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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; Choy, Ernest; Dures, Emma; Hammond, Alison; Hollingworth, William; Kadir, Bryar; Kirwan, John; Plummer, Zoe; Rooke, Clive; Thorn, Joanna; Turner, Nicholas; Pollock, Jon

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


Authors

Nicholas Ambler

Peter 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

Jon Pollock Jon.Pollock@uwe.ac.uk
Associate Professor in Epidemiology



Abstract

Background: Fatigue is a major problem in rheumatoid arthritis (RA). There is evidence for cognitive behavioural therapy (CBT) delivered by clinical psychologists but few rheumatology units have psychologists.

Objectives: To compare clinical and cost-effectiveness of a group CBT programme for RA fatigue (RAFT) delivered by the rheumatology team in addition to usual care, versus usual care alone; to evaluate RAFT tutors’ experiences.

Design: Randomised controlled trial. Central trials unit computerised randomisation in four consecutive cohorts within each of 7 centres. Nested qualitative evaluation.

Setting: Seven hospital rheumatology units in England/Wales

Participants: Adults with RA and fatigue severity >6/10; no recent changes in major RA medication/glucocorticoids.

Interventions: RAFT: group CBT course delivered by rheumatology tutor pairs (nurses/occupational therapists). Usual care; brief discussion of an RA fatigue self-management booklet with the research nurse.

Main outcome measures: Primary: Fatigue impact (Bristol RA Fatigue Numerical Rating Scale) at 26 weeks. Secondary: Fatigue severity/coping (BRAF-NRS), broader fatigue impact (BRAF Multi-Dimensional Questionnaire), self-reported clinical status, quality of life, mood, self-efficacy, satisfaction (26, 52, 78, 104 weeks). Intention-to-treat analysis conducted blind to allocation, adjusted for baseline scores and centre. Cost-effectiveness explored through intervention and RA-related health/social care costs, calculating quality-adjusted life-years (QALYs) with EQ-5D-5L. Tutor interviews/focus group analysed with inductive thematic analysis.

Results: 308/333 patients completed 26 weeks (156/175 RAFT, 152/158 controls). At 26 weeks mean BRAF-NRS Impact was reduced for RAFT (-1.36, p

Journal Article Type Article
Publication Date Oct 1, 2019
Journal Health Technology Assessment
Print ISSN 1366-5278
Publisher NIHR Journals Library
Peer Reviewed Peer Reviewed
Volume 23
Issue 57
APA6 Citation Hewlett, S., Almeida, C., Ambler, N., Blair, P., 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), https://doi.org/10.3310/hta23570
DOI https://doi.org/10.3310/hta23570
Keywords rheumatoid arthritis, fatigue, cognitive therapy, self-management, randomised controlled trial, cost-benefit analysis, qualitative research

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Copyright Statement
© 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 private research and study and extracts (or indeed, the full report) may be included in professional journals provided that 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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