the protocol developed by hewlett, the bristol ra fatigue scales (brafs), can be used to evaluate the severity of disease, and have been translated into 36 languages. once she had developed a metric to measure fatigue, hewlett developed interventions to manage fatigue, including the use of cognitive behavioural therapy (cbt). her research into the design and testing of cbt interventions was supported by the national institute for health research. cbt was shown to reduce the impact and severity of fatigue in patients with ra, and adopted by occupational therapists in scotland and british columbia.