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; Hollingworth, W; Kadir, B; Kirwan, JR; Plummer, Z; Rooke, C; Thorn, J; Turner, N; Pollock, J

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.

Citation

Hewlett, S., Almeida, C., Ambler, N., Blair, P., Choy, E., Dures, E., …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), 465-472. https://doi.org/10.1136/annrheumdis-2018-214469

• Journal Article Type: Article
• Acceptance Date: Jan 11, 2019
• Online Publication Date: Feb 6, 2019
• Publication Date: Mar 12, 2019
• Deposit Date: Mar 13, 2019
• Publicly Available Date: Mar 13, 2019
• Journal: Annals of the Rheumatic Diseases
• Print ISSN: 0003-4967
• Publisher: BMJ Publishing Group
• Volume: 78
• Issue: 4
• Pages: 465-472
• DOI: https://doi.org/10.1136/annrheumdis-2018-214469
• Keywords: cognitive behavioural therapy, fatigue, randomised controlled trial, rheumatoid arthritis
• Publisher URL: https://doi.org/10.1136/annrheumdis-2018-214469
• Related Public URLs: https://ard.bmj.com/
• Additional Information: Corporate Creators : RAFT Study Group