12 research outputs found
Mindfulness-based and acceptance-based interventions and physical activity in the management of fibromyalgia - evaluation of a multicomponent rehabilitation programme
No full textBackground: Fibromyalgia (FM) is a heterogeneous and complex musculoskeletal pain disorder characterised by multiple symptoms. The often unpredictable remission and recurrence of FM symptoms further impair social and physical function and reduce overall quality of life. No curative treatment is available for FM, and pharmacological treatment is inadequate. In Norway, treatment is usually limited to general practitioner (GP) consultations and physiotherapy. Traditionally, health care services have been based on a biomedical approach focusing on pathogenesis, diagnosis, and treatment of diseases. This approach is less likely to benefit patients with FM who have complex symptoms and no effective treatments to access. This condition calls for a broader perspective on health and more holistic management approaches. For optimal management, the European League Against Rheumatism (EULAR) has developed evidence-based recommendations including prompt diagnosis and patient education as first-line treatment. Furthermore, nonpharmacological treatment, such as physical exercise and psychological interventions, should be initiated with the aim of improving patient quality of life. According to Norwegian health authorities, FM treatment is to be provided at the primary care level. However, the treatment modalities described in the EULAR recommendations are available in Norwegian primary health care only to a limited degree.
Aims: The main aim of this thesis was to evaluate the effects of a multicomponent rehabilitation programme combining two nonpharmacological treatment modalities for patients with newly diagnosed FM delivered in primary health care. The specific objectives were 1) to analyse the health effects of mindfulness- and acceptance-based interventions for patients with FM, with an exploration of the content and delivery components in the interventions; 2) to design and implement a randomised controlled trial and to evaluate health effects of a Norwegian mindfulness- and acceptance-based intervention followed by physical activity; and 3) to identify groups of patients with different symptom severity trajectories and to explore differences in baseline characteristics among these groups.
Materials and methods: This thesis comprises a systematic review with meta-analyses, a randomised controlled trial (RCT), and an observational exploratory study. The systematic review included RCTs investigating the effects of mindfulness- and acceptance-based interventions for patients with FM. Furthermore, the Template for Intervention Description and Replication checklist was used to specifically extract, describe, and explore the reported content and delivery components in each study’s intervention. In the RCT, eligible patients were invited to a 3-hour FM patient education programme before randomisation. A multicomponent programme, including a 10-session mindfulness- and acceptance-based group programme followed by 12 weeks of physical activity, was evaluated in comparison to a control group that received treatment as usual, i.e., no treatment or any other treatment of their choice. We collected data using patient-reported questionnaires, with the Patient Global Impression of Change (PGIC) as the primary outcome measure. Secondary outcomes evaluated at the 12-month follow-up were pain, fatigue, sleep quality, psychological distress, physical activity, health-related quality of life, motivation for and barriers to physical activity, mindfulness, and work ability. In the observational exploratory study, to identify groups of patients with different symptom severity trajectories, we evaluated Polysymptomatic Distress Scale (PDS) scores using latent class growth analysis. The study participants were those included in the RCT. We also explored differences in baseline characteristics between groups with different trajectories.
Results: The systematic review included nine RCTs and 750 patients with FM. The metaanalyses, giving standardised mean differences (SMDs) with 95% confidence intervals (CIs), showed small to moderate effects in favour of mindfulness- and acceptance-based interventions at the end of treatment for pain (SMD -0.46 [95% CI -0.75, -0.17]), depression (SMD -0.49 [95% CI -0.85, -0.12]), anxiety (SMD -0.37 [95% CI -0.71, -0.02]), sleep quality (SMD -0.33 [95% CI -0.70, 0.04]), health-related quality of life (SMD -0.74 [95% CI -2.02, 0.54]), and mindfulness (SMD -0.40 [95% CI -0.69, -0.11]). At follow-up, all effect sizes decreased except for anxiety, for which there was a small increase in effect size. We graded the certainty of evidence as very low to moderate. The included studies reported and assessed adherence and fidelity differently. In the RCT, 170 patients were randomised, 85 to the intervention group and 85 to the control group. Our main analysis was the dichotomised PGIC, and we found no statistically significant differences between the intervention and control groups at the 3- and 12-month follow-ups. Additional analyses of the distribution of PGIC showed statistically significant differences between groups in favour of the intervention group at the 3-month follow-up (p=0.01) but not at the 12-month follow-up (p=0.06). For secondary outcomes, we found no statistically significant differences between the groups at the 12-month follow-up, except for a tendency to be mindful (p=0.016) and perception of the benefits of exercise (p=0.033) in favour of the intervention group. We intended to capture patients with FM at an early stage of their disease, but the included patients reported a median symptom duration of 8 years. In the observational study, we identified two distinct groups of PDS trajectories: one group defined by having no improvement and another defined by having some improvement. The analyses showed no statistically significant differences in baseline characteristics between these two groups.
Conclusion: In the systematic review, we found overall small to moderate uncertain effects of mindfulness- and acceptance-based interventions for patients with FM. The RCT demonstrated no enhanced benefit over treatment as usual with the addition of a multicomponent rehabilitation programme that added a mindfulness- and acceptance-based intervention followed by physical activity to patient education. In the observational exploratory study, analyses identified two groups of FM trajectories, one group that improved slightly and one group that experienced no improvements, but the two groups did not differ in baseline characteristics
Employees’ experience after completing a vitality training program: An acceptance-based cognitive behavioral groupintervention
No full textMindfulness- and acceptance-based interventions for patients with fibromyalgia - A systematic review and meta-analyses.
No full textObjectives To analyze health effects of mindfulness- and acceptance-based interventions, including mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT) and acceptance and commitment therapy (ACT). Additionally, we aimed to explore content and delivery components in terms of procedure, instructors, mode, length, fidelity and adherence in the included interventions. Methods We performed a systematic literature search in the databases MEDLINE, PsychINFO, CINAHL, EMBASE, Cochrane Central and AMED from 1990 to January 2019. We included randomized and quasi-randomized controlled trials analyzing health effects of mindfulness- and acceptance-based interventions for patients with fibromyalgia compared to no intervention, wait-list control, treatment as usual, or active interventions. MBSR combined with other treatments were included. Predefined outcomes were pain, fatigue, sleep quality, psychological distress, depression, anxiety, mindfulness, health-related quality of life and work ability. The Template for Intervention Description and Replication (TIDieR) checklist and guide was used to explore content and delivery components in the interventions. Meta-analyses were performed, and GRADE was used to assess the certainty in the evidence. Results The search identified 4430 records, of which nine original trials were included. The vast majority of the participants were women. The analyses showed small to moderate effects in favor of mindfulness- and acceptance-based interventions compared to controls in pain (SMD -0.46 [95% CI -0.75, -0.17]), depression (SMD -0.49 [95% CI -0.85, -0.12]), anxiety (SMD -0.37 [95% CI -0.71, -0.02]), mindfulness (SMD -0.40 [-0.69, -0.11]), sleep quality (SMD -0.33 [-0.70, 0.04]) and health-related quality of life (SMD -0.74 [95% CI -2.02, 0.54]) at end of treatment. The effects are uncertain due to individual study limitations, inconsistent results and imprecision. Conclusion Health effects of mindfulness- and acceptance-based interventions for patients with fibromyalgia are promising but uncertain. Future trials should consider investigating whether strategies to improve adherence and fidelity of mindfulness- and acceptance-based interventions can improve health outcomes
Effects of a mindfulness-based and acceptance-based group programme followed by physical activity for patients with fibromyalgia: a randomised controlled trial
No full textIntroduction: Non-pharmacological approaches are recommended as first-line treatment for patients with fibromyalgia. This randomised controlled trial investigated the effects of a multicomponent rehabilitation programme for patients with recently diagnosed fibromyalgia in primary and secondary healthcare.
Methods: Patients with widespread pain ≥3 months were referred to rheumatologists for diagnostic clarification and assessment of study eligibility. Inclusion criteria were age 20–50 years, engaged in work or studies at present or during the past 2 years, and fibromyalgia diagnosed according to the American College of Rheumatology 2010 criteria. All eligible patients participated in a short patient education programme before inclusion and randomisation. The multicomponent programme, a 10-session mindfulness-based and acceptance-based group programme followed by 12 weeks of physical activity counselling was evaluated in comparison with treatment as usual, that is, no treatment or any other treatment of their choice. The primary outcome was the Patient Global Impression of Change (PGIC). Secondary outcomes were self-reported pain, fatigue, sleep quality, psychological distress, physical activity, health-related quality of life and work ability at 12-month follow-up.
Results: In total, 170 patients were randomised, 1:1, intervention:control. Overall, the multicomponent rehabilitation programme was not more effective than treatment as usual; 13% in the intervention group and 8% in the control group reported clinically relevant improvement in PGIC (p=0.28). No statistically significant between-group differences were found in any diseaserelated secondary outcomes. There were significant between-group differences in patient’s tendency to be mindful (p=0.016) and perceived benefits of exercise (p=0.033) in favour of the intervention group.
Conclusions: A multicomponent rehabilitation programme combining patient education with a mindfulness-based and acceptance-based group programme followed by physical activity counselling was not more effective than patient education and treatment as usual for patients with recently diagnosed fibromyalgia at 12-month follow-u
Trajectories of change in symptom severity in patients with fibromyalgia: exploratory analyses of a randomised controlled trial
No full textpublishedVersio
Trajectories of change in symptom severity in patients with fibromyalgia: exploratory analyses of a randomised controlled trial
No full textForest plot for meta-analyses of effects of mindfulness- and acceptance-based interventions.
No full textRandom-effects meta-analyses of effects of mindfulness- and acceptance-based interventions on pain, depression and anxiety at end of treatment (8-weeks) and follow-up (2–6 months).</p
Characteristics of included studies (n = 9).
No full textCharacteristics of included studies (n = 9).</p
TIDieR-checklist, template for intervention description and replication.
No full textDescription of content and delivery components.</p
