The NIHR Research Design Service is closed to new requests from 30 September 2023. We will continue to support our existing clients with existing projects up to 31 March 2024. If you have a question you can email us.
For support with any new project ideas please now contact the NIHR Research Support Service.

Professor Sarah Hewlett

Professor of Rheumatology Nursing
University of the West of England, Bristol

Reducing Arthritis Fatigue - clinical Teams using cognitive behavioural approaches (RAFT)

A multicentre study designed to test a group cognitive-behavioural intervention for rheumatoid arthritis fatigue was awarded over £1.3m funding from the NIHR Health Technology Assessment (HTA) Programme, obtained with RDS support.

Rheumatoid Arthritis (RA) is a lifelong condition leading to joint damage and disability. Up to 70% of people with RA are tired and experience overwhelming and unmanageable physical exhaustion or ‘wipe-out’. Physical, mental and emotional tiredness disturbs social and work activities, concentration and memory, causing frustration and tearfulness. RA fatigue may be caused by combinations of inflammation, pain, disability, depression, stress, poor sleep, and behaviour. Many patients are unable to manage their fatigue and report that clinical staff don’t help. Recent research has highlighted the critical role of patient self-management in persistent RA fatigue and the need for self-management methods. Cognitive-behavioural therapy (CBT) helps patients make links between beliefs, feelings, behaviours and symptoms in order to help them alter their behaviour. The key self-management skills of problem-solving and goal-setting can be enhanced by sharing the learning process in groups. Additionally, using other patients as role models can help increase self-belief and confidence.

The research team recently developed and studied a psychologist-led CBT approach course to help people manage RA fatigue. The intervention proved to be effective in improving fatigue impact, severity and coping, mood, sleep and disability. They understand that few rheumatology teams have psychologists and have now designed a more practical method suitable for delivery by rheumatology health professionals who are not CBT therapists, using a detailed manual. The RAFT study, led by Professor Sarah Hewlett in Bristol, aims to find out how well this method works and the cost/savings to the NHS in comparison to usual fatigue management.

Professor Sarah Hewlett said “The RDS were critical in helping us work out the best methodology for our multi-centre RCT of a complex intervention into self-management. As collaborators, they advised on and reviewed the developing application and protocol, and calculated our sample sizes that had to include the complexities of potential group and centre effects.”