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Brief intervention to reduce fatigue impact in patients with inflammatory arthritis: design and outcomes of a single-arm feasibility study

Brief intervention to reduce fatigue impact in patients with inflammatory arthritis: design and outcomes of a single-arm feasibility study
Brief intervention to reduce fatigue impact in patients with inflammatory arthritis: design and outcomes of a single-arm feasibility study
Objectives Patients with inflammatory arthritis report that fatigue is challenging to manage. We developed a manualised, one-to-one, cognitive–behavioural intervention, delivered by rheumatology health professionals (RHPs). The Fatigue - Reducing its Effects through individualised support Episodes in Inflammatory Arthritis (FREE-IA) study tested the feasibility of RHP training, intervention delivery and outcome collection ahead of a potential trial of clinical and cost-effectiveness.

Methods In this single-arm feasibility study, eligible patients were ≥18 years, had a clinician-confirmed diagnosis of an inflammatory arthritis and scored ≥6/10 on the Bristol Rheumatoid Arthritis Fatigue (BRAF) Numerical Rating Scale (NRS) Fatigue Effect. Following training, RHPs delivered two to four sessions to participants. Baseline data were collected before the first session (T0) and outcomes at 6 weeks (T1) and 6 months (T2). The proposed primary outcome was fatigue impact (BRAF NRS Fatigue Effect). Secondary outcomes included fatigue severity and coping, disease impact and disability, and measures of therapeutic mechanism (self-efficacy and confidence to manage health).

Results Eight RHPs at five hospitals delivered 113 sessions to 46 participants. Of a potential 138 primary and secondary outcome responses at T0, T1 and T2, there were 13 (9.4%) and 27 (19.6%) missing primary and secondary outcome responses, respectively. Results indicated improvements in all measures except disability, at either T1 or T2, or both.

Conclusions This study showed it was feasible to deliver the intervention, including training RHPs, and recruit and follow-up participants with high retention. While there was no control group, observed within-group improvements suggest potential promise of the intervention and support for a definitive trial to test effectiveness.
medical education & training, rehabilitation medicine, rheumatology
2044-6055
Dures, Emma
feaebb8b-77b9-4041-9a16-15d312c5696b
Bridgewater, Susan
ce8959e2-2ea8-4619-886e-af40b28a34b0
Abbott, Bryan
86df665f-5e78-4be8-a50f-bc567ceffe3d
Adams, Joanna
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Berry, Alice
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McCracken, Lance M.
74d60243-8025-4ac5-8c7b-b93bf8a87089
Creanor, Siobhan
5bc098ef-79f6-4523-8779-8181c3e099d4
Hewlett, Sarah
44c26c22-2f49-46ed-8206-4a761c9e4ecd
Lomax, Joe
a1e01f7f-5f46-48b5-b84b-740c5d14556f
Ndosi, Mwidimi
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Thorn, Joanna
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Urban, Marie
40c42814-1f6c-420c-8b27-9a908cec9605
Ewings, Paul David
252059ba-2e1e-40ec-9337-0707e8dfa0a2
Dures, Emma
feaebb8b-77b9-4041-9a16-15d312c5696b
Bridgewater, Susan
ce8959e2-2ea8-4619-886e-af40b28a34b0
Abbott, Bryan
86df665f-5e78-4be8-a50f-bc567ceffe3d
Adams, Joanna
6e38b8bb-9467-4585-86e4-14062b02bcba
Berry, Alice
9a9bff4d-ac8b-43a4-954b-c9891f92a1fd
McCracken, Lance M.
74d60243-8025-4ac5-8c7b-b93bf8a87089
Creanor, Siobhan
5bc098ef-79f6-4523-8779-8181c3e099d4
Hewlett, Sarah
44c26c22-2f49-46ed-8206-4a761c9e4ecd
Lomax, Joe
a1e01f7f-5f46-48b5-b84b-740c5d14556f
Ndosi, Mwidimi
3e15efa8-8da5-4032-a267-3b26c7c7b1da
Thorn, Joanna
e77f89d2-ec9f-439f-ad5e-237e10cb613c
Urban, Marie
40c42814-1f6c-420c-8b27-9a908cec9605
Ewings, Paul David
252059ba-2e1e-40ec-9337-0707e8dfa0a2

Dures, Emma, Bridgewater, Susan, Abbott, Bryan, Adams, Joanna, Berry, Alice, McCracken, Lance M., Creanor, Siobhan, Hewlett, Sarah, Lomax, Joe, Ndosi, Mwidimi, Thorn, Joanna, Urban, Marie and Ewings, Paul David (2022) Brief intervention to reduce fatigue impact in patients with inflammatory arthritis: design and outcomes of a single-arm feasibility study. BMJ Open, 12 (7), [e054627]. (doi:10.1136/bmjopen-2021-054627).

Record type: Article

Abstract

Objectives Patients with inflammatory arthritis report that fatigue is challenging to manage. We developed a manualised, one-to-one, cognitive–behavioural intervention, delivered by rheumatology health professionals (RHPs). The Fatigue - Reducing its Effects through individualised support Episodes in Inflammatory Arthritis (FREE-IA) study tested the feasibility of RHP training, intervention delivery and outcome collection ahead of a potential trial of clinical and cost-effectiveness.

Methods In this single-arm feasibility study, eligible patients were ≥18 years, had a clinician-confirmed diagnosis of an inflammatory arthritis and scored ≥6/10 on the Bristol Rheumatoid Arthritis Fatigue (BRAF) Numerical Rating Scale (NRS) Fatigue Effect. Following training, RHPs delivered two to four sessions to participants. Baseline data were collected before the first session (T0) and outcomes at 6 weeks (T1) and 6 months (T2). The proposed primary outcome was fatigue impact (BRAF NRS Fatigue Effect). Secondary outcomes included fatigue severity and coping, disease impact and disability, and measures of therapeutic mechanism (self-efficacy and confidence to manage health).

Results Eight RHPs at five hospitals delivered 113 sessions to 46 participants. Of a potential 138 primary and secondary outcome responses at T0, T1 and T2, there were 13 (9.4%) and 27 (19.6%) missing primary and secondary outcome responses, respectively. Results indicated improvements in all measures except disability, at either T1 or T2, or both.

Conclusions This study showed it was feasible to deliver the intervention, including training RHPs, and recruit and follow-up participants with high retention. While there was no control group, observed within-group improvements suggest potential promise of the intervention and support for a definitive trial to test effectiveness.

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Accepted/In Press date: 30 June 2022
e-pub ahead of print date: 18 July 2022
Additional Information: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.
Keywords: medical education & training, rehabilitation medicine, rheumatology

Identifiers

Local EPrints ID: 470354
URI: http://eprints.soton.ac.uk/id/eprint/470354
ISSN: 2044-6055
PURE UUID: bffad17b-28ad-4872-b242-e2db55ca0697
ORCID for Joanna Adams: ORCID iD orcid.org/0000-0003-1765-7060

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Date deposited: 06 Oct 2022 17:12
Last modified: 09 Nov 2022 02:34

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Contributors

Author: Emma Dures
Author: Susan Bridgewater
Author: Bryan Abbott
Author: Joanna Adams ORCID iD
Author: Alice Berry
Author: Lance M. McCracken
Author: Siobhan Creanor
Author: Sarah Hewlett
Author: Joe Lomax
Author: Mwidimi Ndosi
Author: Joanna Thorn
Author: Marie Urban
Author: Paul David Ewings

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