Feasibility, acceptability, and exploratory outcomes of a virtual cognitive behavioural therapy-based group intervention for persistent fatigue in endometriosis: The Managing Fatigue in Endometriosis (MEND) programme

Introduction
This study developed and assessed the feasibility, acceptability, and exploratory outcomes of a six-session cognitive behavioural therapy (CBT)-based intervention for endometriosis-related persistent fatigue, called Managing Fatigue in Endometriosis (MEND).

Methods
MEND was developed based on CBT for persistent fatigue and a prior qualitative study among fatigued patients with endometriosis in South Africa. After expert review, it was delivered online by trained counsellors to small groups. A single-arm within-subjects study with 21 participants (mean age 33.1, range 23–43 years) reporting moderate to severe fatigue pre-intervention was conducted. Feasibility, acceptability and patient-reported outcome measures were assessed.

Results
A high eligibility rate (n = 43, 83%) and lower enrolment rate (n = 21, 49%) were observed. Session attendance varied (43%–76%), with a 57% (n = 12) completion and 28% (n = 5) drop-out rate, mainly due to countrywide power outages during implementation. Qualitative data indicated that the intervention was acceptable to both participants and interventionists. Although not sufficiently powered to determine effectiveness, the Reliable Change Index indicated a mixed pattern of change—some outcomes showed improvement (18%–55%), while others reflected no change (18%–64%) or deterioration (9%–36%).

Conclusion
MEND was found to be feasible and acceptable, although attrition was high. A randomized controlled trial is warranted to assess treatment efficacy more definitively.