Remotely delivered cognitive-behavioural and personalized exercise interventions to lessen the impact of fatigue: a qualitative evaluation

Sarah E Bennett; Celia Almeida; Eva-Maria Bachmair; Stuart R Gray; Karina Lovell; Lorna Paul; Alison Wearden; Gary J Macfarlane; Neil Basu; Emma Dures; LIFT study team

doi:10.1093/rap/rkac051

Remotely delivered cognitive-behavioural and personalized exercise interventions to lessen the impact of fatigue: a qualitative evaluation

Rheumatol Adv Pract. 2022 Jun 25;6(2):rkac051. doi: 10.1093/rap/rkac051. eCollection 2022.

Authors

Collaborators

LIFT study team:
Lorna Aucott, Kathryn Martin, Neeraj Dhaun, Richard Emsley, Elizabeth Kidd, Vinod Kumar, Graeme MacLennan, McNamee Paul, John Norrie, Jon Packham, Stuart H Ralston, Stefan Siebert, Amy Nicol, Karen Norris, Sandra Mann, Lorna Van Lierop, Eli Gomez, Fiona McCurdy, Valerie Findlay, Neil Hastie, Eunice Morgan, Roselyn Emmanuel, Daniel Whibley, Aimee Urquart, Laura MacPerson, Janice Rowland, Gwen Kiddie, Debbie Pankhurst, Johnstone Paul, Hilary Nicholson, Angela Dunsmore, Alison Knight, John Ellis, Callum Maclean, Linda Crighton, Cameron Shearer, Judy Coyle, Susan Begg, Lyndsey Ackerman, Jill Carnevale, Samantha Arbuthnot, Helen Watters, Dervil Dockrell, Debbie Hamilton, Dario Salutous, Susanne Cathcart, Dominic Rimmer, Emma Hughes, Juliet Harvey, Mairi Gillies, Susan Webster, Leeanne Milne, Gary Semple, Katharine Duffy, Lynne Turner, John Alexander, June Innes, Charlotte Clark, Christine Meek, Elizabeth McKenna, Christine Routledge, Helain Hinchcliffe-Hume, Emmanuella Traianos, Beth Dibnah, David Storey, Gemma O'Callaghan, Jenny Yael Baron, Sally Hunt, Natalie Wheat, Pam Smith, Elizabeth Ann Barcroft, Amy Thompson, Johanne Tomlinson, Jill Barber, Gladys MacPerson, Peter White, Sarah Hewlett

Affiliations

¹ Musculoskeletal Research Unit, Bristol Medical School, University of Bristol.
² School of Health and Social Wellbeing, University of the West of England.
³ Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen.
⁴ Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow.
⁵ Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester.
⁶ School of Health and Life Science, Glasgow Caledonian University, Glasgow.
⁷ Division of Psychology and Mental Health, University of Manchester, Manchester.
⁸ Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.

Abstract

Objectives: Fatigue can be a disabling symptom of inflammatory rheumatic diseases. LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomized Trial) is a randomized trial of remotely delivered cognitive-behavioural approach or personalized exercise programme interventions, compared with usual care. The aim of this nested qualitative study was to evaluate participants' experiences of taking part in the intervention, including their ideas about future service delivery.

Methods: Semi-structured telephone interviews were conducted with a subgroup of LIFT participants to discuss their views and experiences of the interventions.

Results: Forty-three participants (30 women) from six sites who had participated in the cognitive-behavioural approach (n = 22) or personalized exercise programme (n = 21) interventions took part. Five themes were identified in the thematic analysis. In the theme 'not a miracle cure, but a way to better manage fatigue', LIFT could not cure fatigue; however, most felt better able to manage after participating. Participants valued 'building a therapeutic relationship' with the same therapist throughout the intervention. In 'structure, self-monitoring and being accountable', participants liked the inclusion of goal-setting techniques and were motivated by reporting back to the therapist.After taking part in the interventions, participants felt 'better equipped to cope with fatigue'; more confident and empowered. Lastly, participants shared ideas for 'a tailored programme delivered remotely', including follow-up sessions, video calling, and group-based sessions for social support.

Conclusion: Many participants engaged with the LIFT interventions and reported benefits of taking part. This suggests an important future role for the remote delivery of fatigue self-management.

Keywords: cognitive-behavioural approaches; exercise; fatigue; patient perspectives; qualitative; rheumatic diseases.