Table Of ContentMONITORING PHYSICAL ACTIVITY IN PERSONS LIVING
WITH FIBROMYALGIA: A HEALTHCARE DELIVERY
INNOVATIONS PROJECT
by
Kira Marie Kitchens
A dissertation submitted in partial fulfillment
Of the requirements for the degree
of
Doctor of Nursing Practice
in
Family and Individual
MONTANA STATE UNIVERSITY
Bozeman, Montana
April 2017
©COPYRIGHT
by
Kira Marie Kitchens
April 2017
All Rights Reserved
ii
DEDICATION
For my family and friends who supported me, believed in me, encouraged me and
kept me sane during this long journey. I could not have done this without you.
iii
ACKNOWLEDGEMENTS
My respect and gratitude go to my advisors, Dr. Linda Torma and Dr. Alice
Running who constantly reminded me that I am capable of more than I believe. Dr.
Torma was an inspiration and guide through the beginning of my time at Montana State
University and this project. My sincere gratitude to Dr. Running for her willingness to
pick up this project halfway though and continue to support the large amount of work it
required. You have both been amazing resources and continued sources of strength. My
gratitude also goes to my committee, Dr. Susan Luparell and Jeannie Osellame for you
insight, guidance and advice during this project. My thanks also to Chris Barbour for his
statistical insight and prompt, professional attention to this project.
Thank you to R.J., who has been at my side through this whole process
reminding me to have fun and live a balanced life. My dad, Craig, was always a phone
call away to provide advise and remind me that all of the hard work would pay off.
Connor, Casey, Cy and Kayden, you are amazing and always had a funny thought to
lighten my mood. The rest of my family, Grandma and Grandpa Weaver, Grandma
Nadine, Grandpa Kitchens, Aunt Connie, Doreen, Venita and Bob, Gay and Scott, Alicia
and Bob, Joel and Annabel, and Curt and Laura, your examples and love have shaped me
and the belief that I can be anything. Last but not least, my friends. Steph and Brigette,
you are the family I have chosen and I cannot believe I have found such amazing people
with whom to share this crazy life. Thank you all for your help and the role you played
in the achievement of my goals. You are all appreciated and will be remembered always.
iv
TABLE OF CONTENTS
1. REASONING AND OVERVIEW 1
Background 1
Problem Statement 1
Purpose of the Project 3
2. BUILDING TOPIC UNDERSTANDING 5
Literature Review 5
Project Theory 5
Fibromyalgia 6
Pathophysiology 6
Diagnosis 8
Treatment 9
Self Management 10
Smart Wearable Body Sensors 11
3. PROJECT SETUP 12
Methods 12
Design 12
Data Collection and Management 13
4. PROJECT FINDINGS 18
Data/Results 18
Quantitative Data Analysis 19
Qualitative Data Analysis 25
Device Usability- Function 25
Device Usability- Wear 26
Personal Awareness – Level of Activity 26
Personal Awareness – Activity versus Symptoms 26
Device Feedback 27
5. PULLING IT ALL TOGETHER 29
Discussion 29
Strengths and Limitations 30
Implications for Nursing Education, Practice and Research 30
Conclusion 31
v
TABLE OF CONTENTS – CONTINUED
Acknowledgements 32
Funding 32
Conflict of Interest 33
REFERENCES CITED 34
APPENDICES 40
APPENDIX A: Questions Asked to Each Participant
During the Exit Interview 41
vi
LIST OF TABLES
Table Page
1. Participant Characteristics 19
2. Individual FIQR Scores 20
3. Average Daily Steps and Hours Device Not Worn by Individual 21
4. Trend of Steps and FIQR from week 1 to 4 21
vii
LIST OF FIGURES
Figure Page
1. FIQR Function vs. Steps by Participant ……………………………………..22
2. FIQR Overall vs. Steps by Participant ……………………………………....23
3. FIQR Symptoms vs. Steps by Participant …………………………………...24
viii
GLOSSARY
ADL- Activities of daily living
FM- Fibromyalgia
FIQR- Revised Fibromyalgia Impact Questionnaire
IADL- Instrumental activities of daily living
PA- Physical Activity
SWBS- Smart, wearable body sensor
ix
ABSTRACT
Physical activity is an important component of symptom management in patients
with fibromyalgia. A means to aid fibromyalgia patients in developing, monitoring and
achieving physical activity goals may be useful in fostering resilience. The aim of the
project was to explore the feasibility and acceptability of using a smart, wearable body
sensor - the Fitbit One - to monitor physical activity in persons living with fibromyalgia.
This project also explores use of the Fitbit One to examine the relationship between
number of steps per week and fibromyalgia symptom impact. This healthcare delivery
innovations project utilized a feasibility study design, where participants were asked to
wear a Fitbit One for four consecutive weeks while performing their usual routines. Each
week participants filled out the Revised Fibromyalgia Impact Questionnaire (FIQR), and
at the end of the four-week period, the researcher interviewed participants about their
experience wearing the Fitbit One. Participants (n=8) all identified as white females and
had a previous diagnosis of fibromyalgia. Content analysis revealed three qualitative
themes: 1) Device usability; a majority (n=7) felt the Fitbit One was easy to use 2)
personal awareness; a majority (n=7) stated that the device increased their exercise
awareness and 3) device feedback; most (n=6) participants felt that device feedback lead
to physical activity goal setting. No participant felt that the device impacted pain. 7 of 8
participants’ FIQR scores indicated decreased or unchanged symptom impact in daily
living. Steps vs. FIQR graphs showed that for 6/8 participants the number of steps either
increased or stayed the same, while self-reported fibromyalgia impact stayed the same or
improved throughout the study. Findings suggest that Fitbit One use and wear are
acceptable to individuals with fibromyalgia. Most participants cited increased awareness
of physical activity as a benefit. Graphical analysis of steps compared to fibromyalgia
impact suggests that increased steps may indicate decreased symptom impact. Given
participants responses to usefulness and acceptability of the device, it seems that
integration of smart, wearable body sensors into healthcare may be effective as another
means to enable fibromyalgia self care.
