Hewlett, S., Ambler, N., Almeida, C., Cliss, A., Hammond, A., Kitchen, K., Knops, B., Pope, D., Spears, M., Swinkels, A. and Pollock, J.
Self-management of fatigue in rheumatoid arthritis: A randomised controlled trial of group cognitive-behavioural therapy.
Annals of Rheumatic Disease, 70 (6).
- Published Version
Publisher's URL: http://dx.doi.org/10.1136/ard.2010.144691
Objectives: To investigate the effect of group cognitive
behavioural therapy (CBT) for fatigue self-management,
compared with groups receiving fatigue information
alone, on fatigue impact among people with rheumatoid
Methods: Two-arm, parallel randomised controlled
trial in adults with RA, fatigue ≥6/10 (Visual Analogue
Scale (VAS) 0–10, high bad) and no recent change in
RA medication. Group CBT for fatigue self-management
comprised six (weekly) 2 h sessions, and consolidation
session (week 14). Control participants received fatigue
self-management information in a 1 h didactic group
session. Primary outcome at 18 weeks was the impact of
fatigue measured using two methods (Multi-dimensional
Assessment of Fatigue (MAF) 0–50; VAS 0–10), analysed
using intention-to-treat analysis of covariance with
multivariable regression models.
Results: Of 168 participants randomised, 41 withdrew
before entry and 127 participated. There were no major
baseline differences between the 65 CBT and 62 control
participants. At 18 weeks CBT participants reported
better scores than control participants for fatigue
impact: MAF 28.99 versus 23.99 (adjusted difference
−5.48, 95% CI −9.50 to −1.46, p=0.008); VAS 5.99
versus 4.26 (adjusted difference −1.95, 95% CI −2.99
to −0.90, p<0.001). Standardised effect sizes for
fatigue impact were MAF 0.59 (95% CI 0.15 to 1.03)
and VAS 0.77 (95% CI 0.33 to 1.21), both in favour of
CBT. Secondary outcomes of perceived fatigue severity,
coping, disability, depression, helplessness, self-effi cacy
and sleep were also better in CBT participants.
Conclusions: Group CBT for fatigue self-management
in RA improves fatigue impact, coping and perceived
severity, and well-being.
Trial registration: ISRCTN 32195100
|Additional Information:||Open Access paid for|
|Uncontrolled Keywords:||rheumatoid arthritis, fatigue, cognitive behavioural therapy, randomized controlled trial|
|Faculty/Department:||Faculty of Health and Applied Sciences|
Professor S. Hewlett
|Deposited On:||19 Jul 2011 09:18|
|Last Modified:||21 Sep 2013 04:33|
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