Physical exercise is an indispensable element in the multidisciplinary treatment of fibromyalgia syndrome (FMS). The present study examined if men diagnosed with FMS engaged in any type of physical activity or exercise, the perceived effects from exercise, and who specifically recommended exercise. A qualitative cross-cultural study was performed in fibromyalgia clinical units in Spain and the United States. A total of 17 participants, 10 men from Spain and 7 men from the US, were included. In Spain, a focus group was completed in two parts, one month apart in 2018. In the US, five individual interviews and one joint interview with two men were completed in 2018. Three central themes appeared in the qualitative data: (1) Understanding what constitutes physical activity or exercise, (2) Facilitating or discouraging the performance of physical exercise, and (3) Effects of physical activity or exercise on psychological and social symptoms. The actual practice of exercise by patients with FMS is often perceived as leading to pain and fatigue, rather than a treatment facilitator. Physical activity and exercise can provide benefits, including relaxation, socialization, and increased muscle tone. However, minor opioids limit physical activity as they cause addiction, drowsiness, and decrease physical activity in Spanish men. Recommendations in a clinical setting should incorporate exercise as well as physical activity via daily life activities.

Fibromyalgia patients experience difficulties in their daily lives that are difficult to identify and recognize due to the stigma associated with the disease. Nurses can help identify them to establish biopsychosocial coping and treatment. The main aim of this study was to explore Spanish nurses’ perceptions of the illness experiences of their fibromyalgia patients. Qualitative content analysis from the etic perspective was used. Eight nurses met in focus groups to report their perceptions of the illness experiences of FM patients after led group-based problem-solving therapy in fibromyalgia patients. Four themes emerged: (1) the presence of a “specific trigger” (stressful event) for FM symptoms; (2) fulfilling expected gender roles; (3) a lack of support from the family; (4) abuse. Nurses recognize the mind-body connection after the impact of stress on patients’ bodies. The expected gender roles interfere with patients’ recovery because they feel frustration and guilt about not being able to fulfil them. Managing emotions and improving communication in fibromyalgia is recommended. Clinicians might also consider issues such as abuse and the absence of social-family support for the comprehensive evaluation and effective management of fibromyalgia.

INTRODUCTION: Chronic pain, fatigue and insomnia are classic symptoms of fibromyalgia (FM) and chronic fatigue syndrome (CFS) and seriously affect quality of life. Nutrition and chronobiology are often overlooked in multicomponent approach despite their potential. This study aims to evaluate the effectiveness of a multidisciplinary group intervention based on nutrition, chronobiology, and physical exercise in the improvement of lifestyle and quality of life in FM and CFS. METHODS: Mixed-methods study based on a randomized clinical trial and qualitative analysis with a descriptive phenomenological approach. The study will be conducted in primary care in Catalonia. The control group will follow the usual clinical practice and the intervention group the usual practice plus the studied intervention (12 hours over 4 days). The intervention based on nutrition, chronobiology and physical exercise will be designed considering participants’ opinions as collected in 4 focus groups. To evaluate effectiveness, EuroQol-5D, multidimensional fatigue inventory, VAS pain, Pittsburgh Sleep Quality Index, erMEDAS-17, biological rhythms interview of assessment in neuropsychiatry, REGICOR-Short, FIQR and Hospital Anxiety and Depression Scale questionnaires will be collected at baseline, and at 1, 3, 6, and 12 months post-intervention. Food intake, body composition, resistance and, strength will also be evaluated. The effect size will be calculated using Cohen d and logistic regression models will be used to quantify the impact of the intervention by adjusting for different variables. DISCUSSION: It expected that the intervention will improve the patients’ quality of life, fatigue, pain and insomnia, as well as food and physical exercise habits, providing effectiveness evidence of a new therapy in addressing these syndromes in Primary Heath Care. Improvements in the quality of life will have a positive socioeconomic impact by reducing health expenditure on recurrent medical consultation, medication, complementary medical tests, etc and favor the maintenance of an active working life and productivity.

Fibromyalgia syndrome (FMS) is a chronic musculoskeletal disorder of unknown etiology that affects up to 5.0% of the world population. It has a high female predominance, between 80 and 96%. Due to the low number of diagnosed men, research work has focused mainly on women. The extensive body of literature on sex differences in pain in the general population suggests that men and women differ in their responses to pain, with greater sensitivity to pain and a higher risk of clinical pain commonly observed among women. This review aims to: (1) determine how pain is assessed or what types of questionnaires are used, (2) examine whether there are differences in pain characteristics between men and women with FMS and (3) describe how pain is conceptualized or manifested in patients at a qualitative level. In this study, the scoping review method of articles published in the last 5 years (2016-2022) was used. Ten articles were included. The most used questionnaires and scales to assess pain were the PVAS (Pain Visual Analogue Scale) and the FIQ (Fibromyalgia Impact Questionnaire). On the other hand, five categories were obtained: (1) qualities of pain, (2) uncertainty and chaos, (3) pain as an aggravating factor, (4) adaptation to the new reality and (5) the communication of pain. It has been observed that both subjective perception and widespread pain are higher in women. Men, on the other hand, have a worse impact of the pathology, more painful experiences and more catastrophic thoughts about pain. An updated knowledge of pain in FMS and whether it differs according to sex would be beneficial for clinicians to make an earlier diagnosis and treatment and, in turn, benefit patients suffering from this chronic disease.

Objective: To perform an economic evaluation on a multicomponent intervention programme for patients with fibromyalgia syndrome compared with usual clinical practice in primary care.Design: A cost-utility analysis was conducted alongside a pragmatic randomised controlled trial (ClinicalTrials.gov: https://clinicaltrials.gov/ct2/show/ record/NCT04049006) from a societal perspective, a human capital approach, and a 1-year time horizon.Patients: Patients diagnosed with fibromyalgia syndrome from the public health system in south Catalonia, Spain.Methods: Crude and adjusted incremental cost utility ratios were estimated to compare the treatment strategies based on cost estimations (direct medical costs and productivity losses) and quality adjusted life years. One-way and 2-way deterministic sensitivity analyses were performed.Results: The final analysed sample comprised 297 individuals, 161 in the intervention group and 136 in the control group. A crude incremental cost-utility ratio of euro 1,780.75 and an adjusted ratio of euro 851.67 were obtained, indicating that the programme significantly improved patients’ quality of life with a cost-increasing outcome that fell below the costeffectiveness threshold. The sensitivity analysis confirmed these findings when varying large cost components, and showed dominance when increasing session attendance.Conclusion: The proposed multicomponent intervention programme was cost-effective compared with usual care for fibromyalgia, which supports its addition to standard practice in the regional primary care service.LAY ABSTRACTFollowing the gold standard trial design for evaluating healthcare technologies, a health economic evaluation was conducted on a new multidisciplinary intervention programme for patients with fibromyalgia syndrome in primary care centres in Catalonia, Spain. Estimations of direct healthcare and social costs were assessed jointly with the effect on quality of life, in order to compare the new intervention with usual clinical care. The results showed that the programme proved its cost-utility for society, as patients’ perceived health improvements outweighed the cost increase, according to the maximum price accepted for an extra unit of quality of life in Spain. These findings were verified when cost estimations were corrected with the actual health expenditure. In addition, the intervention implementation scheme demonstrated cost-saving potential by increasing participants’ session attendance to at least 66%. Therefore, patients and society could benefit from this new therapeutic strategy for fibromyalgia if adopted by the regional services portfolio.

We explored the views of the professionals (from primary care and social services) and users (caregivers and patients) who participated in the clinical trial of the Salut+Social integrated care model to identify the implementation barriers and facilitators, to assess the impact on health and wellbeing and to obtain an assessment of the program. A qualitative descriptive study with a pragmatic, utilitarian approach was performed. Participants were recruited by purposive and convenience sampling. A focus group (FG) and in-depth interviews were conducted with professionals and users, respectively. Thematic content analysis was employed. A total of 11 professionals and 8 users participated in the FG and interviews, respectively. Seven themes were identified: (1) contextualizing the previous scenario; (2) achievements of the program from the professionals’ perspective; (3) facilitators and barriers of the integrated care model; (4) proposals for improving the integrated care model; (5) users’ assessment of the care received within the program framework; (6) users’ perception of the impact on health and wellbeing; (7) users’ demands for better care. Professionals reported improved coordination between services and highlighted the need for a protocol for emergencies and to strengthen community orientation. Users proposed more frequent home visits. This study shows the acceptability of the new model by professionals and the users’ satisfaction with the care received.

Fibromyalgia syndrome (FMS) disrupts patients’ biopsychosocial spheres. A multicomponent intervention (MCI) program, which combined health education, cognitive behavioral therapy, and physical activity, was conducted in South Catalonia’s primary care centers with the aim of improving symptom self-management and quality of life. A qualitative interview study was carried out to understand patients’ lived experiences during the intervention program. Sampled purposively, 10 patients were interviewed via phone calls and face-to-face. The encounters were audio-recorded, verbatim transcribed, and analyzed through thematic analysis. As a result, four themes emerged: legitimizing fibromyalgia through the MCI, the MCI as a socializing experience, learning how to live with FMS through the MCI, and room for improving the MCI. Participants agreed on the program being an insightful experience that promoted illness knowledge and acceptance and that improved their coping skills and symptom self-management. The inclusion of additional psychological guidance, expressive psychological group therapy, and providing relatives with information were proposed for enhancing the program. Our findings have contributed to gaining insight into the subjective impact of the MCI and identifying new therapeutic targets to tailor the program to patients’ needs, which will hopefully increase its effectiveness and improve their quality of life.

After the end of their time as a caregiver, former caregivers have needs and feelings that have been subject to little study to date. The aim of the study is to determine and analyse the feelings, perceptions and practices of former caregivers in the reconstruction of their daily lives. This is a qualitative study based on the Grounded Theory developed by Charmaz. The study involved 14 former caregivers who had cared for their relative for more than 2 years and who had stopped caring for them more than 2 years previously. Fourteen in-depth interviews were conducted and data were collected over 13 months between 2015 and 2017. Data were analysed using the Grounded Theory Method. In addition, this study was approved by the ethics committee of the Institut Universitari d’Investigacio en Atencio Primaria Jordi Gol. The former caregiver experiences a transition, which begins in the days before the death of their relative and may continue for more than 3 years. Three critical moments in the post-caring transition were found: (1) the post-caring emptiness; (2) the end of the period as a caregiver; and (3) the movement towards a new life. Family and professional support is needed during this transition. Former caregivers experience a transition in the rebuilding of their daily lives; furthermore, former caregivers may be a source of support for other caregivers, which is linked to positive mental health factors. Healthcare organisations need to acknowledge the emotional, psychosocial and psychological health of former caregivers.

Aim: The aim of this study was to analyze the caregiving experience of parents whose adolescent children with a mental illness require admission to a day treatment hospital for mental health services.Method: The study used qualitative interpretative research methods. A total of 18 parents participated in the semi-structured interviews. Data were then transcribed and analyzed in accordance with established methods for the analysis of inductive thematic data.Results: Seven themes were identified: questioning an unseen disease, abnormal behavior, a long road, truancy and loss of parental authority, internalized stigma on admission, regaining the meaning of life and an uncertain future.Discussion: The experience of the parents was analyzed and various emotional, psychological and interpersonal barriers were found that influenced the help-seeking for the adolescent’s treatment.Implications for practice: Nursing interventions should be based on detecting barriers and validating the experience of parents with mentally ill adolescents.