310 Patients’ perceptions of a six-week fibromyalgia education/exercise group: a phenomenological exploration

Abstract

Background: Fibromyalgia is a chronic widespread pain disorder. The effectiveness however of medication is limited, yet research supports the use of fibromyalgia education/exercise groups (FEEGs) to promote self-management in reducing the severity of symptoms. Despite this evidence, the literature and clinical practice identifies high attrition rates from such programmes, suggesting a significant number of patients are opting not to engage in FEEGs. Positively, individuals who do complete FEEGs demonstrate improvements in physical functioning and self-efficacy. The aim of this research was to: investigate the lived experience of attending FEEGs and explore factors influencing attrition and attendance. Objective: To identify any areas for improvement to enhance the patients' experience of attending FEEGs. Methods: A qualitative phenomenological study was completed in one NHS Trust in the North-West of England. Semi-structured interviews were completed with six patients who attended two or less FEEGs sessions, which commenced between September 2016 and March 2017 and six patients who attended five or six of the FEEGs six sessions. Participants were recruited through purposeful sampling with non-coercive means, as the researcher was not known to participants. Transcripts were analysed manually using thematic analysis. Participants statements which appeared to have similar themes were coded and pertinent patient statements were chosen to illustrate each theme. Appropriate ethical approval for this study was obtained. Results: Seven themes emerged; expectations of the group, sharing of experiences, attitude and behaviour change, reasons for opting-out, dislikes, positive relationship with staff/group members and suggestions for improvements. Conclusion: The six participants who opted out of the FEEGs gave a variety of reasons including; group too big, contributions from other group members, seeing others with more severe disease, health problems, not learning anything new, caring responsibilities and because attending FEEGs will not cure fibromyalgia, but importantly for three participants, the reason involved conflict with group dynamics. Participants (n=6) who completed the FEEGs described changes in their attitude and behaviour and had adopted positive coping strategies. Interestingly, they established strong therapeutic relationships with staff and formed friendships with other group members. Whilst initially apprehensive, a sense of achievement in completing the exercise sessions was apparent. In addition, the exercise tolerance of these participants also improved in keeping with published research findings. Nine participants stated how meeting others with fibromyalgia had positively influenced their condition management. Collectively, the results of this research identified potential service improvements. These include; alterations to the selection process, enhanced provision of written information prior to FEEGs, including patients' preferences within the course content, staff training in group facilitation/conflict management, improving FEEGs accessibility and the need to consider efficient on-going therapy review strategies to maintain positive improvements achieved at the end of FEEGs.