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 disabling long-term consequences of traumatic brain injury (TBI). Individuals with TBI frequently identify fatigue as their most challenging symptom, reporting that it substantially affects daily functioning, social participation, emotional well-being, and overall quality of life. PTBIF is often persistent, difficult to manage, and can remain problematic for years following injury. Fatigue after TBI is associated with cognitive difficulties such as reduced attention and slower information processing, as well as emotional concerns including depression, anxiety, and pain. Despite its prevalence and impact, effective fatigue management options for people with TBI remain limited.

Research in other chronic health conditions suggests that cognitive behavioral approaches are among the most effective interventions for managing fatigue because they teach practical self-management skills and help individuals identify and modify behaviors, thoughts, and routines that may contribute to fatigue. However, most existing fatigue management programs have been developed and tested in populations such as individuals with multiple sclerosis and cancer, with relatively few interventions specifically designed for people with TBI. In addition, many individuals with TBI face significant barriers to accessing behavioral health services, including transportation challenges, financial limitations, limited availability of specialized providers, and geographic distance from rehabilitation programs.

To address these challenges, this study focuses on FACETS-TBI (Fatigue: Applying Cognitive Behavioral and Energy Effectiveness Techniques to Lifestyle for Traumatic Brain Injury), an adaptation of the original FACETS program developed for individuals with multiple sclerosis. FACETS is an evidence-based fatigue management intervention that combines cognitive behavioral strategies with practical energy conservation and self-management techniques. The program was adapted specifically for adults with TBI through a systematic and stakeholder-informed adaptation process guided by the ADAPT framework. The adaptation incorporated input from researchers, clinicians, individuals living with TBI, and other key stakeholders to ensure that the content is relevant, acceptable, and responsive to the unique experiences of post-traumatic brain injury fatigue.

The purpose of this study is to evaluate the feasibility of delivering FACETS-TBI remotely to adults with TBI who experience significant fatigue and to generate preliminary data that will inform the development of a future large-scale randomized controlled trial. The study will assess participant engagement, retention, session attendance, understanding of intervention content, satisfaction with participation, and overall acceptability of the intervention. The study will also provide preliminary information regarding potential changes in fatigue-related outcomes, fatigue self-management confidence, and participation in everyday activities and community life.

FACETS-TBI is delivered remotely in a group format and is designed to support the development of practical fatigue management skills that participants can apply in their daily lives. The intervention addresses topics such as understanding fatigue, identifying contributing factors, balancing activity and rest, improving sleep and recovery practices, managing stress, recognizing unhelpful thinking patterns, developing effective coping strategies, and creating sustainable plans for long-term fatigue management. The program emphasizes participant involvement through facilitated discussions, structured activities, guided reflection, and between-session practice assignments. Participants are encouraged to apply newly learned strategies in real-world settings and reflect on their experiences throughout the program.