Adaptation and Feasibility Testing of a Fatigue Intervention in Adults With TBI

Post‐traumatic brain injury fatigue (PTBIF) is one of the most common and disablinglong‐term consequences of traumatic brain injury (TBI). Individuals with TBI frequentlyidentify fatigue as their most challenging symptom, reporting that it substantiallyaffects daily functioning, social participation, emotional well‐being, and overallquality of life. PTBIF is often persistent, difficult to manage, and can remainproblematic for years following injury. Fatigue after TBI is associated with cognitivedifficulties such as reduced attention and slower information processing, as well asemotional concerns including depression, anxiety, and pain. Despite its prevalence andimpact, effective fatigue management options for people with TBI remain limited.Research in other chronic health conditions suggests that cognitive behavioral approachesare among the most effective interventions for managing fatigue because they teachpractical self‐management skills and help individuals identify and modify behaviors,thoughts, and routines that may contribute to fatigue. However, most existing fatiguemanagement programs have been developed and tested in populations such as individualswith multiple sclerosis and cancer, with relatively few interventions specificallydesigned for people with TBI. In addition, many individuals with TBI face significantbarriers to accessing behavioral health services, including transportation challenges,financial limitations, limited availability of specialized providers, and geographicdistance from rehabilitation programs.To address these challenges, this study focuses on FACETS‐TBI (Fatigue: ApplyingCognitive Behavioral and Energy Effectiveness Techniques to Lifestyle for Traumatic BrainInjury), an adaptation of the original FACETS program developed for individuals withmultiple sclerosis. FACETS is an evidence‐based fatigue management intervention thatcombines cognitive behavioral strategies with practical energy conservation andself‐management techniques. The program was adapted specifically for adults with TBIthrough a systematic and stakeholder‐informed adaptation process guided by the ADAPTframework. The adaptation incorporated input from researchers, clinicians, individualsliving with TBI, and other key stakeholders to ensure that the content is relevant,acceptable, and responsive to the unique experiences of post‐traumatic brain injuryfatigue.The purpose of this study is to evaluate the feasibility of delivering FACETS‐TBIremotely to adults with TBI who experience significant fatigue and to generatepreliminary data that will inform the development of a future large‐scale randomizedcontrolled trial. The study will assess participant engagement, retention, sessionattendance, understanding of intervention content, satisfaction with participation, andoverall acceptability of the intervention. The study will also provide preliminaryinformation regarding potential changes in fatigue‐related outcomes, fatigueself‐management confidence, and participation in everyday activities and community life.FACETS‐TBI is delivered remotely in a group format and is designed to support thedevelopment of practical fatigue management skills that participants can apply in theirdaily lives. The intervention addresses topics such as understanding fatigue, identifyingcontributing factors, balancing activity and rest, improving sleep and recoverypractices, managing stress, recognizing unhelpful thinking patterns, developing effectivecoping strategies, and creating sustainable plans for long‐term fatigue management. Theprogram emphasizes participant involvement through facilitated discussions, structuredactivities, guided reflection, and between‐session practice assignments. Participants areencouraged to apply newly learned strategies in real‐world settings and reflect on theirexperiences throughout the program.To support interpretation of the feasibility and preliminary outcome findings, the studyincludes an attention control program designed to account for the non‐specific effects ofgroup participation, facilitator attention, intervention dose, and social interaction.The attention control program is adapted from the Brain Health Group, an educationalsupport intervention previously used with adults with TBI. Participants in the attentioncontrol program receive the same frequency and duration of group sessions as participantsin FACETS‐TBI and engage in structured discussions about general health and wellnesstopics relevant to life after TBI, such as memory, attention, emotional well‐being, andhealthy lifestyle behaviors. The attention control curriculum intentionally excludesfatigue management content and does not include the key cognitive behavioral andself‐management strategies incorporated into FACETS‐TBI. By providing a comparable groupexperience without the intervention's hypothesized active ingredients, the attentioncontrol program will help researchers distinguish the specific effects of FACETS‐TBI fromimprovements that may result from receiving attention, support, education, orparticipation in a group‐based program.The study also seeks to better understand participants' experiences with theintervention. Participants who complete FACETS‐TBI will provide feedback regarding theprogram's content, delivery, usefulness, and perceived impact. These perspectives will beused to identify strengths of the intervention, determine areas for improvement, andguide future refinements to the program before testing in a larger trial.Data collected during the study will include participant‐reported measures related tofatigue, fatigue impact on daily life, fatigue severity, confidence in managing fatigue,and participation in social and community activities. Additional information regardingparticipant engagement, intervention delivery, treatment fidelity, and satisfaction willbe collected to evaluate the practicality of implementing FACETS‐TBI in a remoterehabilitation setting. Qualitative interviews will provide further insight intoparticipants' perceptions of the intervention and recommendations for future development.By evaluating the feasibility, acceptability, and preliminary effects of FACETS‐TBI, thisstudy aims to advance the development of accessible, evidence‐based interventions forindividuals living with post‐traumatic brain injury fatigue. Findings from this work willinform the design of a larger clinical trial and may ultimately contribute to expandingrehabilitation options for both civilian and military populations affected by TBI.