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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


Nicholas Ambler

Peter S. Blair

Ernest H. Choy

Emma Dures
Associate Professor in Rheumatology and Self-management

Alison Hammond

William Hollingworth

Bryar Kadir

John Richard Kirwan

Zoe Plummer

Clive Rooke

Joanna Thorn

Nicholas Turner

Jon Pollock
Associate Professor in Epidemiology


© 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


Hewlett, S., Almeida, C., Ambler, N., Blair, P. S., Choy, E. H., 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.

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 5, 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
Keywords rheumatoid arthritis, fatigue, cognitive behavioural therapy, randomised controlled trial
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