Self-Efficacy and Rehabilitation of Patients with Fibromyalgia
PhD-thesis abstract: Marianne Uggen Rasmussen RN, MPH
Aim: To investigate self-efficacy after multidisciplinary rehabilitation by developing an instrument to assess pain self-efficacy in a Danish setting, and apply the instrument to examine the relationship between potential changes in pain self-efficacy and observed and self-reported activity, health-related quality of life, pain and catastrophizing. Further to describe how self-efficacy and coping is affected by rehabilitation from the patients’ perspective.
Methods: The Pain Self-Efficacy Questionnaire (PESQ) was translated and culturally adapted to a Danish setting, and the psychometric properties of the Danish version (PSEQ-DK) were evaluated. Subsequently, the instrument was applied in analyzing secondary outcomes (n=187) of a randomized-controlled trial (RCT), the IMPROvE-study. Potential change in pain self-efficacy was correlated to changes in observed and self-reported activity, quality of life, pain intensity and pain catastrophizing. A Grounded Theory study was conducted in which focus-group interview data was analyzed to explore how rehabilitation influence self-efficacy and ability to cope, from the perspectives of the patients.
Results: The reliability of the PSEQ-DK was high and the validity was acceptable. No improvement in pain self-efficacy was observed in the rehabilitation group compared to controls on the group level. A subgroup across the study sample (34%), achieved a clinically significant improvement in pain self-efficacy. This group was significantly younger and more recently diagnosed compared to those with no improvement. Change in pain self-efficacy was not associated with changes in observed activity and pain intensity, not even in a subgroup with clinically relevant improved observed functioning. Correlations were weak to moderate with changes in self-reported activity, quality of life and pain catastrophizing. A descriptive Grounded Theory was derived and an explanatory core category was identified: “Learning to accept and live with pain as a life condition”, linked to three additional categories: “Increased acceptance of living with the disease, Experiencing acceptance from others, and Developing new coping strategies”.
Conclusion: The relationship between pain self-efficacy and functioning may be limited to perceived, cognitive-emotional aspects, detected in self-reports, rather than to actual observed performance of activities. However, when directly asked in interviews, the patients did perceive to improve their self-efficacy and coping from rehabilitation, as reflected in the observed activity measure. Thus, it cannot be excluded that the self-reported measures were unable to detect actual observed and patient perceived improvements.
Improving the ability to perform activities of daily living in women with fibromyalgia
Abstract: Cecilie von Bülow, M.Sc.OT, Ph.d
Objective: To explore and compare ADL-ability outcomes of interdisciplinary rehabilitation followed by add-on adaptation or physical activity programs in women with fibromyalgia.
Methods: Women (n=85), quasi-randomised to two-week interdisciplinary rehabilitation followed by 16-week adaptation (e.g. changing routines, using assistive devices, modifying tasks and physical/social environments) (ADAPT) or physical activity (e.g. sports and brisk walking) (ACTIVE) programs. Primary outcomes were ADL motor and ADL process ability measured with the Assessment of Motor and Process Skills (AMPS) at four-week follow-up. Data were analysed per protocol.
Results: Participants (ADAPT n=21; ACTIVE n=27) did not differ from withdrawers (n=37). Improvements in ADL-ability in the ADAPT: ADL motor mean change=0.43 logits (95% CI=0.31 to 0.56); ADL process mean change=0.34 logits (95% CI=0.17 to 0.52) and ACTIVE: ADL motor mean change=0.33 logits (95% CI=0.22 to 0.43); ADL process mean change=0.25 logits (95% CI=0.12 to 0.38) groups were statistically significant, without differences between groups. Responder analyses revealed that 63% of all participants obtained clinically relevant improvements in ADL motor ability and 48% in ADL process ability.
Conclusion: Although limited by a large dropout, this exploratory study showed that interdisciplinary rehabilitation followed by adaptation or graded physical activity programs improved observed ADL-ability in the main part of participants. ADL-ability outcomes were independent of group allocation (ADAPT versus ACTIVE) suggesting efficacy of both programs.