A pilot pathway for people living with persistent widespread pain and fibromyalgia: Individualised assessment, care planning and stratified rehabilitation options

Abstract

Keyword: Fibromyalgia Purpose: NHS Forth Valley does not have a pathway for patients with persistent widespread pain and fibromyalgia (FM). People with FM are often diagnosed and discharged by Rheumatology, as it is not an inflammatory condition. However, FM is characterised by emotional distress and/or functional disability and people often struggle to self manage due to lack of support, understanding and validation (Toye et al., 2021). The NICE (2021) and SIGN (2013) guidelines for chronic pain highlight the importance of a biopsychosocial assessment and individualised care plans that promote self-management. Pain Management Physiotherapy currently provides this; however, there is limited capacity (1.4WTE). People perceived to be coping by Consultants were often discharged with advice. The aim of this project was to address gaps and inefficiencies identified by people with FM and clinicians, through a comprehensive biopsychosocial assessment and care plan, with stratified options, including a physiotherapy-led group. Methods: A tool was developed by Pain Management and Rheumatology for GPs to help them with identification and diagnosis of FM in the community. Prior to this, people were referred to secondary care services for diagnosis. We reviewed 7 patient journeys within the Pain Management and Rheumatology caseloads. Patient feedback was collated to identify what improvements would be valued. We pragmatically developed a four session physio-led group using existing Pain Management Programme materials. Each patient was referred by a cnsulatant and assessed by a physiotherapist prior to commencing the group. Content of the group included understanding FM and the impact on people's lives. The project is currently staffed within current job plans. It is delivered via MS Teams, due to COVID 19 restrictions. A qualitative survey was completed by participants in the group. Results: Following a review of pathways for patients with FM in NHS Forth Valley, we identified inequities in patients’ healthcare experiences. As there are limited biomedical treatment options for people with FM, discussions with clinicians in Rheumatology, GPs and patients, identified that support to develop self management skills is needed. The feedback suggested that group sessions normalise symptoms, reduce isolation and stigma, validate experience and increases the access to an intervention that promotes recovery and behaviour change. Participants valued the discussion and reflection in the group format. They reported making meaningful changes to their lives. “I got more than I expected from the group” [P3] The facilitators “are very knowledgable and understanding” [P5] Conclusion(s): This pilot demonstrates that even when perceived to be functioning well, the validation, deeper understanding of their condition and guidance on how to move forward was valued by people living with FM. The physiotherapy-led group is an efficient and person-centred way to support this population. Efficacy data will continue to be collected. Impact: This project is part of a larger redesign project to equitably meet the needs of people living with FM. The physiotherapy-led group offers more options for people diagnosed with FM to learn how to self manage their persistent pain condition. The next phase of the project will involve collaboration with the Rheumatology Service to develop the pathway further. Funding acknowledgements: This project was not funded.