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Running head: FIBROMYALGIA AND FATIGUE STUDY

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Fibromyalgia and Fatigue Study Mrs. Susan R. Hemann Walden University

FIBROMYALGIA AND FATIGUE Fibromyalgia and Fatigue Study

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Fibromyalgia is a problem that effects many people around the world. The fatigue can be debilitating as the pain for some. This study will be determining whether meditation is an effective method in reducing fatigue in fibromyalgia patients. Fatigue continues to be a significant issue for many fibromyalgia patients. It is not known how or to what extent meditation affects fibromyalgia fatigue among adults. The purpose of this research is to determine the effectiveness of meditation on fatigue among adult fibromyalgia patients. What is the value of meditation on fibromyalgia fatigue in adults? The null hypothesis is that meditation will not reduce fatigue in adult fibromyalgia patients. The hypothesis is that meditation will reduce fatigue in adult fibromyalgia patients. Review of Literature “Fibromyalgia is a common syndrome in which a person has long-term, body-wide pain and inflammation in the joints, muscles, tendons, and other soft tissues” (Fibromyalgia, 2012). Fatigue with fibromyalgia studies has not been widely done. These future studies are with fibromyalgia and meditation, but not to reduce fatigue in patients. Lush & Salmon et al. discovered: In a Fibromyalgia study [Mindfulness] MBSR treatment significantly reduced basal electro dermal and [skin conductance level] SCL activity during meditation (t = 4.389, p = .001), consistent with reduced SNS activation. The conclusion was basal SNS activity was reduced following [meditation] MBSR treatment.

or objects. et al. p < . This pilot study suggests that the treatments and health promotion programs offered at the Maharishi Ayurveda Health Centre in Norway led to long-term reductions in symptoms of fibromyalgia. Significant relationships were found between fatigue and sleep at both pre. thoughts. p < . 2002). “Lastly. It is not an end all or cure-all. a fourth Carlson & Garland research with cancer patients demonstrated that fatigue scores were fatigue scores were statistically significant. and other studies are warranted” (Rasmussen et al. had almost no symptoms and significantly lower FIQ change scores (−92% to 97%) than the non-meditators on all outcomes. including breathing. a person focuses attention on sensations. meditation behavioral cognitive therapy (MBCT) participants reported lower levels of fatigue (the primary clinical outcome) than the waiting-list group”(Rimes & Wingrove. Mindfulness is an option when constructing a treatment plan for patients with fibromyalgia” (Von Weiss & Millea.001. a fifth study done at the Maharishi Ayurveda Health Centre verified that at 24 months. 2011).(r = .(r = . which is considered a treatment-resistant condition. “Next.74. a third study demonstrated analysis of covariance controlling for pretreatment scores indicated that. at post treatment.32.05) and post. 2012).001) intervention” (2005). This technique provides an additional method for treating fibromyalgia.. during meditation.FIBROMYALGIA AND FATIGUE 3 “Next.53. the four subjects who continued practicing [meditation] TM. . “Nonetheless. p < . t (62) = 3. This study showed that meditation can reduce fatigue symptoms. Additional fatigue specialized studies would clarify whether meditation is an established strategy for lowering fibromyalgia fatigue. which this study will examine with Fibromyalgia patients.. this second report shows that.

It would be appropriate to believe that they would like to try something that may contribute to their quality of life. Pain can be treated with drugs. The results of the study will be publicized for perusal by all who wishes to see it. Fatigue is something that effects quality of life and to seek a solution that is useful for scientific inquiry and beneficial for society. Pain is a serious issue. The importance of the present study it may represent the value of meditation for fatigue in fibromyalgia. but with many other pain related conditions. These patients are motivated to go through a rehabilitation program for pain reduction. If this is successful. the control group and the experimental (treatment group). The groups will be taken from two classrooms from which the people who have fibromyalgia will be divided into two groups. Meditation is not a drug treatment. Method .FIBROMYALGIA AND FATIGUE 4 Gaps in research have been found for fibromyalgia fatigue and meditation. Fatigue due to sleep and pain issues concerns patients on a daily basis. The rationale for the design is that it is easier to motivate someone who wants to improve their quality of life than someone who is just curious. This is a leading short-term study. The study should be pursued because fatigue is an issue in not just fibromyalgia. Research in fibromyalgia has been focused on pain mostly. The nature of the article is nonequivalent (pre-test and posttest) quasiexperimental group design. Reducing fatigue with a noninvasive or nondrug method can potentiate more research and help those it wants to help. fatigue cannot. but pain is not the only issue a Fibromyalgia patient may experience. it may help more fibromyalgia patients with a better quality of life.

it is a coefficient of reliability (or consistency)” (Introduction to SAS. The subsequent data from the two groups will be analyzed and collected.test will be given asking the same question. The analytical tools I am going to use are the Reliability-Corrected ANCOVA. Data sets will be the pre and post test results. The scale will be on a one to 10 scale. after the treatment. A pretest will be given as a scaled questionnaire that will determine how much fatigue the subject has at the present time.FIBROMYALGIA AND FATIGUE Participants The plan is quasiexperimental with 40 participants. The adjusted pre-test value equals the original pretest value plus the reliability (adjusted pretest value + original pretest value) “Cronbach's Alpha for reliability is used because Cronbach's alpha is a measure how closely related a set of items is as a group. Then. The first day will be when the treatment is applied for the first time. Technically speaking. The reliability of the instrument (meditation) will be the direction given during the group training and subsequent question and answer session. Instrumentation will be a pre-test and posttest. a convenience sample of 20 in the 5 control group (no treatment) and 20 in the experimental group (treatment). The device is meditation. 2007). One is the least fatigue and 10 being the most. This will create a before and after look at how meditation affects fatigue. Cronbach's alpha is not a statistical test . A meditation diary and the timer will be used twice daily for validity. Cronbach’s Alpha Figure 1 . a post.

Weaknesses are that meditation is a habit that needs to be incorporated into a daily routine and subjects may fail to write down when and how long. 2006). the control and treatment group.. This will be addressed by using a computerized system to randomize the participants into the two groups. This internal validity threat will be addressed by giving out meditation CDs. Participants will be given contact numbers. the limitations would be the number of participants and the age ranges. and phone numbers so participants can feel confident that they are meditating correctly. Fibromyalgia fatigue is the key issue. and a meditation CD will be given to assist participants meditate effectively. diaries. “The Non Equivalent Groups Design is susceptible to the internal validity threat of selection. Moreover. Any prior differences between the groups may affect the outcome of the study” (Trochim. first . the weaknesses will also be addressed by a meditation digital timer. The meditation diary will address the issue of accuracy. The participants will receive a training session to learn the meditation technique and a logbook will be given to them to write down when and how long. Meditation for 30 minutes will be done at the same time. The significance of the study is for fibromyalgia patients and others who experience fatigue.FIBROMYALGIA AND FATIGUE 6 Subsequently. Treatment is voluntary. Questions will be sincerely welcomed. The practical contribution of this study is that it will help people with fibromyalgia deal with fatigue in a nondrug way. W. Detailed instructions will be given. The ethical concerns of the study will be addressed by explaining fully and giving out informed consent forms to be read and understood by every participant. twice each day to account for dropout due to time constraints. The research is essential.

Consider the quantitative research project. “Frankfort-Nachmias also explains that it is simpler because it can infer causal influences whether the independent variable causes changes in the dependent variable” (2008). Research Design Quasiexperimental “The strength of the Controlled Experimentation Group Design is that it allows for pretest. a pretest control group. hypotheses. Experimental Designs Quasiexperimental . Next. the research questions. and variables. There is a pretest experimental group. 2008). and control group-experimental group comparisons” (Frankfort-Nachmias & Nachmias. explains that it helps us understand the logic of all research designs. and a non-pretest control group. “Frankfort-Nachmias.FIBROMYALGIA AND FATIGUE 7 for people who suffer from fibromyalgia or fatigue. This design takes the sensitization into account and accounts for that extraneous variable by not pretesting two of the groups. et al. non-pretest experimental. it is a model in which we can compare other research designs” (2008). Meditation may have other benefits such as stress reduction. another research design is the Solomon-Four Group Design. The pre-test sensitizes the subjects before the experiment. posttest. second. for understanding about alternative treatments.

The second objective is to affect positive change so research will benefit.FIBROMYALGIA AND FATIGUE 8 Moreover. Bias would be an issue if the researcher had a financial interest in the investigation. they are not randomly assigned as in the classic experimental design. maybe months. Moreover. The participants will be able to be guided through the meditation process. the time issue. the Quasiexperimental model is when scientists put people in the experimental group and the control group. . The pretest helps the researcher select the participants who are within research parameters. There is a partnership to help motivate the participant to succeed in incorporating healthy habits. It would take more than the three weeks. Furthermore. There is a pretest and posttest. another model would not be used because the researcher would have to lay out fliers in all the hospitals and placed ads in the local newspaper. the motivation is that the participants are in a place that they can learn meditation easily with generous support from the research team. Subsequently. the results should remain neutral. The main objective in this three week program is to find alternative ways to augment medication or reduce it. If the researcher remains within defined research protocols. Teaching meditation during the pain rehab program is convenient for the researcher. The study helps these caregivers learn how meditation may be put into practice in the program as a method for reducing fatigue in people affected by pain. The fibromyalgia participants are chosen within the pain rehab program because it is easier to prevent noncompliance. the reason the quasiexperimental plan would be ease of handling since it a study with only 40 participants.

but this negative reactivity would be minimal since it is a non-evasive and nondrug quasiexperimental design. It may skewer the results. the validity would increase by having the group being treated with the meditation guided through the experience twice each day for thirty minutes. changes in the measuring instruments pretest to posttest. which refers to dropout problems. Selection would be based on whether the person had fibromyalgia and fatigue. all the events that occurred during the study maturation. 1) The intrinsic factors. 9 For example. Also. reactivity of measurement may be a threat in some studies. and social processes that produce changes. 6) Regression is another possibility which individuals have been assigned to the experimental group on the basis of their high scores on the pretest. Recommend a quantitative plan for your research proposal. if the researcher would place the people that said they had extreme fatigue in the treatment group. as well. which may be due to other physical factors. 5) Testing. also.FIBROMYALGIA AND FATIGUE Frankfort-Nachmias & Nachmias explained that certain aspects need to be assessed to avoid threats to the validity of the study. The question is whether meditation alleviates fatigue. 2) Psychological. 4) Instrumentation. A true experimental proposal would not be recommended since it could not have the easy access to participants. Not whether it alleviates extreme fatigue. it would be able to be fully supervised which in a normal home environment could not. history. biological. Furthermore. The participants would have to be found . 3) Experimental mortality. A quasiexperimental design recommended because of the easy access to research participants.

Diary is to be kept by the participant for use for after experiment. This study is to help participants develop a habit of meditation and for research study. Another study significantly found that yoga reduces fatigue in fibromyalgia patients. That was a factor in the qualitative research that will be resolved in this quantitative supervised research with adults. “Morone. direct pain reduction.FIBROMYALGIA AND FATIGUE 10 from the general population which would be difficult. improved attention skills. and variables. Tucker discovered: Compared with controls. improved sleep latency. This study will eliminate the possibility of forgetting to log in the journal since it will be supervised. The classic experimental design would be too impersonal for a small quasiexperimental design with meditation. Support your work with references to the literature. Even though this was a pain related research it relates to fatigue. narrative study several themes. For designs that the researcher did not want. which were well-being. mood elevation. It would be difficult to keep extraneous variables to a limited degree since the subjects would be ‘on their own’ in relation to meditation and daily logs. hypotheses. Lynch. et al. “Meditation has been known to help alleviate chronic pain. significant improvements were seen in the yoga group on the visual analog scale and the Pain . found in a qualitative. “Pain and chronic fatigue are often co-morbid. and improved quality of life” (2008).447 randomly selected adults in a Dutch community sample. better pain coping. quality of sleep. state why each one is not appropriate for the research questions. 2011). chronic fatigue was increasingly common among those with more intense and widespread pain” (p 75-78. Marcus & Deodhar found in a survey of 2. The participants are already in a program to reduce symptoms so for them to acquiesce to being in a quasi-experiment of this nature would not be unfamiliar to them.

Using this design and management can verify statistical accuracy. This study will focus on Fibromyalgia and the fatigue that often occurs with it. It is commonly comorbid with Chronic Fatigue Syndrome which is a concerning issue. and a meditative method to conceivably lower it. Literature Review Summary The studies have shown that fatigue is a common issue in patients with Fibromyalgia. helping participants in proper meditative practice and ensuring journal use twice daily. and the Fibromyalgia Health Assessment Questionnaire. p. This necessitates monitoring. the Pittsburgh Sleep Quality Index. 72) 11 Moreover. the Multidimensional Assessment of Fatigue scale. “Furthermore.FIBROMYALGIA AND FATIGUE Rating Index on ranked values. The Quasi-experimental study design has been validated by using strict controls in relation to documentation and training. both for pain. it is found that fatigue has been diagnosed in over 70 percent of Chronic Fatigue Syndrome patients. This study will further clarify the need for further studies and inform on Fibromyalgia and its overwhelming fatigue. . must someone with fibromyalgia meditate? “The medical benefits of meditation has been widely documented and continues to grow in quality and quantity. Meditation is also a nondrug and noninvasive method. suggesting that these “overlap syndromes” are very closely related or share a common pathogenesis [origination and development of a [the] disease]”(Lapp. It has no undesirable side effects. there were more than 70 scientific articles published on mindfulness meditation practice” (Fortney & Taylor. It has also been validated by other Quasi-experimental Fibromyalgia studies. The design is quasiexperimental using narrow boundaries. 2010). 2003). (2005. In 2007.

The subjects will also be surveyed initially to find out if they have a problem with fatigue and fibromyalgia. “Walliman similarly asserted the ordinal level of assessment can be rank ordered” (2011. “Walliman 12 calculated the nominal level of measurement will distribute the data into different categories that can be compared with each other” (2011. the reliability will be confirmed by replicating the research for another three weeks with different participants. p. Empirical validity will be ensured by using a Likert scale measuring fatigue before the three week study and after. the content. The construct validity will be ensured by a daily fatigue and participation diary for the subjects. they will be screened out. “Hopkins defined this as test-retest reliability” (2000. p. If they do not. Likewise. The content validity will be ensured by the enlistment of people already in a pain rehab program. All potential participants will be screened for other issues such as anxiety or depression. and construct validity. 97). The scale measurements will be a Likert scale from a level of one to 10. The measurements will be on a one to 10 level of fatigue.FIBROMYALGIA AND FATIGUE Measurements and Instruments The nominal and ordinal levels of measurement will be used for this study. 1). the validity needs be ensured. Consequently. This ordinal scale will be used because the level of fibromyalgia fatigue is rank ordered. one being no fatigue to 10. 96). The data can then be rank ordered to allow comparison from before treatment to after treatment. being extreme fatigue. empirical. “It will also use change . This numerical data then can be divided into categories that can be compared with each other. Since the study’s participants are in a three week ongoing program. the study can be duplicated twice in a six week period with an entirely different set of participants. p.

determines the discriminate power of the items. 2000. 424) “Secondly. 1). after any shifts in the mean have been taken into account”(2000. 1) Change in the mean is the difference in the mean from the first test to the second test. typical error. the split half reliability assessment tests reliability. The split half method estimates reliability by treating each of the two parts of measuring instrument as a separate scale” (Frankfort-Nachmias & Nachmias. The . 156). administers these items to the subjects.FIBROMYALGIA AND FATIGUE 13 in the mean. computes a total score for each subject. and retest correlation” (Hopkins. “Hopkins quantified it as the standard deviation in each participant's measurements between tests. and then tests the scales reliability” (2008. “The typical error is that random Figure 1 Standard Deviation variation of the scores. these are the strengths and limitations of the Likert scale: “The first strength is the measurement determines the strength of attitude on the ordinal and internal level” (FrankfortNachmias & Nachmias. Moreover. 422) “Frankfort-Nachmias & Nachmias clarified that the Likert Scale assembles a list of scale items. 2008. p. p. 2008. p. p. p. selects the scale items.

the use of parametric methods or nonparametric methods when comparing scale indicators of the median or mean. acquiescence bias. & Liao. the direction of the response categories. . It only asks one or two questions regarding fatigue. The treatment is being done in a medical facility. item reactivity. p. (Lewis. A thorough explanation of how to do meditation will be explained before starting treatment (meditation). social desirability bias. using an odd or even number of responses. mode of delivery. number of responses. dealing with missing data. length or number of items. the lack of attending behaviors. 714). All of these have the potential for influencing score reliability and validity. Bryman. Barnette alleged: The limitations [likert scale] were the reading level. p.FIBROMYALGIA AND FATIGUE split half reliability will be used to ensure reliability in the process of measuring fatigue in fibromyalgia subjects. 2004. 953) The strength of the instrument is ease of participant understanding. The split half test Figure 2 Spearman Brown 14 utilizes the Spearman Brown prophecy formula. use of negatively worded items”(2010. central tendency bias. labeling of a middle response. The questions will be asked before and after treatment.

(2007). p. This is simply using the scale to help the participants put a number on their . 2004. the actual “neutral” point is unknown in the Likert method because this position is unlikely to correspond precisely to the midpoint of the resulting scale. or standard error of measurement (σE)” (Chen & Cross. Additionally. The Likert method in comparing the fibromyalgia meditation group to the fibromyalgia relaxation group is the best way of determining the level of fatigue before and after treatment in these two groups. Figure 4 Chronbach's Alpha “In order to interpret test scores accurately. 953). Also. and classifies individuals on a single element of favorability. Fabrigar & Wood specified: The limitations of the Likert series are that it creates a scale that is object specific.FIBROMYALGIA AND FATIGUE Figure 3 Standard of Error Measurement 15 Reliability assured via the split-half methods for estimating score reliability. researchers need to take unreliability into consideration. assumes unidimensionality. which is gauged by the square root of the errors of measurement variance.

05. the statistical scores can be measures using a one tail t test illustrated by figure 5 below. since the comparison it does between two groups is such a common comparison. Figure 5 t Test (2007. Salkind believed: The t test is one of the most popular of all inferential tests. The performance of each student was assessed for significant pretest-to-posttest differences using a one tailed t test with an alpha or significance level of . This study determined the effects of conflict resolution and related social skill development on students' metacognitive competencies. p. .FIBROMYALGIA AND FATIGUE 16 fatigue. 991). (2007). Then. The study was conducted over a 5-year period with fourth and fifth graders.

In summary. Population The quantitative sampling strategy will first determine the effect size. One formula for computing the t value: “X¯1 is the mean for Group 1.2). “effect size identifies the strengths of the conclusions about group differences or the relationships among variables in [these] quantitative studies” (2009). n2 is the number of participants in Group 2” (Salkind.5). then the statistical tests Spearman Brown Prophecy Formula (fig. To achieve the effect size “divide the mean difference by the standard deviation” (Burkholder. 991).d. the reliability and validity of this experiment with meditation and fatigue levels in fibromyalgia patients will be confirmed by. The sample determines effect size. Simply stated. n1 is the number of participants in Group 1.). sample size in this quantitative analysis relates to the number of participants in the study.FIBROMYALGIA AND FATIGUE 17 The t test in this study will calculate the difference between fatigue before treatment and fatigue after treatment using SPSS. . p. The scale that is going to be used is the Likert scale. the Chronbach’s Alpha Coefficient (fig. 2007. The effect size is the number of participants that need to participate to obtain a useable statistic or result.4). The mean and mode will be calculated first. at a minimum. 3) and the t test (fig. n. Creswell stated even more clearly. X¯2 is the mean for Group 2. Standard of Error Measurement (fig. four types of statistical tests and one scale.

1) s21 + (N2 . The sample size will be determined on how the pain rehab participants respond on the survey. (2000). an example of how effect size is gauged in this basic design is similar to the two group design. while a different group of people is exposed to or possesses the other level of the variable. Cortina & Nouri also declared: The effect size can also be found using information normally conveyed from ANOVAs. Of greatest interest is the difference in the dependent variable scores between the two groups. the sample is composed of two small groups of 20 fibromyalgia participants. Figure 1 Cohen's d Cohen’s d statistic is also a way to find effect size: Thereafter.FIBROMYALGIA AND FATIGUE 18 Furthermore. or possesses one level of a dichotomous variable. ANOVA example of effect size calculation: sp = {[(N1 .2]}. The resulting value is a standardized measure of magnitude of effect and can be used to compare the contributions of different variables within a given study or the contributions of the same variable across different studies. (2000). In this study. Cortina & Nouri found: One group of people is exposed to. the sample size will be determined by the participant pool.1) s22]/ [N1 + N2 . The fibromyalgia subjects will be screened and put into two .

easy to access” (Convenience Sample. Logically. etc. “The advantages of convenience samples are that they are inexpensive and. Participants willing to be in this fibromyalgia study would be comparatively straightforward. Additionally. The study will take into account these extraneous variables. this is the soundest sample plan because it recruits fibromyalgia patients who are in a Pain Rehabilitation Program. diabetes. The population being screened have fibromyalgia and are in a Pain Rehabilitation Program in Rochester. a Likert type scale measuring anxiety and depression and ‘yes or no’ whether a candidate has fibromyalgia will be employed. It is also deemed more authentic when gaining access to the population of interest is difficult” (Convenience Sample. but they are nevertheless essential to consider. null).FIBROMYALGIA AND FATIGUE 19 different groups. anxiety. in comparison to employing advertising methods. depression. the meditation group and the relaxation group. by definition. fibromyalgia. cancer. “Convenience sampling becomes more appropriate and acceptable when the population of interest is difficult to determine to provide any valid form of random sampling. The estimated sample size will be 20 in each group. Minnesota at the Pain Rehabilitation Clinic. Sample size goal is 20 participants in each group. null). Osborn stated: The rationale that a small sample size is good is that the population of interest is small. Potential fibromyalgia participants will be screened for fatigue. A convenience nonprobability sample design is being used. People suffering from rare diseases or conditions will of course be a small group from which to get a sample. Also. Sample size needs to be sufficient to determine the effect of treatment. rheumatoid arthritis. the 40 participant fibromyalgia sample will be drawn by survey method screening. Research conducted on a small size is convenient for regional analysis and . The study will be repeated twice in the course of six weeks with four sets of participants.

this fibromyalgia fatigue study will be a preliminary report to spearhead other notable studies. 2006).FIBROMYALGIA AND FATIGUE practitioner feedback (i. (b) defining the population. Summary References . the sample size will be small because of convenience in relation to population size.. and (d) using cautious language (2008). such as fatigue due to other conditions. It is also necessary to remember that bigger is not necessarily better. Also. let's consider four components of the rationale that require particular care when using them: (a) defining the research design. This sample will represent the population more than just a local pool. classroom–level action research). the sample quality that is required regarding sample size. This convenience sample will include quality subjects who have been screened. “After a certain number of people. Nevertheless. to take into account. (c) defining the context. Given that there is some justification possible for using a small sample. but it is usually not worth the added cost of obtaining the additional cases” (McCready. The law of large numbers states that as the size of a sample increases any estimated proportion rapidly approaches the true proportion that the estimate represents”(2006). Correspondingly.e. the range of precision goes down. Finding additional cases would not be cost effective. Additionally. Furthermore. the screening would have to take into account extraneous variables. the small sample size is employed because the Pain Rehabilitation 20 Program is three weeks. the participants will be from different areas of the nation. The disadvantages would be to find the number of subjects that have fibromyalgia within the three week time frame. “McCready remarked that is the elements of the sample.

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