue severity. However, for some individuals physical activity levels were quite high in advance.
Implications: Given the various complaints and individual differences in levels of physical activity and fatigue severity of patients with Q-fever, we advise a multidisciplinary problem analysis to determine which disciplines could be beneficial for each individual patient.
Keywords: Q-fever, physical activity, fatigue
Funding acknowledgements: This study was funded by foundation Q-support (grant number UMCN160627-00).
Purpose: The primary objective of this study was to assess the efficacy of physical therapy in reducing fatigue severity and improve physical activity in patients with QFS. The secondary objective was to determine whether individualized physical therapy is superior to group-based physical therapy.
Methods: Fifteen patients with QFS (nine patients) or persistent experienced fatigue after acute Q-fever (six patients) were included in this randomized non-concurrent multiple-baseline single-case study design. Seven patients were randomized to a group intervention focusing on cardio and strength exercises in a physical therapy practice, with a duration of thirteen weeks. Eight patients were randomized to an individualized physical therapy intervention tailored to the patients' individual needs and level of physical fitness. The duration of this intervention varied, but the maximum duration was thirteen weeks. Primary outcomes were physical activity, determined daily with an activity tracker (Fitbit zip), and fatigue severity, determined by an online survey in which patients fulfilled a VAS score about experienced fatigue, three times per week. In this online survey also VAS scores about self-management, illness perception, coping and the Patient Specific Complaints are determined. Before and after thirteen, weeks fatigue severity was also determined with the Multidimensional Fatigue Inventory.
Results: Four males and eleven women participated (mean age 51, range: 25 and 68 years). Visual inspection of the repeated measures data, by celeration lines and 2-SD band method, and randomization testing according Tyrell et al. 2013 demonstrated no effects for physical activity (p=0.131) and fatigue severity (p=0.337) between baseline phase and intervention phase. Likewise, other repeated measures and before and after analysis showed no effect of both interventions on used parameters. Some individuals showed small improvement in experienced fatigue and physical activity and other participants could maintain their functioning.
Conclusion(s): No effect was found for both physical therapy interventions in improving physical activity and reducing fatigue severity. However, for some individuals physical activity levels were quite high in advance.
Implications: Given the various complaints and individual differences in levels of physical activity and fatigue severity of patients with Q-fever, we advise a multidisciplinary problem analysis to determine which disciplines could be beneficial for each individual patient.
Keywords: Q-fever, physical activity, fatigue
Funding acknowledgements: This study was funded by foundation Q-support (grant number UMCN160627-00).
Topic: Disability & rehabilitation; Health promotion & wellbeing/healthy ageing
Ethics approval required: No
Institution: Radboudumc
Ethics committee: CMO-light Radboudumc
Reason not required: The CMO-light Radboudumc judged that the study participants are not subjected to actions or are not imposed to specific behavior, that the study must be regarded under the remit of the Medical Research Involving Human Subjects Act.
All authors, affiliations and abstracts have been published as submitted.
