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Training and delivery of a novel fatigue intervention: a qualitative study of rheumatology health-care professionals' experiences

Dures, Emma; Rooke, Clive; Hammond, Alison; Hewlett, Sarah


Emma Dures
Professor in Rheumatology and Self-management

Clive Rooke

Alison Hammond


Objectives. Successful, non-pharmacological research interventions are challenging to implement in clinical practice. The aim of the study was to understand the experiences of rheumatology nurses and occupational therapists (tutors) delivering a novel fatigue intervention in a trial setting, and their views on requirements for clinical implementation. After training, tutors delivered courses of a manualized group cognitive-behavioural intervention to patients with RA in a seven-centre randomized controlled trial [Reducing Arthritis Fatigue by clinical Teams using cognitive-behavioural approaches (RAFT)], which demonstrated reduced fatigue impact at 2 years. Methods. Fourteen tutors participated in interviews, and eight tutors also participated in a focus group. Data were audio-recorded, transcribed and analysed using inductive thematic analysis. Results. The following five main themes were identified: 'exciting but daunting' reflected the mixture of excitement and anxiety in intervention training and delivery; 'skills practice and demonstrations were essential' captured the value of learning and practising together, even though the process could be uncomfortable; 'an individual approach to a standardized intervention' showed how tutors negotiated adherence to the manual with delivery using their own words; 'becoming a better practitioner' described how participation enhanced tutors' wider clinical practice; and 'pragmatic and flexible' highlighted practical adaptations to facilitate training and intervention roll out. Conclusion. These insights inform strategies for clinical implementation of an evidence-based intervention that addresses a patient priority, with implications for other successful research interventions. Tutors believed that the skills acquired during RAFT enhanced their wider clinical practice, which highlights the benefits of upskilling members of clinical teams to provide self-management support to patients.

Journal Article Type Article
Acceptance Date Aug 19, 2019
Online Publication Date Aug 27, 2019
Publication Date Jul 1, 2019
Deposit Date Mar 31, 2020
Publicly Available Date Apr 2, 2020
Journal Rheumatology Advances in Practice
Print ISSN 2514-1775
Electronic ISSN 2514-1775
Publisher Oxford University Press
Peer Reviewed Peer Reviewed
Volume 3
Issue 2
Article Number rkz032
Pages 1-7
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Novel Fatigue Intervention (180 Kb)


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Copyright Statement
C The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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