Managing fatigue after an acquired brain injury: a pilot randomised controlled trial and qualitative investigation

Abstract

Background/Aims Fatigue after brain injury is common and enduring, and rehabilitation improves patient understanding and strategy development. The aim of this study was to determine whether therapy supporting fatigue management can be provided economically in groups to inpatients undertaking rehabilitation. Methods A mixed-methods study was undertaken, including a pilot randomised control trial and a parallel qualitative investigation. A total of 78 adult inpatients with moderate to severe acquired brain injury were recruited to the study; 40 were allocated to routine usual care and 38 were allocated to the intervention, which consisted of routine usual care plus four group therapy sessions that took place over 2 weeks, run by an experienced occupational therapist. Participants were aged between 18 and 65 years and were considered to be able to manage learning in a group setting. Outcome measures were collected at baseline and at the end of the therapy intervention (Barrow Neurological Institute Fatigue Scale, Quality of Life after Brain Injury questionnaire and a Fatigue Knowledge questionnaire assessing knowledge related to the aims of the education modules). A qualitative study was conducted after the quantitative investigation in the form of patient interviews. A total of 10 patients were interviewed to discuss their fatigue journey and impressions of receiving fatigue management therapy in a group. Results A repeated measures analysis of variance with time as a within-subject factor and group as a between-subjects factor showed no interaction effect of group × time for fatigue, quality of life or acquisition of knowledge; however, knowledge improved over time, irrespective of group allocation (P<0.01). Although most participants found the group work satisfactory in terms of overall knowledge development, a number would have preferred to address their specific fatigue issues in an individual session. Participants described a confusing journey understanding fatigue symptoms before therapy, but reported an improved understanding and acquiring management strategies after receiving the educational therapy sessions. Conclusions Education regarding fatigue following brain injury can be provided successfully to inpatients receiving rehabilitation in group settings. However, it may be important to build in an additional individual therapy session to address each patient's individual issues and queries.