Fibromyalgia Self-Management Programme – 12 month new service evaluation

Purpose

A need was identified within the service for effective long-term management of patients with pre-existing or newly-diagnosed fibromyalgia. These patients make up 25% of all referrals into the Pain Team. Fibromyalgia is a complex, long-term, multi-factorial health condition that has high healthcare and societal burden. Previously these patients have received inconsistent management which has been frustrating for patients and clinicians alike. The goal was to be able to create a clear, consistent and effective patient pathway within the Moving Well Service at Lancashire & South Cumbria NHS Foundation Trust and with external referrers. To educate and empower the patient and to improve the quality of their life whilst living with a long-term pain condition.

67%
showed an improvement in FIQr (37% MCID)
77%
showed improvement in WEMWBS (73% MCID)

Approach

A thorough literature review on effective management of fibromyalgia was carried out. A standard operating procedure was written and agreed, with clear pathways for access to this service. The assessment process was streamlined. A thorough biopsychosocial proforma and an effective screening process were designed using shared decision making to ensure the patient is in control of their management plan. The Fibromyalgia Self-Management Group was created. A group setting enables a larger volume of patients to be seen and allows an effective multi-disciplinary approach with Physiotherapy, Occupational Therapy, Psychology and Specialist Pain Nurse involvement. A group also offers a social aspect to patients, providing peer support long-term. The venue is in community settings in two locations to ensure accessibility. Each of the five sessions incorporates education, exercise and relaxation. A psychologically informed, solutions focused approach is used throughout and a positive and friendly environment encouraged. A booklet has been created to reinforce the education component and to act as a long-term resource for the patient. The final session focuses on onward management to ensure each patient feels supported long-term and are aware of all local available resources to them. Outcome measures are used to measure self-efficacy and well-being (FIQr, WEBWBS, PSEQ) alongside a patient satisfaction questionnaire. A pilot group was initially completed and this was followed by a focus group evaluation with appropriate content changes/adaptations. Eight subsequent groups have since run over the past twelve months.

Outcomes

Results: We have been able to demonstrate significant improvement in mental well-being and self-efficacy. 67% of patients showed an improvement in FIQr (37% MCID), 77% in WEMWBS (73% MCID) and 75% in PSEQ (48% MCID). Patients also reported extremely positive feedback. Patients are discharged from the service at the end of the programme but are able to self-refer back within twelve months. There have been no re-referrals back into the service within this twelve month period which further demonstrates the effectiveness of long-term self-management.

Conclusion(s): There is now a clear patient pathway and improved communication across whole of the Service, providing consistent and effective long-term management of fibromyalgia.

Cost and savings

Not applicable.

Implications

Future plans include engagement with local councils for long-term health management within the community, to create and support a patient led persistent pain support group and to further increase our communication with external referrers into this Service.

Top three learning points

No further information. 

Funding acknowledgements

Not applicable.