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Randomized Controlled Trial
. 2019 Apr;78(4):465-472.
doi: 10.1136/annrheumdis-2018-214469. Epub 2019 Feb 6.

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

Sarah Hewlett  1 , Celia Almeida  2 , Nicholas Ambler  3 , Peter S Blair  4 , Ernest H Choy  5 , Emma Dures  2 , Alison Hammond  6 , William Hollingworth  4 , Bryar Kadir  4 , John Richard Kirwan  7 , Zoe Plummer  2 , Clive Rooke  8 , Joanna Thorn  4 , Nicholas Turner  9 , Jon Pollock  10 ; RAFT Study Group
Collaborators, Affiliations
Randomized Controlled Trial

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

Sarah Hewlett et al. Ann Rheum Dis. 2019 Apr.

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.

Keywords: cognitive behavioural therapy; fatigue; randomised controlled trial; rheumatoid arthritis.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Participant flowchart. CBT, cognitive behavioural therapy.
Figure 2
Figure 2
BRAF-NRS Impact scores (0–10) over weeks 0–104 by trial arm. BRAF-NRS, Bristol RA Fatigue Numerical Rating Scale.
See this image and copyright information in PMC

References

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