VBCR - October 2012, Volume 1, No 5 - Fibromyalgia

By Rosemary Frei, MSc

An intense program of telephone support does not have a significant effect on the motivation of patients with fibromyalgia to exercise or on their disease symptoms, according to the first randomized study to expressly address exercise in this patient population (Ang DC, et al. Clin J Pain. 2012 Oct 5 [Epub ahead of print]).

Motivational interviewing, which was the modality tested in this study, involves trained professionals helping people resolve ambivalence about a behavior change—in this case, adherence to a regular exercise regimen.

This approach was compared over 12 weeks with people in an education control group who had an equal number of fibromyalgia-relevant education sessions, all of which were conducted over the phone. Participants were assessed at baseline, immediately after the treatment sessions, and after 3 and 6 months.

The investigators were surprised that the results did not show a higher percentage of patients in the motivational interview group who reported an increase of at least 30 minutes per week in moderate-to-vigorous physical activity or a reduction in physical impairment resulting from fibromyalgia.

“I did not expect for the education control group to improve, but it did—likely because education control subjects may have consciously or sub­consciously increased their physical activity level, given that they were involved in an exercise trial,” said lead investigator Dennis C. Ang, MD, MS, Chief, Section on Rheumatology & Immunology, Wake Forest Baptist Medical Center, Winston-Salem, NC, in an interview with Value-Based Care in Rheumatology.

Dr Ang conducted the study while he was at Indiana University-Purdue University, Indianapolis, IN. He and his colleagues randomized 107 people with fibromyalgia to 6 motivational interviewing sessions and another 109 people to 6 education sessions on fibromyalgia self-management.

The motivational interview therapists who participated in the study had received roughly 24 hours of initial training in motivational interviews and approximate 60 hours of ongoing training before and during the study.

The first 2 motivational interview sessions focused on increasing patient motivation to exercise, and the next 2 were devoted to strategies that strengthen commitment to exercise. The last 2 calls focused on follow-through strategies to prevent relapse to inactivity.

For their part, participants in the education control group received educational health information on fibro­myalgia, pain, fatigue, sleep, stress, and living well with fibromyalgia.

There were no significant differences at any of the time points between the 2 groups in the primary outcomes of increase in exercise and improvement in the scores on the Fibromyalgia Impact Questionnaire (FIQ)-Physical Impairment scale.

However, more patients who had motivational interviewing than education control had meaningful im­provements in FIQ scores (global symptom severity) at their 6-month follow-up (62.9% vs 49.5%; P = .06). Furthermore, those in the motivational interview group made greater gains on the 6-minute walk test compared with the education control group members.

The motivational interview cohort also had a greater increase in the number of hours of physical activity immediately postintervention and a greater reduction in pain severity immediately postintervention and at their 3-month follow-up.

Dr Ang said that his team intends to delve further into this approach. “We would like to know if motivational interviewing therapists’ degree of adherence to the principle of motivational interviewing was associated with increased physical activity.”

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