title: Self-management of fatigue in rheumatoid arthritis: a randomised controlled trial of group cognitive-behavioural therapy.
abstract: OBJECTIVE
  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 arthritis (RA).
  
  
  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-efficacy 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.
  
  
  BACKGROUND
  ISRCTN 32195100.
authors.affiliation: Department of Nursing and Midwifery, University of the West of England, Bristol, UK. Sarah.Hewlett@uwe.ac.uk
authors.forename: Sarah
authors.initials: S
authors.lastname: Hewlett
authors.forename: Nick
authors.initials: N
authors.lastname: Ambler
authors.forename: Celia
authors.initials: C
authors.lastname: Almeida
authors.forename: Alena
authors.initials: A
authors.lastname: Cliss
authors.forename: Alison
authors.initials: A
authors.lastname: Hammond
authors.forename: Karen
authors.initials: K
authors.lastname: Kitchen
authors.forename: Bev
authors.initials: B
authors.lastname: Knops
authors.forename: Denise
authors.initials: D
authors.lastname: Pope
authors.forename: Melissa
authors.initials: M
authors.lastname: Spears
authors.forename: Annette
authors.initials: A
authors.lastname: Swinkels
authors.forename: Jon
authors.initials: J
authors.lastname: Pollock
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005221:Fatigue / Q000209:etiology* / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011615:Psychotherapy, Group / Q000379:methods; D012648:Self Care / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome