Proof of concept of prehabilitation: a combination of education and behavioural change, to promote physical activity in people with FM 2023 McVeigh

[Andy]

Objectives

To establish proof of concept of a prehabilitation intervention, a combination of education and behavioural change, preceding a physical activity programme in people with fibromyalgia (FM).

Settings

Open-label, feasibility clinical trial.

Participants

Eleven people with FM (10 women).

Interventions

The prehabilitation intervention consisted of 4 weeks, 1 weekly session (~1 to 1.5 hours), aimed to increase self-efficacy and understand why and how to engage in a gentle and self-paced physical activity programme (6 weeks of walking with telephone support).

Primary and secondary outcome measures

Primary outcome was the acceptability and credibility of the intervention by means of the Credibility/Expectancy Questionnaire. Secondary outcomes comprised scales to measure FM severity, specific symptoms and sedentary behaviour. An exit interview was conducted to identify the strengths and weaknesses and barriers to the intervention.

Results

One participant dropped out due to finding the walking programme excessively stressful. Participants expected the intervention would improve their symptoms by 22%–38% but resulted in 5%–26% improvements. Participants would be confident in recommending this intervention to a friend who experiences similar problems. The interviews suggested that the fluctuation of symptoms should be considered as an outcome and that the prehabilitation intervention should accomodate these fluctuation. Additional suggestions were to incorporate initial interviews (patient-centred approach), to tailor the programmes to individuals’ priorities and to offer a variety of physical activity programmes to improve motivation.

Conclusions

This feasibility study demonstrated that our novel approach is acceptable to people with FM. Future interventions should pay attention to flexibility, symptoms fluctuation and patients support.

Open access, https://bmjopen.bmj.com/content/13/7/e070609

 

[Trish]

Is it just me, or is it an enormous waste of money and patients time to spend up to 6 hours spread over 4 weeks talking to patients about how to engage in an upcoming physical activity program?

Here's what it involves:

The sessions focused on education and skills training in: exercise/physical activity, symptom flares, pacing, causes of symptoms in FM (eg, pain and fatigue) and their management.

Participants were taught how to set goals based on the principle (specific, meaningful, adaptable, realistic and timely goals) and were encouraged to base their goals on what was valuable or meaningful to them. Participants identified a ‘committed action’ linked to their goal, which was revisited throughout the programme.

The principles of third wave cognitive–behavioural therapy/acceptance and commitment therapy (CBT-ACT) were used to address maladaptive thought processes such as catastrophising.

Stress management and the skills of relaxation were also covered in the prehabilitation programme. Participants were advised on the use of pedometers to monitor physical activity.

The purpose of the initial prehabilitation programme was to gain participant ‘buy-in’ to the programme, to assist participants engage with exercise, to help participants overcome barriers to exercise and improve self-efficacy for exercise. The prehabilitation phase enabled participants to understand why and how to perform gentle self-paced exercise.

Does that really take 6 hours? I reckon half an hour going over a one page guide would be sufficient.

 

[obeat]

The therapist is being paid byt the hour so it's definitely worthwhile for them

 

[shak8]

Pre-habilitation is an intervention of exercise and education done before surgery or invasive medical treatment.

Here, it seems to be before a walking program.

At least the researchers learned from 11 subjects that "symptoms fluctuate" and that in subsequent studies they would need to offer a wider range of activities to aide in motivation. (I think the Spanish "walking" researchers will be sad about this development.)

 

[NelliePledge]

Yeah symptom fluctuation should be an outcome
And
The actual perceived improvement being half that expected by the patients


Is definitely telling them useful information that may be new to these researchers -
Need to understand negative impact, does any perceived benefit outweigh the impact on symptoms

At least they reported these points honestly, will they be given proper consideration or dismissed?

 

[DokaGirl]

The therapist is being paid byt the hour so it's definitely worthwhile for them

 

[Creekside]

Proof of concept: if we come up with some appropriate pseudoscientific babble, we can manipulate the study to provide results that look good!

 

[Sean]

Does that really take 6 hours?

If it only took a single half-hour consult and a one page guide, they would be out of a job in a month.

 

[Sean]

Future interventions should pay attention to flexibility, symptoms fluctuation and patients support.

How many decades and how many studies has it taken them to arrive at this conclusion? The same one patients have been telling them for decades, for free.