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THU0728-HPR A mixed methods study of a group physiotherapy programme incorporating exercise and education in fibromyalgia patients
  1. J. Parreira,
  2. C. Caeiro,
  3. R. Fernandes,
  4. E. Cruz
  1. School of Health Care, Polytechnic Institute of Setúbal, Setúbal, Portugal


Background Research on non-pharmacological treatments for fibromyalgia patients has demonstrated that exercise and education have positive effects on pain and disability1. However, the traditional approach of studying treatment effectiveness based exclusively on quantitative measures has been questioned. There is growing recognition of the importance of integrating patients` perspectives into clinical research. Outcome measures focused on patients` perceptions of improvement have been increasingly used, however they do not offer expanded definitions of what constitutes a “successful” outcome2. The further exploration of patients` perspectives about treatment benefits may contribute to the development of treatments that better match patients` needs.

Objectives The aim of this study was twofold: firstly, to examine the effectiveness of a group physiotherapy programme (incorporating exercise and education) on pain intensity, disability and global impression of change in fibromyalgia patients; and, to explore how patients, who achieved success in pain and/or disability (according to the score from the Patient Global Impression of Change Scale - PGIC), understand and make sense of the results.

Methods A sequential explanatory mixed methods approach, combining quantitative (1 st phase) and qualitative methods (2nd phase), was carried out. In the 1 st phase, the participants underwent an 8 week (3 times weekly) standardised group programme. Participants were assessed at baseline, 4 and 8 weeks later. Outcome measures included the Numeric Pain Rating Scale (NPRS), the Revised Fibromyalgia Impact Questionnaire (FIQR) and the PGIC. Participants who had scored ≥5 in the PGIC were invited to participate in a focus group. In the 2nd phase, 2 focus groups meetings were carried out to collect data. A semi-structured interview schedule was used and the sessions were audiotaped and transcribed verbatim.

Results Thirty-seven participants (females; 49.3±10.2 years) completed the 1 st phase. Analysis using SPSS revealed statistically significant improvements on pain intensity (mean SD change:−1.38±2.363,p=0.001) and disability (−21.577±21.02,p<0.001). In what concerns to participants` impression of change, 26 participants (70.3%) perceived substantial improvements on pain and disability (PGIC ≥5). From these, 12 accepted to participate in the focus groups. The qualitative analysis indicated that “doing more daily-life activities” and “taking less medication” were identified as the main reasons for the participants` improvements. According to these participants, the knowledge about strategies for self-management played a key role in their success.

Conclusions The combination of data from both phases provided detailed information about the participants` perceptions regarding the key elements for achieving success with a physiotherapy programme. Further research on patients` perspectives regarding treatment effectiveness is recommended since it may contribute to the design of more effective and patient-centred treatments.

References [1] Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Annals of the Rheumatic Diseases2017;76:318–328.

[2] Evans R, et al. “‘I Know It’s Changed’: a Mixed-Methods Study of the Meaning of Global Perceived Effect in Chronic Neck Pain Patients. European Spine Journal2014;23(4):888–97.

Disclosure of Interest None declared

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