Remotely delivered cognitive-behavioural and personalized exercise interventions to lessen the impact of fatigue: a qualitative evaluation
Authors: Bennett Sarah E , Almeida Celia , Bachmair Eva-Maria , Gray Stuart R , Lovell Karina , Paul Lorna , Wearden Alison , Macfarlane Gary J , Basu Neil , Dures Emma ,   the LIFT study team, Aucott Lorna , Martin Kathryn , Dhaun Neeraj , Emsley Richard , Kidd Elizabeth , Kumar Vinod , MacLennan Graeme , Paul McNamee , Norrie John , Packham Jon , Ralston Stuart H , Siebert Stefan , Nicol Amy , Norris Karen , Mann Sandra , Van Lierop Lorna , Gomez Eli , McCurdy Fiona , Findlay Valerie , Hastie Neil , Morgan Eunice , Emmanuel Roselyn , Whibley Daniel , Urquart Aimee , MacPerson Laura , Rowland Janice , Kiddie Gwen , Pankhurst Debbie , Paul Johnstone , Nicholson Hilary , Dunsmore Angela , Knight Alison , Ellis John , Maclean Callum , Crighton Linda , Shearer Cameron , Coyle Judy , Begg Susan , Ackerman Lyndsey , Carnevale Jill , Arbuthnot Samantha , Watters Helen , Dockrell Dervil , Hamilton Debbie , Salutous Dario , Cathcart Susanne , Rimmer Dominic , Hughes Emma , Harvey Juliet , Gillies Mairi , Webster Susan , Milne Leeanne , Semple Gary , Duffy Katharine , Turner Lynne , Alexander John , Innes June , Clark Charlotte , Meek Christine , McKenna Elizabeth , Routledge Christine , Hinchcliffe-Hume Helain , Traianos Emmanuella , Dibnah Beth , Storey David , O'Callaghan Gemma , Baron Jenny Yael , Hunt Sally , Wheat Natalie , Smith Pam , Barcroft Elizabeth Ann , Thompson Amy , Tomlinson Johanne , Barber Jill , MacPerson Gladys , White Peter , Hewlett Sarah 
Published: June 2022

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.