medwireNews: Telephone-delivered exercise and cognitive behavioral interventions improve fatigue severity and impact versus usual care in people with inflammatory rheumatic diseases, LIFT study data show.
The improvements lasted at least 6 months after the interventions finished and “should be considered as a key component of inflammatory rheumatic disease management in routine clinical practice,” write Neil Basu (University of Glasgow, UK) and co-authors in The Lancet Rheumatology.
Basu and team compared cognitive behavioral approaches (CBA) and personalized exercise programs (PEP) with usual care, namely a Versus Arthritis (formerly Arthritis Research UK) education booklet for fatigue, in 367 people (mean age 57 years, 75% women) with rheumatoid arthritis (55%), connective tissue disease (21%), axial spondyloarthritis (20%), or other inflammatory rheumatic diseases (4%).
The CBA targeted unhelpful beliefs and behaviors, while PEP was an individually tailored exercise program combined with behavioral therapy that was designed to normalize misperceptions of effort and enhance exercise tolerance.
Both programs included accompanying manuals and were delivered by trained rheumatology health professionals during a maximum of seven one-to-one sessions, each up to 45 minutes long, over a 14-week period with a booster session at 22 weeks.
The researchers found that, at 56 weeks, individuals in the CBA group reported significantly greater improvements in fatigue severity, measured on the Chalder Fatigue Scale, and fatigue impact, measured on the Fatigue Severity Scale, than those in the usual care group, with mean differences of 2.36 and 0.58 points, respectively.
The improvements were also significantly better with PEP versus usual care, at a mean difference of 3.03 points for fatigue severity, and 0.64 points for fatigue impact.
“The effects of PEP and CBA were medium sized for the coprimary outcomes of fatigue severity and impact and more than the reported minimum clinically important reductions of the corresponding measures,” Basu et al remark.
The researchers found that both treatments also improved general wellbeing, mental health-related quality of life, and sleep disturbance relative to usual care, while PEP additionally led to significant reductions in depression and work disability and a significant increase in valued life activities.
They comment that the “generic delivery [of the two interventions] across inflammatory rheumatic diseases by trained members of the specialist team should reduce barriers to health service implementation.”
The authors also note that the although the underlying mechanisms behind their findings are unknown, they “do not anticipate that these interventions target the primary causes of fatigue (which remain uncharacterised), but hypothesise that they attenuate factors that maintain the persistence and impact of the symptom.”
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