ABSTRACT
The goals of this study were to (1) provide preliminary reliability and validity of the Barriers to Treatment Adherence Questionnaire, developed for patients with fibromyalgia, and (2) examine barriers to adherence and general adherence to multimodal treatment during a 3-mo. period. A secondary goal was to explore in a focus discussion group format patients' perceptions of the adherence process and ways of managing the treatment program. 39 fibromyalgia patients were followed while participating in a combined outpatient program of physiotherapy, occupational therapy, nursing, and cognitive behavioral therapy. The Barriers to Treatment Adherence Questionnaire demonstrated good reliability. Construct validity of the Barriers to Treatment Adherence Questionnaire was supported through significant positive correlations with the General Adherence Scale at Months 1 and 3. In addition, a significant change was observed in scores on the Barriers to Treatment Adherence Questionnaire for the physiotherapy component of treatment, with scores decreasing between Months 2 and 3. Addressing barriers to improve adherence may maximize the benefit of treatment programs.
Subject(s)
Fibromyalgia/psychology , Patient Compliance/psychology , Personality Inventory/statistics & numerical data , Adult , Aged , Cognitive Behavioral Therapy , Combined Modality Therapy , Female , Fibromyalgia/rehabilitation , Humans , Male , Middle Aged , Nursing Care , Occupational Therapy , Physical Therapy Modalities , Psychometrics , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To describe treatment adherence to a multimodal integrated program for patients with fibromyalgia (FM), identify predictors of adherence to treatment recommendations, and examine the relationship between adherence and patient outcomes. METHODS: Sixty-three patients with FM were followed while participating in a 3-month outpatient program including physiotherapy, occupational therapy, nursing, and cognitive-behavior therapy. Patients completed a battery of psychosocial questionnaires pre- and post-treatment. At the end of each month of the treatment, patients completed 2 adherence questionnaires (for general and specific adherence) and 1 questionnaire about barriers to adherence to treatment. Generalized estimating equations extension of multivariable linear regression analyses for repeated measures examined predictors of general and specific adherence. Conventional linear regression analyses examined the relationships of general adherence with post-treatment FM disability and pain intensity. RESULTS: In general, adherence to treatment recommendations was good (mean general adherence score of 62 points, on a 0 to 100 scale), with no significant changes in mean level of general or specific adherence over the 3-month period. The main predictor for both general and specific adherence was barriers to adherence to treatment. Increased general adherence was significantly associated with lower pain at post-treatment. CONCLUSION: The items described in the questionnaire for barriers to treatment are the main problem when it comes to adhering to a multimodal treatment program for FM. Healthcare professionals are advised to discuss these barriers directly with patients and assist in overcoming them.
Subject(s)
Cognitive Behavioral Therapy , Fibromyalgia/psychology , Fibromyalgia/rehabilitation , Occupational Therapy , Patient Compliance/statistics & numerical data , Physical Therapy Modalities , Adult , Aged , Disability Evaluation , Female , Fibromyalgia/nursing , Humans , Linear Models , Middle Aged , Multivariate Analysis , Outpatients/psychology , Outpatients/statistics & numerical data , Predictive Value of Tests , Psychology , Surveys and Questionnaires , Treatment OutcomeABSTRACT
OBJECTIVES: The goal of this study was to identify predictors of general and medication adherence in women with fibromyalgia (FM). METHODS: Participants were 142 women recruited from tertiary care hospitals or the community and 10 rheumatologists. Participants' demographic, clinical, and psychosocial characteristics, as well as patient-physician discordance, were assessed at the index visit. Adherence was assessed 6 months later. Multivariable generalized estimating equations were used to identify predictors of general adherence and adherence to medication. RESULTS: The average age of participants was 50.9 years (SD=10.2) and the median duration of FM was 32 months. Participants reported extensive use of health services and medications. The mean score for general adherence was 61.0 (SD=22.4; range 0-100) and 52.9% of the cohort reported at least one form of behavior reflecting nonadherence to medications. More general adherence was significantly predicted by lower patient-physician discordance on patient well-being and lower patient psychological distress. Medication adherence was significantly predicted by higher affective pain and lower patient psychological distress. CONCLUSIONS: Adherence is influenced by both clinical (patient-physician discordance and pain) and psychological (distress) factors in women with FM. Improvements in these domains may improve adherence in FM.
