Date of Award

2019

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Julie Barroso

Second Advisor

Michelle Nichols

Third Advisor

Jeffrey Meyer

Abstract

Background: Fibromyalgia (FM) is characterized by chronic diffuse pain, fatigue, memory problems, sleep disturbance, depression, and mobility limitations. The Department of Defense (DoD) and Department of Veterans Health Administration (VA) recognize FM as potentially connected to service in the Persian Gulf War, and the rates of FM diagnosis and disability in the VA are rising. Purpose: The purpose of this dissertation was to assess the feasibility and acceptability of heart rate variability biofeedback (HRVB) as an intervention for the treatment of FM in Veterans. Problem/Aims: We conducted an integrative literature review (manuscript 1) and identified a gap in the literature related to HRVB to treat FM-related chronic pain. Overall, HRVB is a promising treatment for chronic pain; however, further research is needed to evaluate the relationship between HRVB and FM pain. We found only one study evaluating HRVB for the treatment of FM, and we did not identify any studies that evaluated the recommended HRVB practice protocols, or any qualitative studies investigating the individual experience of using HRVB. The specific aims of this dissertation were: Aim 1: Examine the feasibility of recruitment and retention of Veterans with fibromyalgia. Aim 2: Determine the feasibility of adherence to the recommended HRVB practice protocol using the emWave2. Aim 3: Examine participant acceptability and satisfaction with the intervention. Design: We used a sequential exploratory multi-method design to determine if it is feasible for Veterans with FM to follow a twice-daily 20-minute HRVB practice protocol. We conducted a focus group post-intervention to explore the participant’s experiences with HRVB. Theoretical framework: The theory of symptom self-management guided the study; it posits that when self-directed interventions are optimized, performance outcomes will improve. Findings: We found that it was not feasible for Veterans with FM to follow the recommended HRVB protocol. Barriers identified were conflicts with family obligations and work schedule as well as difficulties operating the HRVB device. Results from weekly questionnaires suggested an improvement in functional status and quality of life, but no change in pain levels. However, during the focus group discussion, the Veterans reported a reduction in pain levels as well as improvement in sleep, relaxation, and cognition. Conclusion: Limitations of this study were a small size (n=10), possible self-selection bias, and the lack of a control group. While the data suggests HRVB may improve the functional status and quality of life of those with FM, more research is needed.

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