Physiotherapists' perspectives on exercise prescription for fibromyalgia: a qualitative study

Abstract

Introduction: Fibromyalgia (FM) is a debilitating chronic pain syndrome. Physical exercise is recommended for treatment; however, there is low adherence to exercise, alongside high levels of kinesiophobia and catastrophizing, as well as low self-efficacy, all of which facilitate sedentary behavior. Objective: To investigate physiotherapists' perspectives on exercise prescription and to understand factors related to adherence and progress in FM cases. Methods: This is a qualitative study involving content analysis of interviews, based on the Consolidated Criteria for Reporting Qualitative Research (COREQ) and Standards for Reporting Qualitative Research (SRQR). Interviews were conducted by a physiotherapist, involving the interviewer, the participant, and an observer. A pilot test, expert consultation, and field notes were utilized. Data analysis was performed using MAXQDA 2022 software, employing data triangulation to enhance reliability and credibility. Results: Twenty-seven physiotherapists with clinical experience in FM were evaluated. Factors related to the clinical presentation and professional competencies influence adherence to and progress in physical therapy treatment. Individualized care and biopsychosocial factors were highlighted. Barriers regarding exercise were associated with the patient's clinical condition. Prescriptions are typically gradual and include muscle strengthening, aerobic exercise, Pilates, and hydrotherapy. Conclusion: Physiotherapists' perspectives emphasize that the patient experience can be improved through physiotherapist skills, particularly active listening during treatment. Factors related to clinical condition influence patient adherence and progress during treatment. Both mixed exercise regimens and isolated modalities are prescribed during treatment.