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

Aim: The development of a new intervention designed to reduce persistent fatigue following acquired brain injury through personalised support. Rationale: Fatigue 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 procedures: The 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 delivery: Tied 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 personalisation: Patients attend six weekly 1-h sessions. Intervention strategies are adjusted to individual needs and goals throughout the programme, based on ongoing assessment data. Unique features: Continuous personalisation and the integration of real-time data into therapy sessions distinguish this intervention. Purpose and implications: The 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.