Effectiveness and cost-effectiveness of a self-management group program to improve social participation in patients with neuromuscular disease and chronic fatigue: protocol of the Energetic study.
BACKGROUND
Chronic fatigue is present in more than 60% of the patients with a neuromuscular disease and can be their most disabling symptom. In combination with other impairments, fatigue often results in low levels of physical activity and decreased social participation, leading to high societal costs. 'Energetic' is a self-management group program aimed at improving social participation, physical endurance and alleviating fatigue in these patients. The primary aim of this study is to evaluate the effectiveness and cost-effectiveness of the Energetic program.


METHODS
A multicentered, assessor-blinded, two-armed randomized controlled trial is conducted with evaluations at inclusion and four, seven and fifteen months later. The study includes patients with a neuromuscular disease and chronic fatigue and, when present, their caregivers. The participants are randomized (ratio 1:1) to either an intervention group, receiving the Energetic program, or a control group, receiving usual care (i.e., no specific intervention). The Energetic program covers four months and includes four modules: 1) individually tailored aerobic exercise training; 2) education about aerobic exercise; 3) self-management training in applying energy conservation strategies; and 4) implementation and relapse prevention in daily life. Two months after cessation of the program a booster session is provided. The primary outcome is the perceived performance score of the Canadian Occupational Performance Measure (COPM). Secondary outcomes include the COPM-satisfaction score, and measures of fatigue, physical endurance, activity engagement, mood, and self-efficacy. Caregiver burden is also evaluated as a secondary outcome. Health-related quality of life and medical and societal costs are assessed to estimate cost-effectiveness of the program.


CONCLUSIONS
The Energetic study is the first randomized controlled trial to evaluate the effectiveness and cost-effectiveness of a combined physical and self-management group training program for improving social participation, physical endurance and alleviating fatigue in patients with neuromuscular diseases. It will generate new insights in (cost-)effective rehabilitation strategies for these incurable conditions.


BACKGROUND
Clinicaltrials.gov NCT02208687 .
Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands. Yvonne.Veenhuizen@radboudumc.nl.
Yvonne
Y
Veenhuizen
Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands. Edith.Cup@radboudumc.nl.
Edith H C
EH
Cup
Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands. Jan.Groothuis@radboudumc.nl.
Jan T
JT
Groothuis
Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands. Jan.CM.Hendriks@radboudumc.nl.
Jan C M
JC
Hendriks
Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands. Eddy.Adang@radboudumc.nl.
Eddy M M
EM
Adang
Department of Neurology, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands. Baziel.vanEngelen@radboudumc.nl.
Baziel G M
BG
van Engelen
Department of Rehabilitation, Donders Centre for Neuroscience, Radboud University Medical Centre, Nijmegen, Netherlands. Sander.Geurts@radboudumc.nl.
Alexander C H
AC
Geurts
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D017028:Caregivers; D003362:Cost-Benefit Analysis; D015444:Exercise; D015673:Fatigue Syndrome, Chronic / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000534:rehabilitation*; D016730:Program Development; D015397:Program Evaluation; D011615:Psychotherapy, Group / Q000191:economics* / Q000379:methods*; D011788:Quality of Life; D012107:Research Design; D012648:Self Care; D020377:Self Efficacy; D058992:Social Participation; D016896:Treatment Outcome; D055815:Young Adult