Occupational Therapy — Advice Letter on Energy Conservation for a Patient with Multiple Sclerosis
An occupational therapist writes an advice letter to a 39-year-old woman with relapsing-remitting multiple sclerosis on energy conservation strategies for managing daily fatigue. This intermediate case requires translating the four key energy conservation principles into practical daily strategies.
Letter type
Advice
Write to
Patient
Target length
190–210 words
The case notes
Patient: Ms Diana Abara, 39 years old; relapsing-remitting MS; significant fatigue — Fatigue Severity Scale score 52/63 at last assessment; works part-time as an administrator
Energy conservation principles taught: (1) Planning — write a daily plan; spread demanding tasks across the week rather than clustering on one day; schedule rest periods before reaching fatigue, not after; (2) Prioritising — list tasks by importance; 'must do today', 'can wait', 'can delegate'; (3) Pacing — use a timer (20 minutes work, 10 minutes rest) for sustained tasks; alternate heavy and light tasks; (4) Positioning — sit for tasks usually done standing (ironing, food preparation); use arm rests; reduce unnecessary trips
Heat management: Heat worsens MS fatigue (Uhthoff's phenomenon); shower with cool water; avoid hot baths; work in a cool room; carry a small cooling towel when outdoors; plan demanding activities for the cooler part of the day
Work: Employer has agreed to flexible start time (10:00 rather than 09:00) and a 20-minute rest break mid-morning; provided written guidance for occupational health
Sleep: Fatigue is exacerbated by poor sleep — advised sleep hygiene review with GP if sleep remains disrupted; daytime naps: max 20 minutes before 15:00 to avoid disrupting night sleep
Task: Write an advice letter to Ms Abara explaining the four energy conservation principles and the heat management strategy.
Writing task
Write an advice letter to Ms Abara explaining the four energy conservation principles and the heat management strategy.
What to include, what to cut
The hardest mark to win is selection. The same case notes contain decision-relevant facts and distractors. Here is what an examiner expects to see in a Grade B letter for this scenario, and what should be left out.
Include
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The four principles with their key practical application: planning (spread tasks), prioritising (must/can-wait/can-delegate), pacing (20-on/10-off timer), positioning (sit for tasks usually done standing)
These are the specific strategies — they must each have a practical application in the letter. A principle named without its application is not usable by the patient at home.
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Heat management: cool shower, avoid hot baths, cool working environment, plan demanding tasks in the cool part of the day
Uhthoff's phenomenon is a major and specific fatigue exacerbator in MS. Unlike generic fatigue advice, heat management is disease-specific and high-impact. The patient may not have been told about this by their neurologist.
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Schedule rest BEFORE reaching fatigue — not when already fatigued
This is the most important and most counter-intuitive principle of energy conservation in MS. Most people rest reactively (when exhausted). Pre-emptive rest prevents the fatigue crash and is the principle that most reduces the functional impact of MS fatigue.
Leave out
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The FSS score and the clinical fatigue assessment detail
The patient does not need their clinical score in the advice letter. 'You mentioned that fatigue has a significant impact on your daily life' is the right opening. The score is for the clinical record.
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The sleep hygiene advice beyond the nap instruction
Sleep hygiene is a separate consultation and GP matter. One sentence — 'if your sleep is disturbed, please discuss with your GP, as poor sleep worsens fatigue' — is the appropriate delegation.
Criterion in focus · Organisation & Layout
An energy conservation letter with four principles requires a structure that makes the principles navigable. Writing all four in a continuous paragraph makes them indistinguishable. The proficient approach uses a short numbered or labelled structure: 'Planning: ... Prioritising: ... Pacing: ... Positioning: ...' The patient needs to be able to refer back to a specific principle — they are not reading this once for pleasure.
Now write the letter — and find out what is blocking your Grade B
Write a 190–210 words advice letter from these notes, paste it into the free checker for an instant read, then submit it for a human grade against all six criteria. Dr Mariam's team returns line-by-line feedback, from $12.