Fibromyalgia self‐management: Mapping the behaviour change techniques used in a practice‐based programme

Background: Fibromyalgia (FM) is a complex long-term condition associated with pain, fatigue and concentration difficulties. There is limited robust evidence for the effectiveness of pharmacological treatments for FM, with current guidelines recommending nonpharmacological interventions. The clinically developed Fibromyalgia Self-Management Programme (FSMP) is a nonpharmacological, multidisciplinary education group intervention. The FSMP aims to provide condition-specific, patient-centred education and exercise advice, supporting the development of core self-management skills. This research aimed to map the FSMP to a recommended behaviour change taxonomy (BCT). Methods: Non-participatory observations of the 4- and 6-week FSMP were conducted. Detailed notes on the content of the course, therapist delivery and any additional content not included in the manual were recorded. Subsequently, semistructured interviews were conducted with both therapists (n = 4) and patients (n = 9). Observation and a review of the FSMP manual data were deductively coded to the BCT. Interview data were added to the framework. Results: The review of the FSMP manual and observations of the course showed that the programme coded onto 12 of the 16 BCT domains, encompassing 22 behaviour change techniques. Both patient and therapist interviews indicated that patients made positive changes, including increased activity levels, pacing, better quality sleep and improved communication with family members. Patients reported improvements to symptoms as a result of attending the course. Conclusions: The FSMP utilises a range of behaviour change techniques. Patients who attend the course feel supported to make changes to their behaviour, enabling them to manage their symptoms more effectively

A feasibility randomised controlled trial of a fibromyalgia self-management programme in a community setting with a nested qualitative study (FALCON): Study protocol

Background: Fibromyalgia (FM) is a complex long-term condition associated with chronic widespread pain, fatigue, sleep problems, memory and concentration difficulties and irritable bowel syndrome. Current guidelines for the treatment of FM recommend nonpharmacological interventions. The Fibromyalgia Self-Management Programme (FSMP) is a nonpharmacological, multidisciplinary exercise and education group intervention. It aims to provide education and teach core skills, enabling those affected by FM to self-manage. The FSMP is currently codelivered by a multidisciplinary team within a secondary care service. The aim of this feasibility randomised controlled trial (RCT) is to determine the practicality and acceptability of delivering the FSMP in a community setting, informing a future RCT of effectiveness. Methods: The feasibility RCT aims to recruit 70 people with FM. Participants will be randomised to either a community FSMP or control arm. All participants will be asked to complete six patient-reported outcome measures and one health economics questionnaire on three occasions; baseline, 6 weeks (end of the intervention) and 6 months. Between 12 and 16 participants and four therapists delivering the FSMP will be invited to take part in a semi-structured interview to explore their experiences of the FSMP. Patient participants will be purposively selected based upon key characteristics. Analysis: Quantitative data will be analysed descriptively to summarise recruitment and attendance, participant reported outcomes and health economic data. Semi-structured interviews will be transcribed, anonymised and inductively coded. The codes will be grouped into categories and theoretically thematically analysed, comparing the results to existing literature. Trial registration: The trial is registered with ISRCTN registry and was assigned on 29th of April 2020. The registration number is ISRCTN10824225

Evaluation of a 10-week progressive resistance training programme for people with inflammatory arthritis

Background Inflammatory arthritis [IA] has adverse effects on strength, function, fatigue and well-being. Guidelines recommend people with IA should exercise to improve strength and cardiovascular fitness. In 2015, our Rheumatology Physiotherapy Team introduced an evidence-based Progressive Resistance Training Programme [PRTP] for people with IA. This research aimed to evaluate its effectiveness within a United Kingdom National Health Service [NHS] setting. Methods A pre- to post-treatment evaluation was conducted. People with IA attending Rheumatology Physiotherapy were offered the supervised PRTP (1-hour x 10 weeks), performing 7 resistance exercises each session (70-80% 1RM, 3 x 8-12 reps). Pre- and post-treatment outcomes included Health Assessment Questionnaire [HAQ], EQ5D-5L, Self-Efficacy (SARAH Trial), 30 second Sit-to-Stand [STS], FACIT-F (fatigue scale) and Grip Strength. Changes in outcomes were analysed using Paired Samples t-tests and standardised mean difference (SMD) were calculated. Results 201 patients commenced the programme between May 2015 and April 2019, with 121 participants completing it. Diagnoses included Rheumatoid Arthritis (n = 149), Psoriatic Arthritis (n = 42), Juvenile Idiopathic Arthritis (n = 5), Enteropathic IA (n = 2), Oligoarthritis (n = 1), Reactive Arthritis (n = 1) and Undifferentiated IA (n = 1). Age = mean 56.8 ± SD 14.8 years; number of sessions attended = 7.7 ± 3.4. There were no differences between participants not completing (n = 54; 72% women; age 55.0 ± 14.6 years; HAQ 0.99 ± 0.70) versus those completing the PRTP (n = 147; 78% women; age 57.5 ± 14.8 years; HAQ 0.86 ± 0.65). A pragmatic decision was made to analyse all available data for each outcome

P179 A feasibility randomised controlled trial of a fibromyalgia self-management programme in a community setting with a nested qualitative study

Abstract Background/Aims Fibromyalgia (FM) is a complex long-term condition affecting over 5% of the UK population. FM symptoms include widespread pain, fatigue, sleep problems, stiffness, cognitive dysfunction and psychological distress. The condition is associated with high levels of disability, frequent use of healthcare resources and loss of workdays. Current guidelines for the treatment of FM recommend non-pharmacological interventions, including cognitive behaviour therapy, aerobic exercise, warm water therapy, relaxation, and patient education. A typical patient goal is to develop the knowledge and skills needed to self-manage their condition independently. Our Fibromyalgia Self-Management Programme (FSMP) comprises six 2.5-hour sessions over six consecutive weeks and includes education about fibromyalgia, sleep hygiene, goal setting, pacing, and dietary advice. To date, the FSMP has been co-delivered by a multidisciplinary team within a secondary care service. However, delivery in the community may help improve the accessibility of the programme to people with FM. Therefore, this feasibility study aimed to determine the practicality and acceptability of conducting a future definitive randomised controlled trial (RCT) of the FSMP in a community setting. Methods An exploratory, parallel-arm, one-to-one, RCT design was used. Participants were recruited from general practices across South West England, and the FSMP was co-delivered by physiotherapists and occupational therapists across two community sites. To determine the outcome measures for a future definitive trial, several outcomes were tested. All clinical outcome measures were patient-reported and collected at baseline, six weeks and six months. Semi-structured interviews were conducted with patient participants, occupational therapists and physiotherapists to explore the acceptability and feasibility of delivering the FSMP in a community setting. Results Between April and August 2019, 20 General Practices across two sites in SW England invited 1414 patients with an FM diagnosis to participate in the study. A total of 74 participants were randomised to the FSMP intervention (n = 38) or control arm (n = 36). Attrition from the trial was 42% (31/74) at six months. A large proportion of those randomised to the intervention arm (34%, 13/38) failed to attend any sessions, with six of the 13 formally withdrawing before the intervention commenced. The proportion of missing values was small for each of the outcome measures. For the nested qualitative study, 13 patient participants and four therapists were interviewed. Three overarching themes emerged: (1) barriers and facilitators to attending the FSMP; (2) FSMP content, delivery and supporting documentation; and (3) trial processes. Conclusion It is feasible to recruit people with FM from primary care to participate in an RCT testing the clinical and cost-effectiveness of the FSMP delivered in a community setting. However, improvement in attrition and engagement with the intervention is needed. Disclosure J. Pearson: None. J. Coggins: None. S. Derham: None. J. Russell: None. N. Walsh: None. E. Lenguerrand: Other; Erik Lenguerrand and his institution are receiving funding from Ceramtec to conduct an orthopaedic research project that has no relationship to the study presented here. S. Palmer: None. F. Cramp: None

A feasibility randomised controlled trial of a fibromyalgia self-management programme for adults in a community setting with a nested qualitative study (FALCON)

Background: Fibromyalgia is a condition associated with widespread musculoskeletal pain, fatigue and sleep problems. Fibromyalgia treatment guidelines recommend non-pharmacological interventions and the development of self-management skills. An example of a programme that fits these guidelines is the Fibromyalgia Self-management Programme (FSMP) which consists of one 2.5-hour weekly session over six successive weeks and includes education about fibromyalgia, goal setting, pacing, sleep hygiene and nutritional advice. The FSMP is currently provided in a secondary care hospital setting and co-delivered by a multidisciplinary team. Delivery in a primary care setting has the potential to improve the accessibility of the programme to people with fibromyalgia. Therefore, this feasibility study aimed to determine the practicality and acceptability of conducting a future definitive randomised controlled trial of the FSMP in a community setting.Method: An exploratory, parallel-arm, one-to-one, randomised controlled trial. Participants were recruited from general practices across South West England, and the FSMP was co-delivered by physiotherapists and occupational therapists across two community sites. To determine the outcome measures for a future definitive trial several were tested. The Revised Fibromyalgia Impact Questionnaire, Arthritis Self-Efficacy Scale-8, Chalder Fatigue Scale, Short form 36, 5-Level EQ-5D version and Jenkins Sleep Scale were collected at baseline, six weeks and six months. Semi-structured interviews were conducted with patient participants, occupational therapists and physiotherapists to explore the acceptability and feasibility of delivering the FSMP in a community setting.Results: A total of 74 participants were randomised to the FSMP intervention (n=38) or control arm (n=36). Attrition from the trial was 42% (31/74) at six months. A large proportion of those randomised to the intervention arm (34%, 13/38) failed to attend any sessions with six of the 13 withdrawing before the intervention commenced. The proportion of missing values was small for each of the outcome measures. Three overarching themes were derived from the interview data; (1) barriers and facilitators to attending the FSMP; (2) FSMP content, delivery and supporting documentation; and (3) trial processes.Conclusion: It is feasible to recruit people with fibromyalgia from Primary Care to participate in a randomised controlled trial testing the FSMP in a community setting. However, improvement in trial attrition and engagement with the intervention is needed