Exercise-based Motivational Interviewing for Fibromyalgia

描述（由申请人提供）：纤维肌痛（FMS），定义为存在慢性广泛性疼痛和检查发现11/18个压痛点，影响2%的一般人群。FMS的药物治疗在很大程度上是对症的，因为对疾病的发病机制还没有完全的了解。在过去的17年里，有监督的有氧运动已经成为一种重要的治疗方式，以改善疼痛，有氧能力，功能和福祉。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，在一个结构良好的监督锻炼计划完成后六个月，锻炼坚持率低得令人不安。此外，虽然有监督的有氧运动在研究环境中的疗效是有据可查的，这种干预在临床环境中的适用性是值得怀疑的。因此，我们建议进行鼓励纤维肌痛运动的研究（REEF），这是一项随机注意力对照试验，其主要目的是评估电话激励访谈（MI）鼓励运动在改善FMS患者运动依从性和自我报告身体功能（共同主要结局指标）方面的疗效。REEF将招募200名FMS患者，将他们随机分配到MI组或注意力控制（AC）组。每组的参与者将在12周内接到总共6个电话。在打电话之前，两组的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，让他们开始一项运动计划。所有受试者将在基线、第12周、第24周和第36周接受全面结局评估。本申请的次要目的是确定MI与自我报告身体功能改善之间的介导物。拟议的研究是重要的，因为我们的重点是促进坚持锻炼计划，足够的强度，以最大限度地提高功能和健康的FMS患者。由经过培训的执业护士（LPN）使用主要基于家庭的锻炼计划和电话提供的MI可能会使大多数FMS患者更容易获得所提出的干预措施。此外，如果证明有效，Ml可以容易地应用于其他慢性疼痛病症（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).