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

Sarah Hewlett*, Celia Almeida, Nicholas Ambler, Peter S Blair, Ernest Choy, Emma Dures, A. Hammond, William Hollingworth, Bryar Kadir, John Kirwan, Zoe E Plummer, C. Rooke, Joanna Thorn, Nicholas Turner, Jonathan Pollock, on behalf of the RAFT Study Group

*Corresponding author for this work

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Abstract

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<0.0001).

CONCLUSION: Multiple RA fatigue impacts can be improved for 2 years by rheumatology teams delivering a group programme using cognitive behavioural approaches.

TRIAL REGISTRATION NUMBER: ISRCTN52709998.

Original languageEnglish
Pages (from-to)465-472
Number of pages8
JournalAnnals of the Rheumatic Diseases
Volume78
Issue number4
Early online date6 Feb 2019
DOIs
Publication statusPublished - 1 Apr 2019

Structured keywords

  • BTC (Bristol Trials Centre)
  • BRTC

Keywords

  • Rheumatoid Arthritis
  • Fatigue
  • Cognitive Behavioural Therapy
  • Randomised Controlled Trial
  • BRTC

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    Hewlett, S., Almeida, C., Ambler, N., Blair, P. S., Choy, E., Dures, E., Hammond, A., Hollingworth, W., Kadir, B., Kirwan, J., Plummer, Z. E., Rooke, C., Thorn, J., Turner, N., Pollock, J., & on behalf of the RAFT Study Group (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. https://doi.org/10.1136/annrheumdis-2018-214469