Reducing arthritis fatigue impact : two-year randomised controlled trial of cognitive behavioural approaches by rheumatology teams (RAFT)

Hewlett, S, Almeida, C, Ambler, N, Blair, PS, Choy, EH, Dures, E, Hammond, A ORCID: https://orcid.org/0000-0002-5266-9991, Hollingworth, W, Kadir, B, Kirwan, JR, Plummer, Z, Rooke, C, Thorn, J, Turner, N and Pollock, J 2019, 'Reducing arthritis fatigue impact : two-year randomised controlled trial of cognitive behavioural approaches by rheumatology teams (RAFT)' , Annals of the Rheumatic Diseases, 78 (4) , pp. 465-472.

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Abstract

Objectives: To see if a group course delivered by rheumatology teams using cognitive-behavioural approaches, plus usual care, reduced RA fatigue impact more than usual care alone.

Methods: Multicentre, 2-year randomised controlled trial in RA adults (fatigue severity≥6/10, no recent major medication changes). RAFT (Reducing Arthritis Fatigue: clinical Teams using CB approaches) comprises seven sessions, codelivered by pairs of trained rheumatology occupational therapists/nurses. Usual care was Arthritis Research UK fatigue booklet. Primary 26-week outcome fatigue impact (Bristol RA Fatigue Effect Numerical Rating Scale, BRAF-NRS 0–10). Intention-to-treat regression analysis adjusted for baseline scores and centre.

Results: 308/333 randomised patients completed 26 week data (156/175 RAFT, 152/158 Control). Mean baseline variables were similar. At 26 weeks, the adjusted difference between arms for fatigue impact change favoured RAFT (BRAF-NRS Effect −0.59, 95% CI –1.11 to -0.06), BRAF Multidimensional Questionnaire (MDQ) Total −3.42 (95% CI –6.44 to -0.39), Living with Fatigue −1.19 (95% CI –2.17 to -0.21), Emotional Fatigue −0.91 (95% CI –1.58 to -0.23); RA Self-Efficacy (RASE, +3.05, 95% CI 0.43 to 5.66) (14 secondary outcomes unchanged). Effects persisted at 2 years: BRAF-NRS Effect −0.49 (95% CI −0.83 to -0.14), BRAF MDQ Total −2.98 (95% CI −5.39 to -0.57), Living with Fatigue −0.93 (95% CI −1.75 to -0.10), Emotional Fatigue −0.90 (95% CI −1.44, to -0.37); BRAF-NRS Coping +0.42 (95% CI 0.08 to 0.77) (relevance of fatigue impact improvement uncertain). RAFT satisfaction: 89% scored > 8/10 vs 54% controls rating usual care booklet (p<0.0001).

Conclusion: Multiple RA fatigue impacts can be improved for 2 years by rheumatology teams delivering a group programme using cognitive behavioural approaches.

Trial registration number ISRCTN52709998.

Item Type: Article
Uncontrolled Keywords: cognitive behavioural therapy, fatigue, randomised controlled trial, rheumatoid arthritis
Schools: Schools > School of Health and Society
Journal or Publication Title: Annals of the Rheumatic Diseases
Publisher: BMJ Publishing Group
ISSN: 1468-2060
Related URLs:
Funders: National Institutes for Health
SWORD Depositor: Publications Router
Depositing User: Publications Router
Date Deposited: 13 Mar 2019 11:24
Last Modified: 13 Mar 2019 11:30
URI: http://usir.salford.ac.uk/id/eprint/50384

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