Improvement in fatigue following a multidisciplinary, biopsychosocial intervention: data from 50 primary Sjogren's syndrome patients

Background. The Newcastle CRESTA Fatigue clinic is a UK NationalHealth Service multidisciplinary clinic, established in 2013 to support peoplewith the symptom of fatigue alongside a physical health condition. Localprimary Sjogren’s syndrome (PSS) patients experiencing fatigue, are offered a referral to this clinic by their rheumatology clinician. A medical consultant and an occupational therapist assess all new PSS patients to the CRESTA Fatigue clinic. The medical clinician identifies reversible causes of fatigue including; autonomic dysfunction, untreated comorbidities and reviews medications. The occupational therapist coordinates therapy interventions, ensuring these are tailored according to the needs of the patient. Therapy interventions include occupational therapy (activity management), physiotherapy (core strengthening exercises), health psychology, cognitive behavioural therapy for insomnia or a combination of therapies.Methods. Patient outcomes are collected routinely at each rheumatology out-Background. The Newcastle CRESTA Fatigue clinic is a UK National Health Service multidisciplinary clinic, established in 2013 to support people with the symptom of fatigue alongside a physical health condition. Local primary Sjogren’s syndrome (PSS) patients experiencing fatigue, are offered a referral to this clinic by their rheumatology clinician.A medical consultant and an occupational therapist assess all new PSS patients to the CRESTA Fatigue clinic. The medical clinician identifies reversible causes of fatigue including; autonomic dysfunction, untreated comorbidities and reviews medications. The occupational therapist coordinates therapy interventions, ensuring these are tailored according to the needs of the patient. Therapy interventions include occupational therapy (activity management), hysiotherapy (core strengthening exercises), health psychology, cognitive behavioural therapy patient clinic visit. We compared fatigue (visual analogue scale 0-100) at referral, discharge and at 6-12 months following discharge from the CRESTA Fatigue clinic for the first PSS patient cohort (n=50) accessing the CRESTA Fatigue clinic using a Wilcoxon signed rank paired analysis. Next, we entered other baseline clinical data (age, disease activity (ESSDAI), dryness (1-10), pain (1-10), depression and anxiety scores (Hospital Anxiety and Depression Scale) into a multivariate analysis to identify factors which predict improvements in fatigue following the intervention.Results. Each patient had a median of 8.5 (IQR 10.25) clinic appointments. Fatigue scores improved from a mean of 78.4 to 65 and were maintained at 6-12 months follow-up. These results were statistically significant (p<0.001) and clinically meaningful1. High pain and low anxiety scores at baseline predicted greater improvements in fatigue following the intervention (p<0.05).Conclusion. A tailored multidisciplinary fatigue intervention has improved fatigue severity in this PSS patient group. These findings demonstrate the clinical effectiveness of interdisciplinary care for fatigue management in PSS.References1. GEORGE A, POPE JE: The minimally important difference (MID) for patient-reported outcomes including pain, fatigue, sleep and the health assessment questionnaire disability index (HAQ-DI) in primary Sjogren’s syndrome.