Patient perspectives of managing fatigue in ankylosing spondylitis, and views on potential interventions: a qualitative study

<p>Background: Fatigue is a major component of living with ankylosing spondylitis (AS), though it has been largely over-looked, and currently there are no specific agreed management strategies.</p> <p>Methods: This qualitative exploratory study involved participants who are members of an existing population-based ankylosing spondylitis (PAS) cohort. Participants residing in South West Wales were invited to participate in a focus group to discuss; (1) effects of fatigue, (2) self-management strategies and (3) potential future interventions. The focus groups were audio-recorded and the transcripts were analysed using thematic analysis.</p> <p>Results: Participants consisted of 3 males/4 females (group 1) and 4 males/3 females (group 2), aged between 35 and 73 years (mean age 53 years). Three main themes were identified: (1) The effects of fatigue were multi-dimensional with participants expressing feelings of being ‘drained’ (physical), ‘upset’ (emotional) and experiencing ‘low-mood’ (psychological); (2) The most commonly reported self-management strategy for fatigue was a balanced combination of activity (exercise) and rest. Medication was reluctantly taken due to side-effects and worries over dependency; (3) Participants expressed a preference for psychological therapies rather than pharmacological for managing fatigue. Information on Mindfulness-Based Stress Reduction (MBSR) was received with interest, with recommendations for delivery in a group format with the option of distance-based delivery for people who were not able to attend a group course.</p> <p>Conclusions: Patients frequently try and manage their fatigue without any formal guidance or support. Our research indicates there is a need for future research to focus on psychological interventions to address the multi-faceted aspects of fatigue in AS.</p&gt

Assessment of fatigue in the management of patients with ankylosing spondylitis

BACKGROUND: Pain, stiffness, functional impairment, range of motion and quality of life are the main conventional domains used in studies evaluating ankylosing spondylitis (AS). However, fatigue has been reported as the major complaint of AS patients. OBJECTIVES: To evaluate fatigue as a potential independent domain in comparison with the 'conventional' ones and to evaluate the sensitivity to change after non-steroidal anti-inflammatory drug (NSAID) therapy. METHODS: Patients were classified as having painful AS (modified New York criteria). The following variables were recorded at baseline and after 6 weeks of therapy (either placebo or NSAIDs): pain (VAS), function (Bath Ankylosing Spondylitis Functional Index), patient's global assessment (VAS), inflammation (night pain), morning stiffness, metrology (Schober test, finger-to-floor) and fatigue using 0-100 VAS scale. Analysis consisted of (i) the prevalence of fatigue (VAS value of at least 50 mm), (ii) the independence of the information evaluated using a regression model, and (iii) the sensitivity to change, by calculating the standardized response mean (mean change/s.d. change) (SRM) between placebo and NSAID group. RESULTS: Fatigue was considered important in 401 patients (out of 639: 63%). The information provided by the variables 'pain', 'function' and 'global assessment' explained only 44% of the variability of the variable 'fatigue' (similar analyses considering 'pain' on the one hand and 'function' on the other hand as the dependent variables showed an R2 value of 34 and 60%, respectively). The NSAID treatment effect (SRM) was higher for the variables 'pain' and 'function' (0.76 and 0.71, respectively) than for the variable 'fatigue' (0.34). CONCLUSION: This study strongly suggests that fatigue should be considered as an independent domain to be systematically evaluated in AS patients and that conventional therapy such as NSAIDs have a lower effect on this domain than on pain or functional impairment