Exercise-based Motivational Interviewing for Fibromyalgia

描述(申请人提供)：纤维肌痛(FMS)，定义为既存在慢性广泛性疼痛，又在检查中发现11/18痛点，影响2%的总人口。FMS的药物治疗在很大程度上是有症状的，因为对这种疾病的发病机制还没有完全了解。在过去的17年里，有监督有氧运动已经成为一种改善疼痛、有氧能力、功能和幸福感的重要治疗方式。能够坚持锻炼的人几乎总是保持锻炼的症状益处。不幸的是，在结构良好的监督锻炼计划完成六个月后，坚持锻炼的比率低得令人失望。此外，尽管在研究环境中监督有氧运动的有效性是有充分证据的，但这种干预在临床环境中的适用性是值得怀疑的。因此，我们建议开展研究以鼓励纤维肌痛患者锻炼(REEF)，这是一项随机注意力控制试验，其主要目的是评估电话传递的动机访谈(ML)在提高FMS患者的锻炼依从性和自我报告身体功能(共同主要结果指标)方面的有效性。REEF将招募200名FMS患者，将他们随机分为ML组或注意控制(AC)组。每个小组的参与者将在12周内收到总共6个电话。在通话之前，两组参与者都将收到一份个性化的运动处方和两次有监督的运动训练课程，让他们开始锻炼计划。所有受试者将在基线、第12周、第24周和第36周接受全面的结果评估。这项应用的次要目的是确定ML和自我报告身体功能改善之间的中介。这项拟议的研究意义重大，因为我们的重点是促进坚持适当强度的锻炼计划，以最大限度地提高FMS患者的功能和幸福感。使用主要基于家庭的锻炼计划和由训练有素的执业护士(LPN)电话提供的ML可能会使更多的FMS患者更容易获得拟议的干预。此外，如果被证明是有效的，ML可以很容易地用于其他慢性疼痛的情况(例如，慢性背痛)。

DESCRIPTION (provided by applicant): Fibromyalgia (FMS), defined as the presence of both chronic widespread pain and the finding of 11/18 tender points on examination, affects 2% of the general population. Drug therapy for FMS is largely symptomatic as there is not yet a complete understanding of the pathogenesis of the disease. In the past 17 years, supervised aerobic exercise has emerged as an important treatment modality to improve pain, aerobic capacity, function and well-being. Individuals who are able to adhere to exercise almost always maintain the symptomatic benefits of exercise. Unfortunately, the rate of exercise adherence six months after the completion of a well-structured supervised exercise program is disappointingly low. Furthermore, although the efficacy of supervised aerobic exercise in the research setting is well documented, the applicability of such intervention in the clinic setting is doubtful. Therefore, we propose to conduct the Research to Encourage Exercise for Fibromyalgia (REEF), a randomized attention-controlled trial whose primary Aim is to evaluate the efficacy of telephone-delivered motivational interviewing (Ml) to encourage exercise, in improving exercise adherence and self-report physical function (co-primary outcome measures) for FMS patients. REEF will enroll 200 FMS patients, randomizing them to either the Ml group or the attention-control (AC) group. Participants from each group will receive a total of six telephone calls within a 12-week period. Prior to the phone calls, participants from both groups will receive an individualized exercise prescription and two supervised exercise training sessions to get them started on an exercise program. All subjects will undergo comprehensive outcome assessment at baseline, week 12, week 24 and week 36. The secondary Aim of this application is to determine the mediators between Ml and improvement in self-report physical function. The proposed research is significant because our focus is the promotion of adherence to an exercise program, of adequate intensity, in order to maximize functioning and well-being for patients with FMS. The use of a predominantly home-based exercise program and telephone-delivered Ml by a trained licensed practice nurse (LPN) could potentially make the proposed intervention more accessible to the greater majority of FMS patients. Furthermore, if proven efficacious, Ml could readily be applied to other chronically painful conditions (e.g. chronic back pain).