P198 The lived experiences of cognitive dysfunction in adults with fibromyalgia: a qualitative systematic review
Authors: Derham Sandra , Lewis Jenny , Dures Emma , Cramp Fiona 
Published: April 2020

Abstract

Background
Adults with fibromyalgia frequently report symptoms of cognitive dysfunction (often referred to as fibrofog). However primary research exploring cognitive dysfunction in the lives of adults with fibromyalgia is limited. The aim of this review was to (i) synthesise the qualitative literature on the lived experiences of cognitive dysfunction in adults with fibromyalgia, (ii) develop common themes through thematic analysis and (iii) identify knowledge gaps to inform future research and clinical practice in this area.

Methods
Seven electronic databases (MEDLINE, Embase, CINAHL, PsycINFO, Amed, Scopus and OpenGrey), reference lists of key articles and two high impact qualitative journals were searched from 1990 to November 2018. Articles were eligible for inclusion if they reported primary qualitative data exploring the experiences of cognitive dysfunction in adults with fibromyalgia. Included studies were appraised using the Critical Appraisal Skills Programme (CASP) qualitative checklist and extracted data analysed using narrative synthesis. SD conducted critical appraisal and data extraction on all included studies. FC, JL and ED reviewed five papers each. All papers were reviewed by two co-authors.

Results
Of the 1,413 records identified, 15 studies were selected for inclusion. These studies included 208 women and 22 men with fibromyalgia, aged 18 to 72 years and representing seven different countries. Duration of diagnosis was four months to 34 years. Fourteen studies used interviews and one used focus groups. None of the included studies focused exclusively on cognitive function in adults with fibromyalgia. Three studies identified themes specific to cognitive dysfunction and fibromyalgia symptoms. The remaining 12 studies presented relevant data intertwined with the overall lived experiences of fibromyalgia. Cognitive dysfunction, as a part of fibromyalgia, was often unpredictable. Problems with memory and concentration were most reported, were emotionally distressing and affected functional and vocational activities. Participants found communication effortful, with a negative impact on work, leisure and social activities. Stress, fear and worry around perceived cognitive changes were commonly expressed. Lost employment or changed work roles and relationships, due to cognitive difficulties, had negative impacts for many participants. The terms cognitive dysfunction and fibrofog were used interchangeably within the included studies but lacked common definition. This introduced uncertainty around whether participants and authors were describing the same phenomenon.

Conclusion
Adults with fibromyalgia experience unpredictable and emotionally impactful difficulties related to cognitive dysfunction. Functional impact was broad reaching, particularly around work ability and lost employment opportunities. It was unclear how cognitive symptoms in fibromyalgia related to co-morbid symptoms such as pain, fatigue and poor sleep. Further research, focusing exclusively on the full impact of cognitive function on the lives of adults with fibromyalgia is recommended to inform clinical practice. Research to establish clarity of definition of the terms cognitive dysfunction and fibrofog within fibromyalgia is highly recommended.

Disclosures
S. Derham None. J. Lewis None. E. Dures None. F. Cramp None.