Impact of a fatigue management in work programme on meeting work demands of individuals with rheumatic diseases: A pilot study

R, McCormack; O’Shea, Finbar; Doran, Michele F.; Connolly, Deirdre

doi:10.1002/msc.1237

Cited by 11 publications

(21 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Other studies have explored the impact of AS on work and have reported that individuals with AS are three times more likely to resign from work than the general population [45]. Work-focused self-management interventions result in significant improvements in work performance pain, fatigue, and mood [46]. This indicates that work-focused self-management interventions should be offered to individuals who report difficulty in work due to their fatigue.…”

Section: Discussionmentioning

confidence: 99%

Disease Activity, Occupational Participation, and Quality of Life for Individuals with and without Severe Fatigue in Ankylosing Spondylitis

Connolly

Fitzpatrick

O’Shea

2019

Occupational Therapy International

Self Cite

View full text Add to dashboard Cite

Background. Fatigue is one of the most frequently reported symptoms by individuals with ankylosing spondylitis. However, it is often overlooked clinically and in research. Literature researching the impact of severe fatigue on occupational participation in ankylosing spondylitis is limited. Therefore, the aim of this research was to explore the impact of severe fatigue on occupational participation, disease activity, and quality of life in people with AS. Methods. A sequential exploratory mixed method study design was used in this study. Self-reported questionnaires gathered quantitative data which were analysed with descriptive and inferential statistics. Qualitative data were generated through semistructured interviews and analysed using a content analysis approach. Results. Fifty individuals with AS completed all study questionnaires. Participants had a mean age of 46.5 years; 72% were men with a mean disease duration of 14.5 years. High fatigue was reported by 38% of participants using the Multidimensional Assessment of Fatigue (MAF). Fatigue was significantly associated with lower occupational participation (p=0.018), higher disease activity (p<0.001), higher pain (p<0.001), reduced physical capacity (p=0.018), lower quality of life (p<0.001), and lower global well-being (p<0.001). There were significant differences between those with low and high fatigue levels for occupational participation (p=0.007), disease activity (p<0.001), physical capacity (p=0.015), pain (p<0.001), and quality of life (p<0.001). Participants discussed the impact of fatigue on productivity and leisure. They also discussed a range of strategies for managing their fatigue but reported a lack of education from health professionals on managing this symptom. Conclusion. Severe fatigue is a prevalent symptom for individuals with ankylosing spondylitis and results in reduced occupational participation in productivity and leisure. Early fatigue management interventions may reduce the occupational participation impact of this symptom for individuals with ankylosing spondylitis.

show abstract

Section: Discussionmentioning

confidence: 99%

Disease Activity, Occupational Participation, and Quality of Life for Individuals with and without Severe Fatigue in Ankylosing Spondylitis

Connolly

Fitzpatrick

O’Shea

2019

Occupational Therapy International

Self Cite

View full text Add to dashboard Cite

show abstract

“…8,12 An uncontrolled pilot study of a self-management programme specifically for fatigue at work for patients with inflammatory rheumatic diseases examined presenteeism and demonstrated improvements in four domains of functioning while at work: physical and mental demands, work scheduling and work outputs. 112 It is possible that the weekly review of daily activity diaries in the RAFT programme, accompanied by encouragement to break up large periods of intense activity through factoring in short breaks, may help presenteeism.…”

Section: Discussionmentioning

confidence: 99%

Group cognitive–behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations

Hewlett

Almeida

Ambler

et al. 2019

Health Technol Assess

View full text Add to dashboard Cite

Background Fatigue is a major problem in rheumatoid arthritis (RA). There is evidence for the clinical effectiveness of cognitive–behavioural therapy (CBT) delivered by clinical psychologists, but few rheumatology units have psychologists. Objectives To compare the clinical effectiveness and cost-effectiveness of a group CBT programme for RA fatigue [named RAFT, i.e. Reducing Arthritis Fatigue by clinical Teams using cognitive–behavioural (CB) approaches], delivered by the rheumatology team in addition to usual care (intervention), with usual care alone (control); and to evaluate tutors’ experiences of the RAFT programme. Design A randomised controlled trial. Central trials unit computerised randomisation in four consecutive cohorts within each of the seven centres. A nested qualitative evaluation was undertaken. Setting Seven hospital rheumatology units in England and Wales. Participants Adults with RA and fatigue severity of ≥ 6 [out of 10, as measured by the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scale (BRAF-NRS)] who had no recent changes in major RA medication/glucocorticoids. Interventions RAFT – group CBT programme delivered by rheumatology tutor pairs (nurses/occupational therapists). Usual care – brief discussion of a RA fatigue self-management booklet with the research nurse. Main outcome measures Primary – fatigue impact (as measured by the BRAF-NRS) at 26 weeks. Secondary – fatigue severity/coping (as measured by the BRAF-NRS); broader fatigue impact [as measured by the Bristol Rheumatoid Arthritis Fatigue Multidimensional Questionnaire (BRAF-MDQ)]; self-reported clinical status; quality of life; mood; self-efficacy; and satisfaction. All data were collected at weeks 0, 6, 26, 52, 78 and 104. In addition, fatigue data were collected at weeks 10 and 18. The intention-to-treat analysis conducted was blind to treatment allocation, and adjusted for baseline scores and centre. Cost-effectiveness was explored through the intervention and RA-related health and social care costs, allowing the calculation of quality-adjusted life-years (QALYs) with the EuroQol-5 Dimensions, five-level version (EQ-5D-5L). Tutor and focus group interviews were analysed using inductive thematic analysis. Results A total of 308 out of 333 patients completed 26 weeks (RAFT, n/N = 156/175; control, n/N = 152/158). At 26 weeks, the mean BRAF-NRS impact was reduced for the RAFT programme (–1.36 units; p < 0.001) and the control interventions (–0.88 units; p < 0.004). Regression analysis showed a difference between treatment arms in favour of the RAFT programme [adjusted mean difference –0.59 units, 95% confidence interval (CI) –1.11 to –0.06 units; p = 0.03, effect size 0.36], and this was sustained over 2 years (–0.49 units, 95% CI –0.83 to –0.14 units; p = 0.01). At 26 weeks, further fatigue differences favoured the RAFT programme (BRAF-MDQ fatigue impact: adjusted mean difference –3.42 units, 95% CI –6.44 to – 0.39 units, p = 0.03; living with fatigue: adjusted mean difference –1.19 units, 95% CI –2.17 to –0.21 units, p = 0.02; and emotional fatigue: adjusted mean difference –0.91 units, 95% CI –1.58 to –0.23 units, p = 0.01), and these fatigue differences were sustained over 2 years. Self-efficacy favoured the RAFT programme at 26 weeks (Rheumatoid Arthritis Self-Efficacy Scale: adjusted mean difference 3.05 units, 95% CI 0.43 to 5.6 units; p = 0.02), as did BRAF-NRS coping over 2 years (adjusted mean difference 0.42 units, 95% CI 0.08 to 0.77 units; p = 0.02). Fatigue severity and other clinical outcomes were not different between trial arms and no harms were reported. Satisfaction with the RAFT programme was high, with 89% of patients scoring ≥ 8 out of 10, compared with 54% of patients in the control arm rating the booklet (p < 0.0001); and 96% of patients and 68% of patients recommending the RAFT programme and the booklet, respectively, to others (p < 0.001). There was no significant difference between arms for total societal costs including the RAFT programme training and delivery (mean difference £434, 95% CI –£389 to £1258), nor QALYs gained (mean difference 0.008, 95% CI –0.008 to 0.023). The probability of the RAFT programme being cost-effective was 28–35% at the National Institute for Health and Care Excellence’s thresholds of £20,000–30,000 per QALY. Tutors felt that the RAFT programme’s CB approaches challenged their usual problem-solving style, helped patients make life changes and improved tutors’ wider clinical practice. Limitations Primary outcome data were missing for 25 patients; the EQ-5D-5L might not capture fatigue change; and 30% of the 2-year economic data were missing. Conclusions The RAFT programme improves RA fatigue impact beyond usual care alone; this was sustained for 2 years with high patient satisfaction, enhanced team skills and no harms. The RAFT programme is < 50% likely to be cost-effective; however, NHS costs were similar between treatment arms. Future work Given the paucity of RA fatigue interventions, rheumatology teams might investigate the pragmatic implementation of the RAFT programme, which is low cost. Trial registration Current Controlled Trials ISRCTN52709998. Funding This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 57. See the NIHR Journals Library website for further project information.

show abstract

“…However, even with high levels of flexibility and autonomy, fatigue remains a persistent challenge to employment for people with RDs (Holland & Collins, ; Mancuso et al, ). Thus, further research on fatigue management interventions is essential (McCormack, O'Shea, Doran, & Connolly, ),…”

Section: Discussionmentioning

confidence: 99%

“I actually just really need to stop work sometimes”: Exploring fatigue‐related barriers to employment among people with rheumatic diseases

Helme

Hegarty

Stebbings

et al. 2018

Musculoskeletal Care

View full text Add to dashboard Cite

Purpose: Fatigue is a common symptom of many rheumatic diseases (RDs), but more research is needed to explore the experience of fatigue and its impact on employment among people with RDs. The aim of the present study was to investigate experiences of fatigue, its impact on employment and strategies that people with RD use to continue working.Method: Semi-structured in-depth interviews were conducted with five participants with a range of RDs living in New Zealand (three women, two men; aged 45-64 years). All participants were employed part time at the time of the interview.The transcripts were subjected to inductive thematic analysis, led by the first author, who had an RD. Results: Four themes resulted from the analysis: (a) workplace management and coping strategies; (b) the function of positive workplace relationships; (c) barriers to understanding; and (d) collectively improving understanding. These themes act to explain how individuals with RDs in employment believe fatigue to have a bearing on their work, how they manage fatigue at work, how they believe coworkers and employers perceive and manage their fatigue, and what they believe could improve the understanding of fatigue in workplaces.Conclusions: Individuals with RDs in employment describe fatigue as playing a substantial role in their experiences at work. This research expands on previous literature addressing barriers to employment in those with RDs by specifically addressing the relevance of fatigue. It is imperative to provide information to employers, and guidelines for employees with an RD who are experiencing fatigue should outline appropriate strategies for success at work.

show abstract

Impact of a fatigue management in work programme on meeting work demands of individuals with rheumatic diseases: A pilot study

Cited by 11 publications

References 33 publications

Disease Activity, Occupational Participation, and Quality of Life for Individuals with and without Severe Fatigue in Ankylosing Spondylitis

Disease Activity, Occupational Participation, and Quality of Life for Individuals with and without Severe Fatigue in Ankylosing Spondylitis

Group cognitive–behavioural programme to reduce the impact of rheumatoid arthritis fatigue: the RAFT RCT with economic and qualitative evaluations

“I actually just really need to stop work sometimes”: Exploring fatigue‐related barriers to employment among people with rheumatic diseases

Contact Info

Product

Resources

About