P201 Therapists' experiences of remotely delivered cognitive-behavioural and graded-exercise interventions to lessen the impact of fatigue in inflammatory rheumatic diseases: a qualitative evaluation

Sarah E Bennett, Emma Dures, Celia J Almeida, Eva-Maria Bachmair, Karina Lovell, Lorna Paul, Alison Wearden, Gary J Macfarlane, Neil Basu

Research output: Chapter in Book/Report/Conference proceedingConference Contribution (Conference Proceeding)


Background/Aims: There is evidence for non-pharmacological interventions to supportpatients to self-manage fatigue, however implementation in clinicalpractice is a challenge. LIFT (Lessening the Impact of Fatigue ininflammatory rheumatic diseases: a randomised Trial) is a multi-centrethree-arm randomised trial using a remotely delivered cognitive-behavioural approach (CBA) or personalized exercise programme(PEP) interventions, in addition to usual care, compared to normal carealone. Interventions were delivered to patients by rheumatology healthprofessionals using a manual, after training. The aim of this nestedqualitative evaluation was to understand their perspectives ofdelivering the interventions.
Methods: A subgroup of rheumatology healthcare professionals who haddelivered the CBA and PEP interventions took part in semi-structuredtelephone interviews to explore their experiences of training anddelivery, the challenges and benefits of learning new skills, and thebarriers and facilitators to supporting patients remotely (mainly bytelephone) using the LIFT manual.ResultsA total of 17 rheumatology healthcare professionals (13 women, 4 men)from the CBA (n¼9) and PEP (n¼8) arms contributed. SB conducted aninductive thematic analysis of the data set. ED, CA, AW and KL revieweda sub-set of transcripts. Five main themes were identified: The benefitsof informative, structured training: Rheumatology healthcare profes-sionals reflected how training, including role-play, helped them topractice their skills, even though this could feel uncomfortable. Thoseallocated shorter four-hour training sessions would have liked more timeto practice. Many felt anxious before meeting patients for the first timebut liked the manual to refer to.Getting into the swing of it: Practice gave rheumatology healthcareprofessionals the confidence to tailor content to individual patients’requirements. Clinical supervision in the PEP and CBA arm supportedrheumatology healthcare professionals to query their own practice,gain valuable feedback, and request assistance where needed.Benefits of telephone delivery: The initial face-to-face session enabledrheumatology healthcare professionals to build rapport with patients.Thereafter, patients seemed engaged and valued the opportunity toaddress their fatigue and challenge their own beliefs via the telephone.Some patients not ready to change: Rheumatology healthcareprofessionals struggled to work collaboratively with a minority ofpatients who were not willing to make changes, lacked motivation tocomplete tasks or stopped engaging with the intervention.LIFT developing clinical skills: Rheumatology healthcare professionals were confident that they were doing the ‘right thing’ for patients withfatigue and gained professional satisfaction seeing patients’ fatigueimprove. Many felt that the skills they acquired and their experiencesof remote delivery were helping them to respond to the current COVID-19 related changes in service provision.
Conclusion: Findings support the value of skills training for rheumatology healthprofessionals to deliver fatigue management interventions remotely.These insights can inform service provision and clinical practice.

DisclosureS.E. Bennett:None.E. Dures:None.C. Almeida:None.E. Bachmair:None.K. Lovell:None.L. Paul:None.A. Wearden:None.G.J.Macfarlane:None.N. Basu:None
Original languageEnglish
Title of host publicationRheumatology v60 nSupplement_1 (20210425)
Publication statusPublished - 27 Apr 2021


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