Long-term fatigue in youth with acquired brain injuries: A 5-year follow-up of the CORE trial

The objective of this study was to evaluate fatigue trajectories of adolescents with paediatric acquired brain injuries (pABI) following metacognitive strategy training (paediatric Goal Management Training; pGMT) or psychoeducation (paediatric Brain Health Workshop; pBHW) for executive dysfunction in the chronic phase after injury. Five-year follow-up data of the CORE randomized controlled trial including participants aged 10–17 years at baseline, randomized to either pGMT or pBHW is presented. Fatigue was measured at five timepoints using the Paediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL MFS). Linear mixed models and Reliable Change Index (RCI) analyses were utilized to assess outcomes. A significant reduction in total fatigue (F(4,62.820) = 2.81, p = .033) and cognitive fatigue (F(4,59.622) = 4.89, p = .002) was observed based on parent-reported data. However, no significant differences emerged between intervention groups or for the group-by-time interaction. Clinically meaningful improvements in fatigue as determined by the RCIs, were noted in 67.6% of participants per parent-report. In conclusion, both pGMT and pBHW may contribute to sustained reductions in fatigue in young people with pABI, particularly cognitive fatigue. The high rate of clinically meaningful change highlights fatigue as a modifiable symptom that should be a key target in long-term rehabilitation strategies.