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

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

Abstract

© Author(s) (or their employer(s)) 2019. 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

• Journal Article Type: Article
• Acceptance Date: Jan 11, 2019
• Online Publication Date: Feb 6, 2019
• Publication Date: Apr 1, 2019
• Deposit Date: Feb 5, 2019
• Publicly Available Date: Feb 8, 2019
• Journal: Annals of the Rheumatic Diseases
• Print ISSN: 0003-4967
• Electronic ISSN: 1468-2060
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 78
• Issue: 4
• Pages: 465-472
• DOI: https://doi.org/10.1136/annrheumdis-2018-214469
• Keywords: rheumatoid arthritis, fatigue, cognitive behavioural therapy, randomised controlled trial
• Public URL: https://uwe-repository.worktribe.com/output/850652
• Publisher URL: http://dx.doi.org/10.1136/annrheumdis-2018-214469
• Contract Date: Feb 5, 2019