Body Reprogramming. Service Improvement analysis of a new group-based therapy for Fibromyalgia

Purpose

Fibromyalgia is a challenging condition for healthcare professionals to manage. It is common, with a prevalence rate of around 2% and adversely impacts on quality of life. The Plymouth Pain Management team has introduced a novel therapeutic approach for patients utilising the Hyland theoretical model for functional disorders. This reconceptualises fibromyalgia through adaptive network theory. The resulting therapeutic approach, named Body Reprogramming(BR), relies on a strong narrative and focus on skills to successfully manage the condition. Core strategies include optimal movement, mindfulness meditation, compassion focused therapy skills and activity patterns analysis. A further free to access, supportive guide is provided on the website www.bodyreprogramming.org. Many of these components align with EULAR guidelines on evidence-based non-pharmacological based modalities for Fibromyalgia. The introduction of a new therapeutic approach requires a robust service improvement evaluation. Initial results are provided here.

Qualitative feedback:
‘Today I can function a lot more independently than before I started.’

Approach

A ‘Body Reprogramming’ course of eight weekly group sessions (2.5 hours) was introduced. Quantitative evaluation methods included: General Anxiety Disorder (GAD-7), Global Quality of Life (GQoL), Fibromyalgia Impact Questionnaire Revised (FIQR). FIQR was the primary outcome measure. Data was collected at the start of the group (Q1), end of course (Q2) and 3 month follow-up (Q3). Seven courses were included in the analysis. Qualitative feedback was collected anonymously at the end of the programme.

Outcomes

Results: 41(67%) patients completed pre and post course questionnaires with 25 of these also completing Q3 (61% of completers). 13 patients (20.1%) did not attend > 50% of the scheduled group sessions. There was incomplete data for 7 patients. FIQR score means: Q1 78.87 (SD 10.74; n=41). Q2 65.98 (SD 15.7; n=41). Q3 58.78 (SD 17.54; n=25). P value < 0.001 for Q1 vs Q2 and Q1 vs Q3. GAD-7: Q1 15.41(SD 4.2; n= 37). Q2 10.81(SD 5.13; n=37). Q3 9.84 (SD 4.37; n=25). P value < 0.001 for Q1 vs Q2 and Q1 vs Q3 GQoL: Q1 34.18 (SD 18.3; n=39). Q2 46.82 (SD 16.49; n=39). Q3 54.09 (SD 18.2; n=23). P value < 0.001 for Q1 vs Q2 and Q1 vs Q3 Examples of qualitative feedback ‘Today I can function a lot more independently than before I started.’ ‘I enjoyed learning about stop programmes and Tia Chi as I did not think it could be adapted to me.’ ‘Enough information about why our bodies respond the way they do.’

Conclusion(s): Early outcomes clearly demonstrate significant clinical improvement across measures demonstrating reduced impact of living with fibromyalgia, general anxiety and global quality of life. The results showed continuing progress at 3 months, despite a lack of further healthcare input. Providing an acceptable narrative based on the Hyland model together with participation in the Body Reprogramming therapeutic approach appears to facilitate sustained improvement in quality of life.

Cost and savings

No further information. 

Implications

Groups based on Body Reprogramming approach provide a clinically significant change for people with Fibromyalgia Syndrome. This therapeutic approach can provide physiotherapists with an evidence-based vehicle to manage fibromyalgia through an integrated combination of education, exercise and lifestyle management skills.

Top three learning points

No further information. 

Funding acknowledgements

No specific funding was received. Work was done as service evaluation.