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Open Access Highly Accessed Research article

Patient perspectives of managing fatigue in Ankylosing Spondylitis, and views on potential interventions: a qualitative study

Helen Davies1*, Sinead Brophy1, Michael Dennis1, Roxanne Cooksey1, Elizabeth Irvine1 and Stefan Siebert2

Author Affiliations

1 College of Medicine, Swansea University, Swansea, South Wales, UK

2 Institute of Infection Immunity and Inflammation, University of Glasgow, Glasgow, Scotland, UK

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BMC Musculoskeletal Disorders 2013, 14:163  doi:10.1186/1471-2474-14-163

Published: 9 May 2013



Fatigue is a major component of living with ankylosing spondylitis (AS), though it has been largely over-looked, and currently there are no specific agreed management strategies.


This qualitative exploratory study involved participants who are members of an existing population-based ankylosing spondylitis (PAS) cohort. Participants residing in South West Wales were invited to participate in a focus group to discuss; (1) effects of fatigue, (2) self-management strategies and (3) potential future interventions. The focus groups were audio-recorded and the transcripts were analysed using thematic analysis.


Participants consisted of 3 males/4 females (group 1) and 4 males/3 females (group 2), aged between 35 and 73 years (mean age 53 years). Three main themes were identified: (1) The effects of fatigue were multi-dimensional with participants expressing feelings of being ‘drained’ (physical), ‘upset’ (emotional) and experiencing ‘low-mood’ (psychological); (2) The most commonly reported self-management strategy for fatigue was a balanced combination of activity (exercise) and rest. Medication was reluctantly taken due to side-effects and worries over dependency; (3) Participants expressed a preference for psychological therapies rather than pharmacological for managing fatigue. Information on Mindfulness-Based Stress Reduction (MBSR) was received with interest, with recommendations for delivery in a group format with the option of distance-based delivery for people who were not able to attend a group course.


Patients frequently try and manage their fatigue without any formal guidance or support. Our research indicates there is a need for future research to focus on psychological interventions to address the multi-faceted aspects of fatigue in AS.