Rationale and description of Tied by Tiredness: A blended care intervention for fatigue after acquired brain injury

Ela Lazeron-Savu; Tom Smejka; Bert Lenaert; Jeanette Dijkstra; Claire Wolfs; Vera Schepers; Rudolf Ponds; Caroline van Heugten

doi:10.1177/02692155251407318

Rationale and description of Tied by Tiredness: A blended care intervention for fatigue after acquired brain injury

Clin Rehabil. 2025 Dec 16:2692155251407318. doi: 10.1177/02692155251407318. Online ahead of print.

Authors

Ela Lazeron-Savu^{1

2}, Tom Smejka³, Bert Lenaert⁴, Jeanette Dijkstra^{1

5

6}, Claire Wolfs^{1

6

7}, Vera Schepers⁸, Rudolf Ponds^{1

7

9}, Caroline van Heugten^{5

7}

Affiliations

¹ School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
² Department of Medical Psychology, Catharina Hospital, Eindhoven, The Netherlands.
³ Section Teaching and Innovation of Learning, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
⁴ Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
⁵ Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
⁶ Department of Medical Psychology, Maastricht University Medical Center, Maastricht, The Netherlands.
⁷ Limburg Brain Injury Center, Maastricht, The Netherlands.
⁸ Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht, The Netherlands.
⁹ Departement of Medical Psychology, Amsterdam University Medical Center, Amsterdam, The Netherlands.

PMID: 41400937
DOI: 10.1177/02692155251407318

Abstract

AimThe development of a new intervention designed to reduce persistent fatigue following acquired brain injury through personalised support.RationaleFatigue is a common and long-lasting consequence after brain injury. Evidence indicates that tailored, multimodal interventions targeting individual experiences are more effective than standardised approaches.Materials and proceduresThe intervention combines real-time data collection using the Experience Sampling Method via a dedicated mHealth app with a workbook containing practical instructions and an online secure feedback environment. Patients complete eight short daily assessments for three consecutive days each week, collecting detailed information on fatigue and contextual factors such as mood, physical activities and social situations.Providers, setting, and deliveryTied by Tiredness is delivered by psychologists or occupational therapists in rehabilitation or outpatient settings to adults with acquired brain injuries aged 18 and over. In face-to-face therapy sessions, patient-collected data are used to tailor personalised feedback and advice on strategies, emphasising collaborative decision-making and active engagement.Dose and personalisationPatients attend six weekly 1-h sessions. Intervention strategies are adjusted to individual needs and goals throughout the programme, based on ongoing assessment data.Unique featuresContinuous personalisation and the integration of real-time data into therapy sessions distinguish this intervention.Purpose and implicationsThe programme aims to provide insight into the personal and environmental factors that contribute to a person's fatigue, enabling patients to implement cognitive and behavioural strategies for effective daily fatigue management. Tied by Tiredness represents a novel, practical approach to supporting self-management after brain injury.Trial registrationOverview of Medical Research in the Netherlands (OMON), ID: NL-OMON21265.

Keywords: Fatigue; brain injury; experience sampling methodology; rehabilitation; stroke.