Therapists' experiences of remotely delivering cognitive-behavioural or graded-exercise interventions for fatigue: a qualitative evaluation

Sarah E Bennett; Celia Almeida; Eva-Maria Bachmair; Stuart R Gray; Karina Lovell; Lorna Paul; Alison Wearden; Gary J Macfarlane; Neil Basu; Emma Dures; LIFT study team

doi:10.1093/rap/rkac083

Therapists' experiences of remotely delivering cognitive-behavioural or graded-exercise interventions for fatigue: a qualitative evaluation

Sarah E Bennett^* (Corresponding Author), Celia Almeida, Eva-Maria Bachmair, Stuart R Gray, Karina Lovell, Lorna Paul, Alison Wearden, Gary J Macfarlane, Neil Basu, Emma Dures, LIFT study team

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

OBJECTIVE: Fatigue is a challenging feature of all inflammatory rheumatic diseases. LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomized Trial) included remotely delivered personalized exercise programme (PEP) or cognitive-behavioural approach (CBA) interventions. The aim of this nested qualitative evaluation was to understand rheumatology health professionals' (therapists') perspectives of delivering the interventions in the LIFT trial.

METHODS: A subgroup of therapists who had delivered the personalized exercise programme (PEP) and cognitive-behavioural approach (CBA) interventions took part in semi-structured telephone interviews.

RESULTS: Seventeen therapists (13 women and 4 men) who delivered PEP ( n = 8) or CBA ( n = 9) interventions participated. Five themes were identified. In 'The benefits of informative, structured training', therapists described how they were able to practice their skills, and the convenience of having the LIFT manual for reference. When 'Getting into the swing of it', supporting patients gave therapists the confidence to tailor the content of the manual to each patient. Clinical supervision supported therapists to gain feedback and request assistance when required. In 'Delivering the intervention', therapists reported that patients valued the opportunity to talk about their fatigue and challenge their beliefs. In 'Challenges in delivering the LIFT intervention', therapists struggled to work in partnership with patients who lacked motivation or stopped engaging. Finally, in 'LIFT developing clinical skills', therapists gained confidence and professional satisfaction, seeing patients' fatigue improve over time.

CONCLUSION: The findings support the provision of training for rheumatology health professionals to remotely deliver fatigue-management interventions. Insights from these trials can be used to better improve clinical practice and service provision.

Original language	English
Article number	rkac083
Number of pages	8
Journal	Rheumatology advances in practice
Volume	6
Issue number	3
Early online date	17 Oct 2022
DOIs	https://doi.org/10.1093/rap/rkac083
Publication status	Published - 17 Oct 2022

Bibliographical note

Funding
This work was supported by Versus Arthritis [grant number 21175].

Supplementary data
Supplementary data are available at Rheumatology Advances in Practice online.

Keywords

fatigue
qualitative
exercise
cognitive-behavioural approaches
rheumatic diseases

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Cite this

Bennett, S. E., Almeida, C., Bachmair, E.-M., Gray, S. R., Lovell, K., Paul, L., Wearden, A., Macfarlane, G. J., Basu, N., Dures, E., & LIFT study team (2022). Therapists' experiences of remotely delivering cognitive-behavioural or graded-exercise interventions for fatigue: a qualitative evaluation. Rheumatology advances in practice, 6(3), Article rkac083. https://doi.org/10.1093/rap/rkac083

Bennett, SE, Almeida, C, Bachmair, E-M, Gray, SR, Lovell, K, Paul, L, Wearden, A, Macfarlane, GJ, Basu, N, Dures, E & LIFT study team 2022, 'Therapists' experiences of remotely delivering cognitive-behavioural or graded-exercise interventions for fatigue: a qualitative evaluation', Rheumatology advances in practice, vol. 6, no. 3, rkac083. https://doi.org/10.1093/rap/rkac083

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title = "Therapists' experiences of remotely delivering cognitive-behavioural or graded-exercise interventions for fatigue: a qualitative evaluation",

abstract = "OBJECTIVE: Fatigue is a challenging feature of all inflammatory rheumatic diseases. LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomized Trial) included remotely delivered personalized exercise programme (PEP) or cognitive-behavioural approach (CBA) interventions. The aim of this nested qualitative evaluation was to understand rheumatology health professionals' (therapists') perspectives of delivering the interventions in the LIFT trial.METHODS: A subgroup of therapists who had delivered the personalized exercise programme (PEP) and cognitive-behavioural approach (CBA) interventions took part in semi-structured telephone interviews.RESULTS: Seventeen therapists (13 women and 4 men) who delivered PEP ( n = 8) or CBA ( n = 9) interventions participated. Five themes were identified. In 'The benefits of informative, structured training', therapists described how they were able to practice their skills, and the convenience of having the LIFT manual for reference. When 'Getting into the swing of it', supporting patients gave therapists the confidence to tailor the content of the manual to each patient. Clinical supervision supported therapists to gain feedback and request assistance when required. In 'Delivering the intervention', therapists reported that patients valued the opportunity to talk about their fatigue and challenge their beliefs. In 'Challenges in delivering the LIFT intervention', therapists struggled to work in partnership with patients who lacked motivation or stopped engaging. Finally, in 'LIFT developing clinical skills', therapists gained confidence and professional satisfaction, seeing patients' fatigue improve over time. CONCLUSION: The findings support the provision of training for rheumatology health professionals to remotely deliver fatigue-management interventions. Insights from these trials can be used to better improve clinical practice and service provision.",

keywords = "fatigue, qualitative, exercise, cognitive-behavioural approaches, rheumatic diseases",

author = "Bennett, {Sarah E} and Celia Almeida and Eva-Maria Bachmair and Gray, {Stuart R} and Karina Lovell and Lorna Paul and Alison Wearden and Macfarlane, {Gary J} and Neil Basu and Emma Dures and {LIFT study team}",

note = "Funding This work was supported by Versus Arthritis [grant number 21175]. Supplementary data Supplementary data are available at Rheumatology Advances in Practice online. ",

year = "2022",

month = oct,

day = "17",

doi = "10.1093/rap/rkac083",

language = "English",

volume = "6",

journal = "Rheumatology advances in practice",

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T1 - Therapists' experiences of remotely delivering cognitive-behavioural or graded-exercise interventions for fatigue

T2 - a qualitative evaluation

AU - Bennett, Sarah E

AU - Almeida, Celia

AU - Bachmair, Eva-Maria

AU - Gray, Stuart R

AU - Lovell, Karina

AU - Paul, Lorna

AU - Wearden, Alison

AU - Macfarlane, Gary J

AU - Basu, Neil

AU - Dures, Emma

AU - LIFT study team

N1 - Funding This work was supported by Versus Arthritis [grant number 21175]. Supplementary data Supplementary data are available at Rheumatology Advances in Practice online.

PY - 2022/10/17

Y1 - 2022/10/17

N2 - OBJECTIVE: Fatigue is a challenging feature of all inflammatory rheumatic diseases. LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomized Trial) included remotely delivered personalized exercise programme (PEP) or cognitive-behavioural approach (CBA) interventions. The aim of this nested qualitative evaluation was to understand rheumatology health professionals' (therapists') perspectives of delivering the interventions in the LIFT trial.METHODS: A subgroup of therapists who had delivered the personalized exercise programme (PEP) and cognitive-behavioural approach (CBA) interventions took part in semi-structured telephone interviews.RESULTS: Seventeen therapists (13 women and 4 men) who delivered PEP ( n = 8) or CBA ( n = 9) interventions participated. Five themes were identified. In 'The benefits of informative, structured training', therapists described how they were able to practice their skills, and the convenience of having the LIFT manual for reference. When 'Getting into the swing of it', supporting patients gave therapists the confidence to tailor the content of the manual to each patient. Clinical supervision supported therapists to gain feedback and request assistance when required. In 'Delivering the intervention', therapists reported that patients valued the opportunity to talk about their fatigue and challenge their beliefs. In 'Challenges in delivering the LIFT intervention', therapists struggled to work in partnership with patients who lacked motivation or stopped engaging. Finally, in 'LIFT developing clinical skills', therapists gained confidence and professional satisfaction, seeing patients' fatigue improve over time. CONCLUSION: The findings support the provision of training for rheumatology health professionals to remotely deliver fatigue-management interventions. Insights from these trials can be used to better improve clinical practice and service provision.

AB - OBJECTIVE: Fatigue is a challenging feature of all inflammatory rheumatic diseases. LIFT (Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomized Trial) included remotely delivered personalized exercise programme (PEP) or cognitive-behavioural approach (CBA) interventions. The aim of this nested qualitative evaluation was to understand rheumatology health professionals' (therapists') perspectives of delivering the interventions in the LIFT trial.METHODS: A subgroup of therapists who had delivered the personalized exercise programme (PEP) and cognitive-behavioural approach (CBA) interventions took part in semi-structured telephone interviews.RESULTS: Seventeen therapists (13 women and 4 men) who delivered PEP ( n = 8) or CBA ( n = 9) interventions participated. Five themes were identified. In 'The benefits of informative, structured training', therapists described how they were able to practice their skills, and the convenience of having the LIFT manual for reference. When 'Getting into the swing of it', supporting patients gave therapists the confidence to tailor the content of the manual to each patient. Clinical supervision supported therapists to gain feedback and request assistance when required. In 'Delivering the intervention', therapists reported that patients valued the opportunity to talk about their fatigue and challenge their beliefs. In 'Challenges in delivering the LIFT intervention', therapists struggled to work in partnership with patients who lacked motivation or stopped engaging. Finally, in 'LIFT developing clinical skills', therapists gained confidence and professional satisfaction, seeing patients' fatigue improve over time. CONCLUSION: The findings support the provision of training for rheumatology health professionals to remotely deliver fatigue-management interventions. Insights from these trials can be used to better improve clinical practice and service provision.

KW - fatigue

KW - qualitative

KW - exercise

KW - cognitive-behavioural approaches

KW - rheumatic diseases

U2 - 10.1093/rap/rkac083

DO - 10.1093/rap/rkac083

M3 - Article

C2 - 36340509

SN - 2514-1775

VL - 6

JO - Rheumatology advances in practice

JF - Rheumatology advances in practice

IS - 3

M1 - rkac083

ER -

Therapists' experiences of remotely delivering cognitive-behavioural or graded-exercise interventions for fatigue: a qualitative evaluation

Abstract

Bibliographical note

Keywords

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