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Qualitative research
Research
The Experience of people with rheumatoid arthritis living with fatigue: a qualitative metasynthesis
  1. Jette Primdahl1,2,
  2. Annette Hegelund3,
  3. Annette Gøntha Lorenzen4,
  4. Katrine Loeppenthin5,
  5. Emma Dures6,
  6. Bente Appel Esbensen7,8
  1. 1 Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
  2. 2 Research department, Sygehus Sønderjylland, Aabenraa and King Christian X’s Hospital for Rheumatic Diseases, Graasten, Denmark
  3. 3 Center of COPD Competences, Hospital of Naestved, Slagelse, Denmark
  4. 4 Department of Quality, Research, Innovation and Education, Odense Universitetshospital, Odense, Denmark
  5. 5 The Danish Cancer Society Research Center, Copenhagen, Denmark
  6. 6 Nursing and Midwifery, University of the West of England, Bristol, UK
  7. 7 Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, VRR, Rigshospitalet, Copenhagen, Denmark
  8. 8 Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Jette Primdahl; jprimdahl{at}gigtforeningen.dk

Abstract

Objectives To identify, appraise and synthesise qualitative studies on the experience of living with rheumatoid arthritis (RA)-related fatigue.

Methods We conducted a qualitative metasynthesis encompassing a systematic literature search in February 2017, for studies published in the past 15 years, in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, SveMed, PsychINFO and Web of Science. To be included, the studies had to report the experience of living with fatigue among adults with RA. The analysis and synthesis followed Malterud’s systematic text condensation.

Results Eight qualitative articles were included, based on 212 people with RA (69% women) and aged between 20 and 83 years old. The synthesis resulted in the overall theme ‘A vicious circle of an unpredictable symptom’. In addition, the synthesis derived four subthemes: ‘being alone with fatigue’; ‘time as a challenge’; ‘language as a tool for increased understanding’ and ‘strategies to manage fatigue’. Fatigue affects all areas of everyday life for people with RA. They strive to plan and prioritise, pace, relax and rest. Furthermore, they try to make use of a variety of words and metaphors to explain to other people that they experience that RA-related fatigue is different from normal tiredness. Despite this, people with RA-related fatigue experience feeling alone with their symptom and they develop their own strategies to manage fatigue in their everyday life.

Conclusions The unpredictability of RA-related fatigue is dominant, pervasive and is experienced as a vicious circle, which can be described in relation to its physical, cognitive, emotional and social impact. It is important for health professionals to acknowledge and address the impact of fatigue on the patients’ everyday lives. Support from health professionals to manage fatigue and develop strategies to increase physical activity and maintain work is important for people with RA-related fatigue.

  • long-term condition
  • tiredness
  • outcome
  • symptom
  • interview
  • impact

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-024338

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    Footnotes

    • Contributors KL, ED, BAE and JP: idea generation; AH, AGL, BAE and JP: literature search and initial analysis; all authors: final analysis and drafting of the manuscript and final approval of the manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement We do not have any additional data to share.

    • Patient consent for publication Not required.