Digitally Assisted Behavioral Physical Activity Intervention in Fibromyalgia

A chair without arms, with rubber tips on the legs, a hard seat of fixed height 46 cm was positioned against a wall. Test protocol required the participant to commence in a seated position with the feet resting flat and ankle joints in the neutral position. All participants were given the instruction to perform the sit-to-stand task as quickly as possible with their arms crossed over the chest and hands on the shoulders. A standard Sit to Stand (STS) movement was viewed as the legs being fully straightened when the stand phase concluded and the hip landing firmly on the chair when seated. A test would be terminated if the participant required assistance or was unable to complete the movement. No encouragement was provided during any STS test protocol.

30 seconds STS tests, subjects were required to perform as many STS movements as possible within 30 seconds, respectively. The number of STS movements completed within the time required was recorded, as appropriate.

The Fibromyalgia Impact Questionnaire (FIQ) was developed in 1991, with subsequent modifications in 1997 and 2002. It has been validated as an effective tool for assessing status and function of patients with fibromyalgia.The FIQ is a self-administered instrument and contains ten questions that assess the following areas: physical functioning, symptoms of pain, fatigue, morning tiredness, stiffness, job difficulty, depression, anxiety, days of work missed, and overall well being in the previous week. The possible range of score is from 0 to 100, with a higher score indicating a greater effect of the syndrome on the individual.

The Pittsburgh Sleep Quality Index (PSQI) is a 19-item self-report measure of sleep quality over the previous month. It consists of seven component scores, each rated on a 0-3 scale, with higher scores implying greater difficulties. These seven component scores can be summed to form a single global score, which ranges from 0 to 21, with higher scores reflecting greater overall sleep disturbance. The PSQI has demonstrated adequate internal consistency, test-retest reliability, and discriminative validity in a mixed sample of participants ages 19-83 (M=49.5), with major depressive disorder, sleep disorders, or no psychiatric disorder. A global PSQI score of 5 or greater is indicative of poor sleep quality among younger adults, though others suggest a cut-off of 8.

The visual analogical scale (VAS) is commonly employed to assess the perception of somatic pain intensity. Validated in fibromyalgia patients, this scale has a score from 0 to 10, where 0 refers to pain free or "no pain" and 10 refers to "worst possible pain". It is a single-item scale. Test-retest reliability has been shown to be good, but is higher among literate (R = 0.94, p < 0.001) than illiterate patients (R = 0.71, p < 0.001) before and after attending a rheumatology outpatient clinic.

Fatigue severity scale (FSS); a Likert scale consisting of nine items that assess fatigue severity and functionality. Items were rated on a scale of 1 to 7 according to their level of agreement with a given statement and included statements such as "I am easily fatigued" or "Fatigue interferes with carrying out certain duties and responsibilities". Values for each item were averaged for a composite score, with higher scores indicating higher levels of impairment as a result of fatigue. FSS has been used in clinical practice for fatigue symptoms in people with chronic neck pain, showing high internal consistency (Cronbach's alpha > 0.8)

Exercise Benefits/Barriers Scale (EBBS) is consisted of 42 items, 14 of the Barriers Scale and 28 of the Benefits Scale. This scale presents answer options of the Likert type with rating levels varying from one (1) to four (4): strongly agree (4), agree (3), disagree (2), strongly disagree (1). When used together, the EBBS has a reverse score of the items of the Barriers Scale, ranging from 42 until 168. Isolatedly, the highest score is of the Benefits Scales that ranges from 28 to 112 and of the Barriers Scale, from 14 until 56, representing the best perception of the benefits and the barriers respectively.

Physical activity awareness will be assessed with Cognitive Behavioral Physical Activity Questionnaire (CBPAQ). The CBPAQ scale consists of 15 items, including three sub-dimensions: personal barriers, outcome expectations and self-regulation. The individual items are rated at 1-5 according to the situation in which they are most appropriate. The higher the score, the higher the level of awareness.

The activity diary is a chart prepared in the form of weekly periods in which patients record their pedometer outputs (walking time, number of steps, walking distance) daily.