Body Reprogramming: An innovative approach for the complex pain conundrum Fibromyalgia.

Purpose

Fibromyalgia is a common rheumatological condition but its complex presentation provides an ongoing challenge in terms of provision of suitable therapeutic management strategies. A new community based pilot service was recently set up within a GP locality in Cornwall to manage patients with a primary diagnosis of Fibromyalgia. This was developed due to a lack of provision within currently commissioned services. Following exploration of current evidence-based literature, including EULAR guidelines, it was agreed to introduce the Body Reprogramming approach. Body Reprogramming provides a relatively new multi-modal therapeutic approach for functional disorders such as Fibromyalgia based on the Hyland conceptual model. The programme was led by a physiotherapist, an occupational therapist and supported by a Pain consultant. Aims To evaluate whether Body Reprogramming courses, based on the Hyland conceptual model, can provide clinically significant therapeutic benefit to patients with a diagnosis of Fibromyalgia within a community based service in Cornwall.

50%-53%
reduction in opiates, gabapentinoids and amitriptyline at 3 months following course completion

Approach

Patients who met the inclusion criteria were referred to the Fibromyalgia pilot service. Three Body Reprogramming courses of eight weeks duration with 10-14 participants were delivered. Sessions were held weekly lasting 3 hours duration. Content included elements of compassion based therapy, Acceptance and Commitment Therapy, mindfulness, Tai Chi and yoga, education sessions on medication, sleep, diet and pacing activities within the concept of the Hyland model. The following questionnaires were used for service outcomes: General Anxiety Disorder (GAD-7), Global Quality of Life (GQoL) Patient Health Questionnaire 9 (PHQ-9,) and revised Fibromyalgia Impact Questionnaire (FIQR). The FIQR was the primary outcome measure. A reduction of 8.1 on the FIQR was accepted as the minimum clinically important difference. Data was collected prior to the course (Q1) and immediately post-completion (Q2) and at three months follow up (Q3). Patients listed medications at each assessment, (Q1,Q2,Q3).

Outcomes

Results: The mean age of participants was 44 years (19 – 74). Attendance rate of 80-90%. 32 patients completed Q1 and Q2. 7/39 patients did not attend Q2 and 18/39 patients did not attend Q3. FIQR score means: Q1 Baseline 69.60 (SD 19.06) vs Q2 Post course 60.42 (SD 19.56), P value < 0.01 (N=32). Q1 Baseline 69.60 (SD 19.06) vs Q3 3-month follow-up 45.95 (SD 19.61), P value < 0.01 (N=21). Medication review demonstrated 50%-53% reduction in opiates, gabapentinoids and amitriptyline and a three fold increase in participants taking no medication at Q3.

Conclusion(s): High attendance rate indicates participants were engaged with the programme. FIQR demonstrated both statistical and more importantly clinically significant improvement. Depression, anxiety and quality of life outcome measures demonstrated a similar pattern of improvement. There were no concerning adverse impacts from the intervention. The Body Reprogramming approach appears to provide a positive narrative that resonates with patients. Since the therapeutic strategies are non-pharmacological and based on lifestyle management (including exercise delivery), there is expectation that sustained adoption may provide enhanced improvement over time. Further longitudinal evaluation and cost benefit analysis will be required to confirm longer-term benefit.

Cost and savings

Total running cost of the project for one year is £30,000. The potential savings from the project are highlighted in the paper by Speath (2009) in the following..‘It has been calculated that a minimal increase in the Fibromyalgia Impact Questionnaire score (for instance, from 78.9 points to 81.5 points, stepping from one decile to the next….) increases the costs by approximately €865 per year.' If the converse is also true a mean reduction in FIQR of 23 points (from this study) should have a considerable financial impact in health care provision costs - saving in GP time, medication costs, keeping people employed and reducing disability.

Implications

Body Reprogramming offers a therapeutic group based intervention that can be successfully delivered by physiotherapists for people with Fibromyalgia.

Top three learning points

No further information. 

Funding acknowledgements

The Pilot Project was funded by the North Kerrier PCN Cornwall. Our locality GP’s have funded a Band 7 Physiotherapist, Band 6 Occupational therapist for 7.5 hours a week and 12 sessions of one hour from our local Pain consultant. Total funding £30,000 for one year of running the project. The PCN have agreed to continue this funding for a further year (into 2020/2021) using this approach for patients with a primary diagnosis of Fibromyalgia.