Table 3.
Themes, subthemes and supporting quotes from the thematic analysis
| Theme | Subtheme | Supporting quotes |
|---|---|---|
| Not a miracle cure, but a way to manage fatigue | Not knowing what was wrong | I think the worst thing was not knowing what was wrong but knowing that I had something wrong [CBA 001] |
| I don’t think I really recognized it as being part of the rheumatoid [PEP 43] | ||
| Not recognized by rheumatology professionals | Fatigue … there seemed to be a non-recognition on the part of rheumatology that this was central to my condition [CBA 007] | |
| I don’t think … fatigue … is very well understood [CBA 016] | ||
| Keen to try | The GP wasn’t helpful, so I had to find my own way, so when this came along I thought, ‘Right, I’ll try… I’ll do anything’ [PEP 041] | |
| I knew it wasn’t a miracle cure, not like it would suddenly, like, take the condition away. I just felt [LIFT] was well, just another tool in my box, sort of thing, that I could pull out when I needed it, and that’s what it transpired to be [CBA 004] | ||
| I was quite happy to take part in it, you know, to try anything to get a benefit and see if I could get a better quality of life … because I’ve tried everything else [PEP 034] | ||
| Building a therapeutic relationship | Therapists who understood IRD fatigue | I liked the physiotherapist that I got allocated, she was really good, and because she has a family member that’s got RA she could relate more [PEP 031] |
| I wouldn’t have liked to join a gym with some super trainer there who has no idea about medical conditions [PEP 026] | ||
| Because she was an OT and [part of the] team that work with [RA] she understood [CBA 004] | ||
| Continuity of care | They remembered things from your last visit and just different things, and I think it was due to the continuity of the same face and the same voice and stuff like that makes a difference [CBA 008] | |
| It was really good having that support, on the end of the phone okay, knowing that someone was there interested in what I’d managed to achieve that week or that fortnight [PEP 029] | ||
| Structure, self-monitoring and being accountable | The value of follow-up | …because you know that person is going to be ’phoning you and asking you. So, you think, ‘Oh, well, I’d better make an effort. Better make sure I’ve made an effort this week’, and I think that’s quite a good thing [PEP 036] |
| I think if I’d been told just to get on with it and I knew that nobody was going to be ’phoning and checking up on me then I probably would’ve … I’d quite easily miss out days and here and there [PEP 031] | ||
| Setting achievable goals | We agreed them [goals] together on the basis of where I live and what seemed suitable [PEP 030] | |
| [The LIFT therapist] said, ‘Don’t get upset or frustrated if you don’t achieve the things that you wanted to achieve, because you’re doing okay’ [CBA 005] | ||
| Better equipped to cope with fatigue | Greater understanding of the symptom | I keep a diary each day now, and I find that brilliant, to be honest. It helps you understand why I did feel the way I did that day [CBA 022] |
| I started keeping a fatigue diary and I still do that now; I’ve kept it going. One of the things that I noticed very, very quickly was a pattern that I hadn’t really thought of, and having noticed the pattern I was then able to alter my working, my working regime to try and avoid the boom and bust sort of idea [CBA 006] | ||
| Feeling more positive in the face of fatigue | What is different is that I have more enthusiasm about doing things.… It’s given me my courage back, I think [PEP 035] | |
| I think it’s given me a lot of confidence, and the fatigue’s a lot better [PEP 037] | ||
| Yes, on the whole, I feel more positive about coping with fatigue [CBA 005] | ||
| Not as effective if already active | I was walking daily anyway, and I still am walking daily, at least one and a half kilometres, maybe two during the week, and much higher at the weekend [PEP 026] | |
| [The LIFT Trial's] overall impact was limited because it did not show me anything that I was unaware of beforehand [CBA 007] | ||
| A tailored programme delivered remotely | Benefits of telephone delivery | I live out-with the city centre in a sort of rural area … just even getting myself organized to go to appointments and things like that, I found really hard, and it just added to the fatigue [CBA 004] |
| I found it quite beneficial because it meant I didn’t have to go travelling up to see them [PEP 027] | ||
| On-going support | It can’t be continual, on-going, but I think if you had somebody … almost like checking up on you, because self-motivation’s okay, but after a while, you know, life just gets in the way [PEP 031] | |
| Maybe another couple of sessions further down the line checking back in, if you’d fallen off the wagon as it were, or just how are you doing kind of thing, would have been quite good [CBA 021] | ||
| I still have a sort of hankering of meeting with other people to see how they were coping because sometimes one feels quite isolated [CBA 005] |
CBA: cognitive behavioural approach; GP: general practitioner; IRD: inflammatory rheumatic disease; LIFT: Lessening the Impact of Fatigue in inflammatory rheumatic diseases: a randomized Trial; OT: occupational therapist; PEP: personalized exercise programme.