Managing fatigue in inflammatory arthritis: a real-world evaluation of program length and delivery

Fatigue is a significant yet often overlooked symptom in rheumatic diseases, impacting sleep, mental health and daily functioning. The aim of this study was to evaluate the effectiveness of a fatigue management program (FMP) developed in NHS Lothian, comparing a 4-week format to a 7-week format. The study also examines the impact of in-person vs online delivery on patient outcomes.

A retrospective analysis was conducted on 22 FMPs delivered between February 2020 and March 2024. Patients with inflammatory arthritis were referred to the program, with 142 patients participating. Initially, sessions were in-person, but due to COVID-19, the program transitioned online and was shortened from 7 to 4 weeks in response to high demand. Standardised patient-reported outcome measures (PROMs) assessed fatigue severity, fatigue impact, mental health and sleep quality. A control group (n = 16) received usual care (fatigue booklet).

Both the 4-week and 7-week FMPs significantly improved fatigue severity (P < 0.01), fatigue impact (P < 0.01), mental health (P < 0.01) and sleep quality (P < 0.01). No significant differences were found between the 4-week and 7-week programs (P > 0.05), nor between online and in-person delivery (P > 0.05). The control group showed no significant improvement in any measure.

A 4-week FMP is as effective as a 7-week program, making it a more accessible option. Virtual delivery provides an equally beneficial alternative to in-person sessions. These findings support the use of shorter, remotely delivered FMPs as a scalable, resource-efficient approach to fatigue management in rheumatology.