The Fibromyalgia Active Management and Exercise (FAME) programme: A service evaluation

ABSTRACT

Keywords Fibromyalgia;Theoretical Framework of acceptability;Rehabilitation Purpose: Fibromyalgia affects over 5% of the UK population. Guidelines recommend multi-modal, non-pharmacological interventions. The Fibromyalgia Active Management and Exercise (FAME) programme was developed by a multidisciplinary team, at King's College Hospital. The Programme, informed by evidence and clinical guidelines, aimed to improve function and quality of life by facilitating self-management and increasing physical activity. It consisted of 12, two hour weekly face-to-face group sessions delivered by a multidisciplinary team (physiotherapists, pain nurses, psychologist) and incorporated education, exercise, Cognitive Behavioural Therapy and mindfulness approaches. This qualitative service evaluation aimed to assess the acceptability of FAME from the perspective of both the patients’ and healthcare practitioners’ (HCP) and identity refinements to the programme. Methods: All patients and HCP involved in the first FAME programme were invited to attend either a focus group (1 patient, 1 HCP group) or 11 semi-structured interviews. Topic guides were developed a priori and informed by previous literature and the Theoretical Framework of Acceptability (TFA, seven constructs (Affective Attitude;Burden;Ethicality;Intervention Coherence;Opportunity Costs;Perceived Effectiveness;Self-efficacy)). Interviews and focus groups were conducted by one of three researchers, audio recorded, transcribed verbatim and analysed thematically. Results: Sixteen participants (six HCP (three physiotherapists, two nurses, one psychologist) and seven patients (mean age 46 (7.5) years, all female, mean duration of symptoms 12 (4.9) years) were enrolled. Focus groups were 60 min and interviews were 30 min duration. FAME was broadly acceptable to HCP participants but not to all patient participants. Some patient participants reported that FAME did not meet their expectations or address areas of importance to them. Five themes that could be explained by four of the TFA constructs were identified role of social support (self-efficacy), FAME as a learning opportunity (perceived effectiveness), fit for FAME (affective attitude), understanding FAME (intervention coherence) and a journey towards self-management (perceived effectiveness). Both patient and HCP participants expressed that social support was important and influenced their experience of FAME. Patient participants perceived that support from peers facilitated their attendance at FAME and adherence to the recommended exercise programme. Learning from the experience of their peers and mindfulness training were their favoured elements of the programme. Conclusion(s) FAME is a new bespoke management programme for people with fibromyalgia. It was acceptable for HCPs but further adaptation was required to optimise acceptability for patients. Refinements made to FAME included establishing an introductory session and active ‘opt-in’ requirement, a booklet rather than handouts, inclusion of an expert patient, and adaptation for online delivery due to COVID-19. Strengths of the project included the recruitment of both patients and HCPS and use of the TFA to inform the study. However, only regular attenders engaged although all patients were invited. Future work should therefore incorporate their views. Impact Working with patient and HCP during the development of interventions is essential to optimise acceptability, and this may influence fidelity and feasibility of the new programme. For patients and HCP social support is the most important element in programmes for fibromyalgia. Thus, social support must be prioritised when transforming services. Funding acknowledgements The work was not funded.