GW4 Community Studying Fatigue in People with Multiple Long-term Conditions

Background

Fatigue is a ubiquitous across multiple neurological and musculoskeletal conditions and is more severe in individuals with two or more long-term conditions, sometimes known as multimorbidity. The number of people living with multiple long-term conditions is increasing, and the presence of multiple long-term conditions poses a challenge to clinicians and patients as clinical guidelines (and the underpinning research) focus on single conditions.  

There is an urgent need to improve understanding and treatment of fatigue in individuals with multiple long-term conditions. At present, it is not clear which mechanistic pathways for fatigue are common across conditions and which are independent of the diagnostic label. Furthermore, it is not clear how fatigue presents across conditions, nor how best to define or measure fatigue across conditions. These factors critically impede the development and testing of targeted interventions for individuals with multiple long-term conditions.  

Our vision is to study fatigue regardless of associated diagnosis. Studying fatigue across multiple conditions, inclusive of multiple concurrent conditions, and at scale will allow us to identify mechanistic pathways that are common across conditions and identify ways in which conditions, or patients within a condition, cluster in their mechanistic pathways for fatigue. It will also enable us to identify the core outcomes that are needed clinically, across conditions and inclusive of multiple concurrent conditions.  

We aim to build on the infrastructure and expertise that exists across GW4 to enable the development of targeted physical [non-pharmacological] interventions for fatigue across diagnostic labels and in individuals with multiple long-term conditions, and ultimately to enable the conduct efficient and novel clinical trials of these interventions.   

Project Summary

The team held five events across the course of the project which enabled them to create a fatigue-focussed community of scholars to identify and address the key uncertainties and define the key boundaries required to deliver the long-term aim of efficient clinical trials of mechanistically informed interventions for fatigue across clinical conditions and in multiple concurrent long-term conditions.  

Initially, a launch event raised awareness of the collaboration and shared current research across GW4. This was followed by a series of workshops, each addressing a key uncertainty that must be resolved to progress towards developing mechanistically informed targeted interventions for fatigue. These workshops highlighted strengths and synergies across GW4 that are not currently being exploited and generated a summary of research priorities and potential pathways to address these priorities.

Alongside these events, a systematic review was conducted to synthesise existing evidence on mechanisms of fatigue in chronic health conditions and identify gaps in understanding to inform targeted studies. The findings from this, and the workshops, informed a final symposium which focussed on identifying collaborative projects for current funding opportunities.