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Self-management of fatigue in rheumatoid arthritis: a randomised controlled trial of group cognitive-behavioural therapy

Hewlett, S; Ambler, N; Almeida, C; Cliss, A; Hammond, A; Kitchen, K; Knops, B; Pope, D; Spears, M; Swinkels, A; Pollock, J


S Hewlett

N Ambler

C Almeida

A Cliss

K Kitchen

B Knops

D Pope

M Spears

A Swinkels

J Pollock


Objectives To investigate the effect of group cognitive
behavioural therapy (CBT) for fatigue self-management,
compared with groups receiving fatigue information
alone, on fatigue impact among people with rheumatoid
arthritis (RA).
Methods Two-arm, parallel randomised controlled
trial in adults with RA, fatigue ≥6/10 (Visual Analogue
Scale (VAS) 0–10, high bad) and no recent change in
RA medication. Group CBT for fatigue self-management
comprised six (weekly) 2 h sessions, and consolidation
session (week 14). Control participants received fatigue
self-management information in a 1 h didactic group
session. Primary outcome at 18 weeks was the impact of
fatigue measured using two methods (Multi-dimensional
Assessment of Fatigue (MAF) 0–50; VAS 0–10), analysed
using intention-to-treat analysis of covariance with
multivariable regression models.
Results Of 168 participants randomised, 41 withdrew
before entry and 127 participated. There were no major
baseline differences between the 65 CBT and 62 control
participants. At 18 weeks CBT participants reported
better scores than control participants for fatigue
impact: MAF 28.99 versus 23.99 (adjusted difference
−5.48, 95% CI −9.50 to −1.46, p=0.008); VAS 5.99
versus 4.26 (adjusted difference −1.95, 95% CI −2.99
to −0.90, p<0.001). Standardised effect sizes for
fatigue impact were MAF 0.59 (95% CI 0.15 to 1.03)
and VAS 0.77 (95% CI 0.33 to 1.21), both in favour of
CBT. Secondary outcomes of perceived fatigue severity,
coping, disability, depression, helplessness, self-effi cacy
and sleep were also better in CBT participants.
Conclusions Group CBT for fatigue self-management
in RA improves fatigue impact, coping and perceived
severity, and well-being


Hewlett, S., Ambler, N., Almeida, C., Cliss, A., Hammond, A., Kitchen, K., …Pollock, J. (2011). Self-management of fatigue in rheumatoid arthritis: a randomised controlled trial of group cognitive-behavioural therapy. Annals of the Rheumatic Diseases, 70(6), 1060-1067.

Journal Article Type Article
Publication Date Jan 1, 2011
Deposit Date May 14, 2012
Journal Annals of the Rheumatic Diseases (ARD)
Print ISSN 0003-4967
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 70
Issue 6
Pages 1060-1067
Publisher URL