The co-creation of a COMbined Fatigue Intervention (COMFI) for people with inflammatory arthritis: a complex intervention

Objectives: To develop a group-based COMbined Fatigue Intervention (COMFI) that integrates a cognitive behavioural approach with physical activity to enhance self-management of fatigue and reduce fatigue severity and impact in people with inflammatory arthritis (IA). Methods: The development was guided by the British Medical Research Council's framework for complex interventions and was based on: (i) the identification of current evidence, (ii) selection of relevant theories, (iii) iterative modelling and refinement through 4 co-creation workshops with relevant stakeholders (patient research partners, patients, relatives, healthcare professionals, and researchers); and (iv) development of a manual for healthcare professionals. COMFI was developed across units in Denmark and Sweden. Results: The development resulted in a 24-week group-based fatigue intervention comprising of: (i) six group sessions delivered over 12 weeks, (ii) a seventh booster session at week 24, (iii) 1 optional individual session, (iv) a support telephone line during weeks 13 to 23, and (v) optional involvement of relatives in session 1 and 6. The intervention integrates the cognitive behavioural approach Focused Acceptance and Commitment Therapy and physical activity. Conclusion: COMFI is a novel co-created evidence-based intervention designed to support self-management of fatigue in people with IA. COMFI is ready for feasibility testing in Denmark and Sweden.