New approaches to improve fatigue in people with inflammatory arthritis

New approaches to improve fatigue in people with inflammatory arthritis

What is the background to this study?

Fatigue is a commonly reported symptom by people who have inflammatory rheumatic diseases (IRDs). This includes conditions such as rheumatoid arthritis, axial spondyloarthritis and lupus, and  patients tell us that fatigue has a significant impact on their daily lives. However, at the moment it is rare for people to receive specific support for their fatigue within their normal visit to their rheumatologist.

The LIFT Study (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomised Trial) looked at two different approaches to managing fatigue:

  • A Cognitive-Behavioural Approach (CBA), designed to address unhelpful thoughts and feelings
  • A Personalised Exercise Programme (PEP) which consisted of sessions designed to support people with IRDs to gradually increase their energy levels

Both of these approaches were delivered by existing members of the rheumatology team who received special training for this, and were delivered remotely either by telephone or Skype.

What did we want to find out?

While a separate part of this research looked at the effectiveness of these two interventions, our aim was to understand the views of the rheumatology health professionals (therapists) who delivered the CBA and PEP sessions. We also asked patients who took part in these sessions what they thought about the type of management they received.

What did we do?

We interviewed 17 therapists and 43 patients who took part in the study. All the patients we spoke to were women.

What did we find?

People with IRDs who took part in LIFT told us about a range of benefits, including feeling less fatigued and more confident. In terms of the different approaches, those who received the PEP told us they felt stronger, while people who received the CBA liked being able to talk about their fatigue with a supportive therapist.

Therapists who delivered LIFT enjoyed the training and being given the opportunity to practise delivering the PEP and CBA before they started to work with patients. The therapists were supported by supervisors and were able to request assistance when required. However, they reported that they struggled to work with patients who did not seem as motivated. Overall, therapists said they gained confidence and professional satisfaction from seeing patients’ fatigue improve as a result of the approaches used in this study.

Why does this matter?

These are encouraging results in supporting people with fatigue. This research shows that members of the rheumatology team can be trained to deliver these types of therapies remotely, while patients themselves reported several benefits from these interventions. These insights will be able to inform future provision and design of healthcare services, as well as clinical practice.

Who authored this study?

The LIFT Trial was led from the Epidemiology Group at the University of Aberdeen. This part of the  study was undertaken by Dr Sarah Bennett from the University of Bristol and Dr Emma Dures from University of the West of England and co-authored by a large team of investigators, including Dr Eva-Maria Bachmair, Professor Neil Basu and Professor Gary J Macfarlane.  

Who funded this work?

This study was funded by Versus Arthritis. The costs of the interventions were met by the NHS boards which took part in the study.

Where can I read more?

You can read the full academic paper here.

A summary of the main trial results (including a link to the full paper) are available here.