How a group-based occupational therapy program works in woman with fibromyalgia: A process evaluation of the ADAPT program

Abstract

Background

The ADAPT Program have improved activities of daily living (ADL) in women with fibromyalgia. To understand the functioning of the program, it is relevant to evaluate how program theory components are linked to outcomes (mechanisms) and how the randomised controlled trial (RCT) context, influenced delivery and outcomes

Objective

To evaluate ADAPT in terms of dose, mechanisms of change and contextual factors.

Material/Methods

Dose was recorded on the n = 21 participants receiving ADAPT in the IMPROvE trial (NCT01352052). A subsample of n = 16 attended one of three 2-hour focusgroups, evaluating mechanisms of change and contextual factors. Interview questions explored participants’ interaction with four program components, i.e. how the ‘client-centred approach’, ‘group-based peer-exchange format’, ‘teaching-learning strategies’ and ‘long-term program format’ triggered mechanisms facilitating/hindering outcomes. Moreover, how randomisation procedures influenced delivery and outcomes.

Results

Attending a long-term educational peer-exchange program, in which participants experienced met by a health professional that legitimised difficulties, facilitated participants knowledge, insights and motivation for changing habits. With time and support, participants experienced increased acceptance of their situation and began to implement more effective ways to perform ADL tasks.

Conclusions/Significance

Results support previous findings of improved ADL ability post-ADAPT and provide initial evidence to support the ADAPT Program theory.

Keywords:

• Activities of daily living (ADL)
• adaptation
• chronic conditions
• chronic widespread pain
• contextual factors
• mechanisms of change
• medical research council framework (MRC)
• peer-exchange
• program theory
• behaviour change techniques taxonomy version 1

Acknowledgement

The authors thank all the participants for attending this study and sharing their experiences with attending ADAPT 1.0. The authors sincerely thank Hans-Jørgen Bendixen, MSc.OT, for conducting the focusgroups in a very qualified and emphatic manner. The authors also thank Mette Søndergaard Msc.OT for assistance in the focusgroups and Kim Lee, OT, PhD for discussing the organization of interview data. Finally, the authors thanks to Thomas Buhl-Wiggers, OT, scientific research assistant, for contributing to the process of discussing and mapping the content of the ADAPT Program to the BCTTv1.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was financially supported by OAK foundation, The Association of Occupational Therapists Research Foundation [R 20 – A695] and Section for Cross-Sectoral Research [P-2019-2-09].