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medwireNews: Findings from the RAFT trial support the use of cognitive behavioral therapy (CBT) delivered by rheumatology teams to reduce the impact of fatigue among patients with rheumatoid arthritis (RA).
Previous CBT interventions that demonstrated a positive impact on fatigue in this patient group were delivered by clinical psychologists, but very few rheumatology units have such specialists, Sarah Hewlett (University of the West of England, Bristol, UK) told delegates at the 2018 British Society for Rheumatology Annual Conference in Liverpool, UK.
She explained that the RAFT (Reducing Arthritis Fatigue by clinical Teams) intervention, consisting of weekly 2-hour group sessions for 6 weeks plus a consolidation session at week 14, was designed to be delivered by conventional rheumatology teams. The intervention included activity monitoring and goal setting as integral components, and addressed links between thoughts, feelings, and behaviors, whereas usual care involved a short discussion of the Arthritis Research UK fatigue booklet.
At the 6-month follow-up, the 156 participants who were randomly assigned to receive the RAFT intervention had significantly lower fatigue impact scores on the Bristol Rheumatoid Arthritis Fatigue Numerical Rating Scales (BRAF-NRS) than the 152 patients given usual care, at 5.74 versus 6.36 points.
Hewlett noted that patients in both arms experienced a significant improvement in BRAF-NRS impact scores from baseline to month 6, but the improvement was significantly greater among those in the RAFT than the control group, with reductions of 1.36 versus 0.88 points.
Patients in the RAFT group also reported a significantly lower degree of emotional fatigue and significantly better RA self-efficacy at 6 months than those given usual care, and the benefits were maintained over 2 years of follow-up, reported Hewlett.
However, she remarked that there was no significant difference in fatigue severity between the two groups, suggesting that the intervention may “have changed patients’ priorities in how they use the energy that they do have.”
Summing up the findings, Hewlett said: “We have an intervention that works, and that lasts for 2 years without further clinical input.”
She believes that “teaching our rheumatology teams to deliver CBT may be a useful therapeutic approach.”
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