From conceptual integration to implementation-ready fatigue care

Davies et al. examine the feasibility of developing an integrative theoretical framework for fatigue across clinical conditions. Drawing on rapid scoping reviews and consensus workshops, they identify substantial inconsistency in definitions, measures, mechanisms, and intervention theory, and conclude that the current evidence base remains too fragmented to support a fully coherent cross-condition account. Their analysis already engages with Medical Research Council guidance on context, programme theory, stakeholder involvement, and implementation. This letter argues that the integrative agenda could be strengthened by specifying how it would be adopted and evaluated in health services organised around diagnoses and specialities. We propose three operational links: incorporating shared fatigue constructs and measures into cross-disease clinical guidance; coordinating referral, rehabilitation, monitoring, and self-management across specialities; and using patient-reported outcomes and lived experience in service evaluation without unnecessary measurement burden. Adoption, feasibility, fidelity, and sustainability should also be assessed as indicators of practical impact. Making these links explicit would extend, rather than replace, Davies et al.'s conceptual work and support the translation of cross-condition fatigue knowledge into patient-centred care.