A telephone-delivered treatment that incorporates cognitive behavioral strategies (CBA) and customized training programs (PEP) has been proven to provide and sustain significantly and statistically significant reductions in the intensity and extent of fatigue in people suffering from rheumatic illnesses. Researchers encourage rheumatologists and other specialists to use this method of treatment in their regular medical practice, according to an article which was released in The Lancet. 1

“Chronic fatigue can be a problem that is not properly managed for people suffering from chronic inflammatory diseases,” investigators stated. “CBA and PEP are efficient, however they aren’t often used due to their efficacy across various inflammatory diseases is unproven and regular face-to face sessions are generally not desirable, especially during a time of pandemic. We believed that remotely administered CBA and PEP could effectively reduce the severity of fatigue and effects across the various inflammatory rheumatic disorders.”

It was the LIFT trial (NCT03248518) consisted of a multi-center controlled, open-label parallel-group study that compared standard treatment in conjunction with a CBA delivered via telephone or PEP in comparison to a standard healthcare approach in hospitals throughout the United Kingdom (England and Scotland). Patients who were eligible, randomly randomized 1:1:1, had stable inflammatory rheumatic disorder and had a clinically significant, chronic fatigue. A web-based system of randomization was used to determine treatment allocation , and CBA and PEP sessions were provided during a six-month period by certified health professionals. The primary outcome was the severity of fatigue, as measured using an assessment called the Chalder Fatigue Scare as well as the impact (Fatigue Severity Scale) at week 56.

Between September 2017 and September 2019 three67 participants were random assigned to the PEP (n = 124) CBA (n = 121) or regular treatment (n was 122). The median age was 57.5 years, and 75 percent (n 274) of patients were women. The majority of participants (n = 200 55 percent) were diagnosed with Rheumatoid Arthritis, 78 (21 percent) had connective tissue diseases 72 (20 percent) suffered from axial spondyloarthritis and 14 (4 4 percent) were suffering from an additional inflammatory rheumatic disorder.

It was found that the Chalder Fatigue Scale included a total of 101 participants from the PEP group, 107 participants in the CBA group as well as 107 who were within the normal care cohort. Participants who were in both the PEP as well as CBA groups both had significantly higher levels of fatigue severity (Chalder Fatigue Scale; PEP adjusted mean difference of 3*03 [97*5% confidence interval -5*05 to 1*02], p=0*0007; CBA: -2*36 [-4*28 up to -0*44(p=0*0058) and the impact of fatigue (Fatigue Severity Scale PEP: -0*64, [-0*95 to 33], p0*0001 CBA: -0*58 [-0*87 up to -0*28], p0*0001) in comparison to the patients who received normal treatment alone. There were no serious adverse events identified.

Some limitations were the absence of complete masking because of the need to involve participants in making changes to their behavior. Furthermore, the comparator group was the usual care since the goal was to find out whether interventions had an effect on practices. However, the risk of detection bias was reduced by omitting the analysts and investigators from their assigned roles. Potential effects of nocebo when compared to the normal care cohort were not significant. Patients who were in the usual care cohort were provided with educational materials previously associated with positive outcomes and are currently associated with higher outcomes when compared with the baseline score and comparable attrition rates. Additionally, while the majority of patients stopped treatments, these numbers were consistent with prior research.

“CBA and PEP offered via telephone resulted in the most significant clinically-based and statistically statistical reduction in the severity of fatigue and impact on a broad variety of patients with a disease that was stabilised,” investigators concluded. “The treatments were well-accepted and their effects were sustained for six months after the end of treatment and were administered by members of multidisciplinary teams of rheumatology after the specialist training.”


Martin KR, Bachmair EM, Aucott L, et al. Protocol for a multicentre randomised controlled parallel-group trial to compare the effectiveness of remotely delivered cognitive-behavioural and graded exercise interventions with usual care alone to lessen the impact of fatigue in inflammatory rheumatic diseases (LIFT). BMJ Open. 2019;9(1):e026793. Published 2019 Jan 30. doi:10.1136/bmjopen-2018-026793