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Group cognitive–behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations

Hewlett, Sarah; Almeida, Celia; Ambler, Nicholas; Blair, Peter S; Choy, Ernest; Dures, Emma; Hammond, Alison; Hollingworth, William; Kadir, Bryar; Kirwan, John; Plummer, Zoe; Rooke, Clive; Thorn, Joanna; Turner, Nicholas; Pollock, Jonathan

Authors

Nicholas Ambler

Peter S Blair

Ernest Choy

Emma Dures Emma2.Dures@uwe.ac.uk
Associate Professor in Rheumatology and Self-management

Alison Hammond

William Hollingworth

Bryar Kadir

John Kirwan

Zoe Plummer

Clive Rooke

Joanna Thorn

Nicholas Turner

Jonathan Pollock



Abstract

BACKGROUND: Fatigue is a major problem in rheumatoid arthritis (RA). There is evidence for the clinical effectiveness of cognitive-behavioural therapy (CBT) delivered by clinical psychologists, but few rheumatology units have psychologists. OBJECTIVES: To compare the clinical effectiveness and cost-effectiveness of a group CBT programme for RA fatigue [named RAFT, i.e. Reducing Arthritis Fatigue by clinical Teams using cognitive-behavioural (CB) approaches], delivered by the rheumatology team in addition to usual care (intervention), with usual care alone (control); and to evaluate tutors' experiences of the RAFT programme. DESIGN: A randomised controlled trial. Central trials unit computerised randomisation in four consecutive cohorts within each of the seven centres. A nested qualitative evaluation was undertaken. SETTING: Seven hospital rheumatology units in England and Wales. PARTICIPANTS: Adults with RA and fatigue severity of ≥ 6 [out of 10, as measured by the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS)] who had no recent changes in major RA medication/glucocorticoids. INTERVENTIONS: RAFT - group CBT programme delivered by rheumatology tutor pairs (nurses/occupational therapists). Usual care - brief discussion of a RA fatigue self-management booklet with the research nurse. MAIN OUTCOME MEASURES: Primary - fatigue impact (as measured by the BRAF-NRS) at 26 weeks. Secondary - fatigue severity/coping (as measured by the BRAF-NRS); broader fatigue impact [as measured by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ)]; self-reported clinical status; quality of life; mood; self-efficacy; and satisfaction. All data were collected at weeks 0, 6, 26, 52, 78 and 104. In addition, fatigue data were collected at weeks 10 and 18. The intention-to-treat analysis conducted was blind to treatment allocation, and adjusted for baseline scores and centre. Cost-effectiveness was explored through the intervention and RA-related health and social care costs, allowing the calculation of quality-adjusted life-years (QALYs) with the EuroQol-5 Dimensions, five-level version (EQ-5D-5L). Tutor and focus group interviews were analysed using inductive thematic analysis. RESULTS: A total of 308 out of 333 patients completed 26 weeks (RAFT, n/N = 156/175; control, n/N = 152/158). At 26 weeks, the mean BRAF-NRS impact was reduced for the RAFT programme (-1.36 units; p 

Journal Article Type Other
Publication Date Oct 1, 2019
Print ISSN 1366-5278
Electronic ISSN 2046-4924
Publisher NIHR Journals Library
Volume 23
Issue 57
Pages 1-130
APA6 Citation Hewlett, S., Almeida, C., Ambler, N., Blair, P. S., Choy, E., Dures, E., …Pollock, J. (2019). Group cognitive–behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations. Health Technology Assessment, 23(57), 1-130. https://doi.org/10.3310/hta23570
DOI https://doi.org/10.3310/hta23570
Keywords Health Policy
Additional Information Contractual start date: 11-2013; Editorial review begun: 6-2018; Accepted for publication: 1-2019

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© Queen’s Printer and Controller of HMSO 2019. This work was produced by Hewlett et al. under the terms of a commissioning
contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of
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suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for
commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation,
Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.





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