Development and Testing of a Text Messaging Intervention to Manage Fatigue for Persons with Disabilities

Research Objectives: To identify key content for and determine trends in change from a 12-week fatigue self-management text message intervention targeting patient activation for persons with multiple sclerosis (MS), spinal cord injury (SCI), and stroke.

Design: Content development included a literature review and feedback from a consumer advisory board (CAB). The preliminary testing was conducted using a single-arm before-after trial.

Setting: CAB meetings were conducted over zoom. The intervention was delivered to participants via text messages.

Participants: The CAB, including two individuals from each disability group, and a neurologist provided input on the intervention content and delivery process. The intervention was then tested with 25 participants with MS (n=9), SCI (n=9), and stroke (n=7), recruited via convenience sampling.

Interventions: A text message library was developed across nine key content areas (e.g., sleep, energy conservation) and customized by patient activation levels, focusing either on building knowledge and awareness (levels 1-2) or increasing self-management skills and behaviors (levels 3-4).

Main Outcome Measures: CAB members rated the clarity and relevance of messages on a 5-point Likert scale. Intervention participants’ patient activation levels were established using the Patient Activation Measure. The primary outcome, fatigue, was measured by the Modified Fatigue Impact Scale and the PROMIS Fatigue short form. Secondary outcomes included physical function, social satisfaction, self-efficacy for managing chronic conditions, and sleep disturbance. Participants also rated their satisfaction with the intervention.

Results: CAB members rated messages with good clarity (mean=3.5-5 of 5) and relevance (mean=3.2-5 of 5). The final library was programmed into a digital platform to deliver prescheduled messages. We found moderate effects for fatigue and mild-to-moderate effects for social satisfaction and sleep (Partial eta2=0.04-0.12). Participant satisfaction with the intervention was high (mean=2.8-3.4 of 5).

Conclusions: For persons with disabilities, whose access to health services are often limited, this intervention may provide a feasible and effective alternative delivery model to increase access to health services and deliver content that aligns with the person’s readiness and needs.

Author(s) Disclosures:

Funding: Foundation for Barnes-Jewish Hospital