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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

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


Authors

S Hewlett

C Almeida

N Ambler

PS Blair

EH Choy

E Dures

W Hollingworth

B Kadir

JR Kirwan

Z Plummer

C Rooke

J Thorn

N Turner

J Pollock



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

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