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OP0139-HPR Reducing arthritis fatigue - clinical teams (RAFT) using cognitive-behavioural approaches: an rct
  1. S Hewlett1,
  2. N Ambler2,
  3. C Almeida1,
  4. P Blair3,
  5. E Choy4,
  6. E Dures1,
  7. W Hollingworth3,
  8. B Kadir3,
  9. J Kirwan3,
  10. Z Plummer1,
  11. C Rooke5,
  12. J Thorn3,
  13. J Pollock1,
  14. on behalf of RAFT Study Group
  1. 1University of the West of England, Bristol
  2. 2Southmead Hospital
  3. 3University of Bristol, Bristol
  4. 4University of Cardiff, Cardiff
  5. 5Bristol Royal Infirmary, Bristol, United Kingdom

Abstract

Background RA fatigue is common. Group Cognitive Behavioural Therapy by CBT therapists is effective1 but few rheumatology teams have psychologists, thus we trained rheumatology teams to deliver RAFT, a cognitive behavioural approach (CBA).

Objectives To test if usual care plus a group CBA course for RA fatigue delivered by rheumatology teams reduces fatigue impact more than usual care alone, in a randomised controlled trial.

Methods A pair of rheumatology nurses/OTs in each of 7 UK hospitals were trained in RAFT. RAFT is 6, weekly 2hr group sessions and a consolidation session (wk 14). Links between thoughts, feelings and behaviours (pacing, communication, sleep, stress) are addressed, with daily diaries of energy expenditure and weekly goal-setting. Usual care was a 5min discussion of the Arthritis Research UK fatigue booklet. Entry criteria were RA, Bristol RA Fatigue (BRAF-NRS) severity ≥6/10 and no recent major medication change. Primary outcome was fatigue impact (BRAF-NRS impact, 0–10) at 26 wks; plus wider aspects of fatigue (BRAF-Multi-Dimensional Questionnaire), pain, disability, sleep, quality of life, mood, self-efficacy, patient global opinion, valued life activities & disease activity. Intention-to-treat regression analysis involved adjustment for baseline scores and centre.

Results 308/333 randomized patients completed 26 wks. The 25 who withdrew had similar (10yr) disease duration but were older (69 vs 62.4 yrs). Baseline fatigue impact was similar for RAFT (n=156, BRAF-NRS 7.10, SD 1.7) and controls (n=152, 7.23, SD 1.6), as were all clinical variables. At 26 wks the RAFT arm had significantly less fatigue impact than controls (BRAF-NRS 5.74, SD 2.4 vs 6.36, SD 2.4). Mean BRAF-NRS impact was reduced by -1.36 (p<0.001) in RAFT vs -0.88 in controls (p<0.004). Regression analysis showed the difference between changes in fatigue impact NRS was -0.59 in favour of RAFT (CI -1.11, -0.06). Regression analysis also showed significant differences in secondary outcomes in favour of RAFT: BRAF-MDQ total fatigue -3.42 (CI -6.44, -0.39); Living with Fatigue -1.19 (CI -2.17, -0.21); Emotional Fatigue -0.91 (CI -1.58, -0.23); and RA self-efficacy (RASE, +3.05, CI 0.43, 5.66). There were no differences between arms for changes in fatigue severity or other clinical variables.

99% of RAFT patients would definitely recommend the course to others compared to 50% controls (p<0.001). 90% of RAFT patients rated satisfaction ≥8/10 (including 62% rating 10/10); in comparison 50% controls rated satisfaction ≥8/10 (including 26% rating 10/10, (p<0.0001). Over 26 weeks 20 control patients sought extra appointments for fatigue help compared to 8 RAFT patients (14.2% vs 5.3%, p<0.01).

Conclusions Rheumatology teams delivering a manualized CBA group intervention addressing fatigue impact, not only improve RA fatigue impact, but also emotional & overall fatigue, living with fatigue and self-efficacy, with very high patient satisfaction. Providing rheumatology teams with CBA skills is a potential new therapeutic approach to change practice and improve patient outcome.

References

  1. Hewlett et al, ARD 2011;70:1060–7.

References

Disclosure of Interest None declared

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