Session Title: Education/Community Programs
Session Type: Abstract Submissions (ARHP)
The Arthritis Program (TAP) at Southlake Regional Health Centre has offered an inter-professional, patient centered Fibromyalgia (FM) education program for nearly two decades. This program currently consists of seven weekly group sessions covering topics such as: medications options, exercise techniques, problem solving skills to attain empowerment, self-management and increased emotional well- being. For many years, TAP has been using the Fibromyalgia Impact Questionnaire (FIQ) and Arthritis Self-Efficacy (ASE) Scale to measure patient outcomes Recently, TAP added the Hospital Anxiety and Depression Scale (HADS). The objective of this study was to examine the clinical utility of adopting HADS in measuring effectiveness of the outpatient FM education program in helping patients to manage anxiety and depression.
A retrospective chart review was performed on 232 outpatients who attended fibromyalgia education program between November 2011 and March 2012. These patients completed HADS, FIQ and ASE just prior to attending the first class. Post-program questionnaires were completed during the final class. Paired t-tests were performed on the 59 cases with complete pre and post program data. Results for the ASE and HADS scales are presented. Large sections of the FIQ were not applicable for this population.
There was significant improvement in the ASE Pain subscale (mean±SD) (N=59) (35.14±15.52 vs. 45.04±17.65, p=0.00) and the ASE Other Symptoms subscale (N=57) (40.02±18.10 vs. 49.44±17.61, p=0.00). ASE Daily Activity subscale did not see significant change (N=59) (63.05±22.47 vs. 61.75±21.20, p=0.521). There was no significant difference between the overall pre and post HADS score, HADS-A (N=61) (11.97±4.04 vs. 11.90±4.16, p=0.866) and HADS-D (N=60) (9.98±3.76 vs. 9.33±3.87, p=0.074). In order to further explore our HADS data, HADS paired pretest and posttest scores were examined for two subsets of patients: (1) those taking one or more neuropathic pain reliever (SNRI, antiepileptics, TCA) and/ or mood stabilizer (SSRI, Bupropion) at the beginning of program and (2) those who were not taking any of these drugs at the beginning of the program. There was a significant improvement in their HADS depression scale score and HADS anxiety scale score in the pre-post period for the group not taking any neuropathic pain reliever or mood stabilizer at baseline (HADS-A (N=19) (10.99±4.29 vs. 9.79±4.17, p=0.043) and HADS-D (N=19) (9.53±4.03 vs. 8.16±3.53, p=0.008)).
HADS is a sensitive outcome measure tool for detecting changes in level of anxiety and depression for certain subsets of fibromyalgia patients. Those who are not taking any neuropathic pain relievers or mood stabilizers at baseline show improvement in level of anxiety and depression measured by HADS upon completion of a seven week outpatient FM education program. Furthermore, improvement in the pain and other symptoms subscales of the ASE were demonstrated in the full sample of patients who completed the outpatient FM education program.
L. J. Bain,
J. C. Thorne,
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ACR Meeting Abstracts - http://acrabstracts.org/abstract/clinical-utility-of-the-hospital-anxiety-and-depression-scale-for-an-outpatient-fibromyalgia-education-program/