POS1509-HPR SELFIE PROJECT - BARRIERS AND FACILITATORS OF A BEHAVIOUR-CHANGE INFORMED HYBRID PHYSICAL EXERCISE PROGRAM FOR INDIVIDUALS WITH FIBROMYALGIA
Authors: M. Carvalho, R. Fernandes, S. Duarte, E. B. Cruz, F. Pimentel Santos, P. Albuquerque, R. Madeira, C. Caeiro
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The recommendations for the intervention in fibromyalgia have reinforced the importance of self-management programs. Although physical exercise plays an important role, adherence tends to be low. The implementation of behaviour-change techniques, as well as remote and/ or digital solutions may promote adherence and overcome identified barriers to regular physical exercise. This study is part of the Selfie Project "Supported self-management of fibromyalgia, co-designing ehealth interventions", in which a behaviour-change informed hybrid physical exercise program for individuals with fibromyalgia was developed, concurrently with a mobile app (Selfie), developed in collaboration with patients and health professionals. This app allows users to have live exercise sessions with a physiotherapist and provides videos of exercises and detailed descriptions for ensuring security while exercising. <h3>Objectives:</h3> The aim of this study was to explore the barriers and facilitators perceived by individuals with fibromyalgia for regular physical exercise through an hybrid physical exercise program supported by the Selfie app. <h3>Methods:</h3> After ethical approval, 9 individuals with fibromyalgia who had previously completed a 12-week hybrid physical exercise program, using the Selfie app, were purposively recruited. Two focus groups were carried out remotely, based on a semistructured interview schedule. Audio was recorded, and data transcribed verbatim for subsequent thematic analysis. To enhance the credibility of the study, investigator triangulation and member checking were carried out. An audit trail was also developed. <h3>Results:</h3> Two main categories were identified: 1) adherence to the hybrid exercise program; and 2) use of the Selfie app to perform the program. These categories addressed facilitators and barriers to the adherence to the exercise program, as well as the features of the Selfie mobile app that promoted or hindered its use. Concerning facilitators for adherence to the program, participants agreed that the complementarity between traditional and remote approaches seemed like a promising solution for exercise adherence since it allowed to benefit from both approaches' advantages. The option to participate in exercise sessions remotely was seen as beneficial, as it allowed to spend time and energy solely for exercising, thereby facilitating symptom management, particularly fatigue. The support provided by the physiotherapist during the program was one of the main motives for adherence since it allowed individualization and personalization of the exercises, enhancing confidence and promoting the sense of safety. The perception of positive effects of exercising seemed to have been one of the main aspects for regular exercise practice after the program and as a self-management strategy. In contrast, the absence of support from a physiotherapist after the program was identified as the main barrier for regular exercise practice. Space and materials available at home were also a barrier to perform the remote sessions for some participants. Participants considered the Selfie app a useful tool to enhance autonomy in exercising, since it offered videos and instructions of the exercises. Other facilitators were the accessibility, portability and flexibility provided by the Selfie app. On the other hand, the default of real-time feedback and interactivity, and the absence of a physiotherapist who could personalize the exercise were considered as main barriers for regular exercise practice using the app. <h3>Conclusion:</h3> The support provided by the physiotherapist was a determinant aspect for exercise adherence, as well as the individualization and personalization of the exercises. The remote component allowed to overcome identified barriers, such as adverse weather, lack of time, and fatigue. The Selfie app was seen as a tool with potential to help in fibromyalgia self-management, contributing for the autonomy for exercising. However, the absence of support and supervision by a physiotherapist after the 12-week program was identified as an important barrier for maintaining regular exercise practice. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> To physiotherapists Beatriz and Ines, engineer Hugo and patient association Myos for their collaboration in this project. <h3>Disclosure of Interests:</h3> <b>None declared.</b>