Bristol Rheumatoid Arthritis Fatigue Scales

Fatigue is a major problem in people with rheumatoid arthritis (RA). Professor Hewlett’s research team have conducted and published qualitative research, which shows that patients struggle to manage both physical and cognitive fatigue and perceive it is being ignored by health professionals.

We have been working with patients to raise the profile of fatigue in RA, we now have international agreement that must be measured in all clinical trials. In addition, we have published a conceptual model of RA fatigue, and a randomised controlled trial of cognitive-behavioural therapy for self-management with excellent results. We are currently conducting Cochrane reviews of fatigue interventions in RA.

Bristol Rheumatoid Arthritis Fatigue Scales

We have developed and validated the Bristol RA Fatigue scales (BRAFs). The BRAF Multi-dimensional Questionnaire (BRAF MDQ), for the first time provides not only a global score but also a score for four different dimensions:

  • living with fatigue,
  • physical fatigue,
  • emotional fatigue and
  • cognitive fatigue.

In addition we have developed and validated a trio of single items that measure fatigue coping, severity and effect, using Numerical Rating Scales (BRAF-NRS).

These scales were developed in a series of studies that started with qualitative interviews with RA patients to identify important concepts, then focus groups of patients to draft specific items, then cognitive interviewing to test the language and understanding. Finally we used a large cohort of 229 patients to test the draft scales, resulting in a robust 20 item BRAF-MDQ, and the three single item BRAF- NRS.

The BRAFs have been shown to be reliable in patients who are stable, and sensitive to change in patients receiving medication change. They have been translated into 36 languages and are freely available for academic and clinical use.

For further information contact Professor Sarah Hewlett

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