Exploring strategies used following a group-based fatigue management programme for people with multiple sclerosis (FACETS) via the Fatigue Management Strategies Questionnaire (FMSQ).
OBJECTIVE
To explore cross-sectional patterns of use of fatigue management strategies in people with multiple sclerosis (MS) who had attended a group-based fatigue management programme, Fatigue: Applying Cognitive behavioural and Energy effectiveness Techniques to lifeStyle ('FACETS'). In a multicentre randomised controlled trial (RCT) the FACETS programme was shown to reduce fatigue severity and improve self-efficacy and quality of life.


METHODS
A questionnaire substudy within a RCT involving the self-completed Fatigue Management Strategies Questionnaire (FMSQ). The FMSQ includes: (1) closed questions about the use and helpfulness of fatigue management strategies taught in FACETS and (2) open items about changes to lifestyle, attitudes or expectations, barriers or difficulties encountered and helpful strategies not covered in FACETS.


METHODS
All had a clinical diagnosis of MS, significant fatigue, were ambulatory and had attended at least 4 of 6 scheduled FACETS sessions.


METHODS
Participants (n=72) were posted the FMSQ with a prepaid return envelope 4 months after the end of the FACETS programme.


RESULTS
82% (59/72) of participants returned the FMSQ. The fatigue management strategies most frequently used since attending FACETS were prioritisation (80%), pacing (78%), saying no to others (78%), grading tasks (75%) and challenging unhelpful thoughts (71%). Adding in those participants who were already using the respective strategies prior to FACETS, the three most used strategies at 4 months were prioritisation (55/59), grading (54/59) and pacing (53/58). Free-text comments illustrated the complex interplay between attitudes/expectations, behaviours, emotions and the environment. Issues related to expectations featured strongly in participants' comments. Expectations (from self and others) were both facilitators and barriers to effective fatigue management.


CONCLUSIONS
Individuals' comments highlighted the complex, multifaceted nature of fatigue management. Revising expectations and a greater acceptance of fatigue were important shifts following the programme. Findings support the relevance of a cognitive behavioural approach for fatigue management. Booster sessions might be a useful addition to the FACETS programme.


BACKGROUND
Current controlled trials ISRCTN76517470; Results.
Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK.
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S
Thomas
Centre for Person Centred Research, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
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P
Kersten
Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK.
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PW
Thomas
Dorset MS Service, Poole Hospital NHS Foundation Trust, Poole, UK.
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Slingsby
Dorset MS Service, Poole Hospital NHS Foundation Trust, Poole, UK.
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A
Nock
MS Research Unit, Bristol and Avon MS Clinical Centre, Southmead Hospital, Bristol, UK.
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R
Jones
MS Research Unit, Bristol and Avon MS Clinical Centre, Southmead Hospital, Bristol, UK.
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Davies Smith
Faculty of Health and Social Care, University of Hull, Hull, Yorkshire, UK.
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KT
Galvin
Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK.
R
R
Baker
Dorset MS Service, Poole Hospital NHS Foundation Trust, Poole, UK.
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C
Hillier
D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003430:Cross-Sectional Studies; D005221:Fatigue / Q000628:therapy*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000523:psychology*; D015397:Program Evaluation; D036301:Qualitative Research; D011788:Quality of Life; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D006113:United Kingdom; D055815:Young Adult
QUALITATIVE RESEARCH