4 Ps of Energy Management for Chronic Fatigue

This handout was adapted from the OT Potential course OT and Multiple Sclerosis Treatment with Makeda Jackson, OTD, OTR/L, MSCS, a Multiple Sclerosis Certified Specialist. Patient education and coaching came up in that conversation as central to MS care, and fatigue management is one of the highest-value topics an OT can teach.

The problem behind the handout is the push-and-crash cycle. A client feels good, does too much, and spends the next day or two recovering. Putting all four strategies on one page gives that conversation a shape the client can take home. The framework isn't specific to MS. It fits anywhere fatigue is limiting participation.

Use it wherever fatigue is the barrier to daily occupations, including home health, outpatient neuro, and community-based settings. It's most useful in the middle of an episode of care, once you understand a client's daily routine well enough to help them sort what matters from what can wait.

Most clinicians work through it during a session rather than sending it home cold. It also gives caregivers concrete language, which helps when a family member is unsure whether to step in or step back.

The Prioritize box has three blank lines. Fill those in together, using a real day the client has coming up, rather than leaving them for later. A specific answer teaches the skill better than a general one.

Four strategies at once is a lot. Pick the P that matches what the client is already struggling with and start there. Position is often the easiest entry point because the changes are physical and immediate. Pace tends to be the hardest, since it asks the client to stop before they feel tired.

To introduce it, ask about a recent day that went badly. Let the client describe the crash, then use the handout to name what happened and what could be shifted. This is a teaching tool that supports your clinical reasoning, not a replacement for an individualized activity analysis.