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Self-management of fatigue in rheumatoid arthritis: a randomised controlled trial of group cognitive-behavioural therapy

Hewlett, S, Ambler, N, Almeida, C, Cliss, A, Hammond, A, Kitchen, K, Knops, B, Pope, D, Spears, M, Swinkels, A and Pollock, J 2011, 'Self-management of fatigue in rheumatoid arthritis: a randomised controlled trial of group cognitive-behavioural therapy' , Annals of the Rheumatic Diseases, 70 (6) , pp. 1060-1067.

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    Abstract

    Objectives To investigate the effect of group cognitive behavioural therapy (CBT) for fatigue self-management, compared with groups receiving fatigue information alone, on fatigue impact among people with rheumatoid arthritis (RA). Methods Two-arm, parallel randomised controlled trial in adults with RA, fatigue ≥6/10 (Visual Analogue Scale (VAS) 0–10, high bad) and no recent change in RA medication. Group CBT for fatigue self-management comprised six (weekly) 2 h sessions, and consolidation session (week 14). Control participants received fatigue self-management information in a 1 h didactic group session. Primary outcome at 18 weeks was the impact of fatigue measured using two methods (Multi-dimensional Assessment of Fatigue (MAF) 0–50; VAS 0–10), analysed using intention-to-treat analysis of covariance with multivariable regression models. Results Of 168 participants randomised, 41 withdrew before entry and 127 participated. There were no major baseline differences between the 65 CBT and 62 control participants. At 18 weeks CBT participants reported better scores than control participants for fatigue impact: MAF 28.99 versus 23.99 (adjusted difference −5.48, 95% CI −9.50 to −1.46, p=0.008); VAS 5.99 versus 4.26 (adjusted difference −1.95, 95% CI −2.99 to −0.90, p<0.001). Standardised effect sizes for fatigue impact were MAF 0.59 (95% CI 0.15 to 1.03) and VAS 0.77 (95% CI 0.33 to 1.21), both in favour of CBT. Secondary outcomes of perceived fatigue severity, coping, disability, depression, helplessness, self-effi cacy and sleep were also better in CBT participants. Conclusions Group CBT for fatigue self-management in RA improves fatigue impact, coping and perceived severity, and well-being

    Item Type: Article
    Themes: Health and Wellbeing
    Schools: Colleges and Schools > College of Health & Social Care
    Colleges and Schools > College of Health & Social Care > School of Health Sciences > Centre for Health Sciences Research
    Colleges and Schools > College of Health & Social Care > School of Health Sciences
    Journal or Publication Title: Annals of the Rheumatic Diseases
    Publisher: BMJ Publishing Group
    Refereed: Yes
    ISSN: 0003-4967
    Depositing User: RH Shuttleworth
    Date Deposited: 14 May 2012 10:54
    Last Modified: 20 Aug 2013 18:27
    URI: http://usir.salford.ac.uk/id/eprint/22688

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