final paper spss 111712

7/27/2019 Final Paper Spss 111712

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Running head: FIBROMYALGIA AND FATIGUE STUDY 1

Fibromyalgia and Fatigue Study

Mrs. Susan R. Hemann

Walden University


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FIBROMYALGIA AND FATIGUE 2Fibromyalgia and Fatigue Study

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.


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FIBROMYALGIA AND FATIGUE 3Next, this second report shows that, during meditation, a person focuses attention on

sensations, including breathing, thoughts, or objects. Mindfulness is an option when

constructing a treatment plan for patients with fibromyalgia (Von Weiss & Millea, et al.,

2002). This technique provides an additional method for treating fibromyalgia. It is not an end

all or cure-all.

Next, a third study demonstrated analysis of covariance controlling for pretreatment

scores indicated that, at post treatment, meditation behavioral cognitive therapy (MBCT)

participants reported lower levels of fatigue (the primary clinical outcome) than the waiting-list

group(Rimes & Wingrove, 2011).

Nonetheless, a fourth Carlson & Garland research with cancer patients demonstrated

that fatigue scores were fatigue scores were statistically significant, t(62) = 3.74,p < .001.

Significant relationships were found between fatigue and sleep at both pre- (r= .32,p < .05)

and post- (r= .53,p < .001) intervention (2005). This study showed that meditation can

reduce fatigue symptoms, which this study will examine with Fibromyalgia patients.

Lastly, a fifth study done at the Maharishi Ayurveda Health Centre verified that at

24 months, the four subjects who continued practicing [meditation] TM, had almost no

symptoms and significantly lower FIQ change scores (92% to 97%) than the non-meditators

on all outcomes. 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, which is considered a treatment-resistant condition, and other

studies are warranted (Rasmussen et al., 2012). Additional fatigue specialized studies would

clarify whether meditation is an established strategy for lowering fibromyalgia fatigue.


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FIBROMYALGIA AND FATIGUE 4Gaps in research have been found for fibromyalgia fatigue and meditation. Meditation is

not a drug treatment. Research in fibromyalgia has been focused on pain mostly. Pain can be

treated with drugs, fatigue cannot. Pain is a serious issue, but pain is not the only issue a

Fibromyalgia patient may experience. Fatigue due to sleep and pain issues concerns patients on a

daily basis. Reducing fatigue with a noninvasive or nondrug method can potentiate more research

and help those it wants to help. This is a leading short-term study. If this is successful, it may help

more fibromyalgia patients with a better quality of life. The results of the study will be publicized

for perusal by all who wishes to see it.

The importance of the present study it may represent the value of meditation for fatigue in

fibromyalgia. The study should be pursued because fatigue is an issue in not just fibromyalgia, but

with many other pain related conditions. Fatigue is something that effects quality of life and to

seek a solution that is useful for scientific inquiry and beneficial for society.

The nature of the article is nonequivalent (pre-test and posttest) quasiexperimental group

design. The groups will be taken from two classrooms from which the people who have

fibromyalgia will be divided into two groups, the control group and the experimental (treatment

group).

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. These patients are motivated to go through

a rehabilitation program for pain reduction. It would be appropriate to believe that they would

like to try something that may contribute to their quality of life.

Method


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FIBROMYALGIA AND FATIGUE 5Participants

The plan is quasiexperimental with 40 participants, a convenience sample of 20 in the

control group (no treatment) and 20 in the experimental group (treatment). Instrumentation will

be a pre-test and posttest. The first day will be when the treatment is applied for the first time.

The device is meditation. The reliability of the instrument (meditation) will be the direction given

during the group training and subsequent question and answer session. A meditation diary and the

timer will be used twice daily for validity.

A pretest will be given as a scaled questionnaire that will determine how much fatigue the

subject has at the present time. Then, after the treatment, a posttest will be given asking the

same question. The scale will be on a one to 10 scale. One is the least fatigue and 10 being the

most. This will create a before and after look at how meditation affects fatigue. The subsequent

data from the two groups will be analyzed and collected. The analytical tools I am going to use

are theReliability-Corrected ANCOVA. Data sets will be the pre and post test results. 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. Technically speaking, Cronbach's alpha

is not a statistical test - it is a coefficient of reliability (or consistency) (Introduction to SAS,

2007). Cronbachs Alpha

Figure 1


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FIBROMYALGIA AND FATIGUE 6

Subsequently, the limitations would be the number of participants and the age ranges. This

will be addressed by using a computerized system to randomize the participants into the two

groups, the control and treatment group. 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.

Detailed instructions will be given. Meditation for 30 minutes will be done at the same time, twice

each day to account for dropout due to time constraints. 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. The meditation diary will address the issue of accuracy.

Moreover, the weaknesses will also be addressed by a meditation digital timer.

Participants will be given contact numbers, and a meditation CD will be given to assist

participants meditate effectively. The Non Equivalent Groups Design is susceptible to

the internal validity threat of selection. Any prior differences between the groups may affect the

outcome of the study (Trochim, W., 2006). This internal validity threat will be addressed by

giving out meditation CDs, diaries, and phone numbers so participants can feel confident that they

are meditating correctly. 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. Questions

will be sincerely welcomed. Treatment is voluntary.

The significance of the study is for fibromyalgia patients and others who experience

fatigue. Fibromyalgia fatigue is the key issue. The practical contribution of this study is that it will

help people with fibromyalgia deal with fatigue in a nondrug way. The research is essential, first
http://www.socialresearchmethods.net/kb/intmult.phphttp://www.socialresearchmethods.net/kb/intmult.php


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FIBROMYALGIA AND FATIGUE 7for people who suffer from fibromyalgia or fatigue, second, for understanding about alternative

treatments. Meditation may have other benefits such as stress reduction.

Research Design

Quasiexperimental

The strength of the Controlled Experimentation Group Design is that it allows for

pretest, posttest, and control group-experimental group comparisons (Frankfort-Nachmias &

Nachmias, 2008). Frankfort-Nachmias, et al. explains that it helps us understand the logic of all

research designs, it is a model in which we can compare other research designs (2008).

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).

Next, another research design is the Solomon-Four Group Design. There is a pretest

experimental group, a pretest control group, non-pretest experimental, and a non-pretest control

group. The pre-test sensitizes the subjects before the experiment. This design takes the

sensitization into account and accounts for that extraneous variable by not pretesting two of the

groups. Consider the quantitative research project, the research questions, hypotheses, and

variables.

Experimental Designs

Quasiexperimental


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FIBROMYALGIA AND FATIGUE 8Moreover, the Quasiexperimental model is when scientists put people in the experimental

group and the control group; they are not randomly assigned as in the classic experimental design.

There is a pretest and posttest. The pretest helps the researcher select the participants who are

within research parameters. Bias would be an issue if the researcher had a financial interest in the

investigation. If the researcher remains within defined research protocols, the results should

remain neutral.

Subsequently, the reason the quasiexperimental plan would be ease of handling since it a

study with only 40 participants. The fibromyalgia participants are chosen within the pain rehab

program because it is easier to prevent noncompliance. Teaching meditation during the pain rehab

program is convenient for the researcher. The participants will be able to be guided through the

meditation process.

Furthermore, the motivation is that the participants are in a place that they can learn

meditation easily with generous support from the research team. There is a partnership to help

motivate the participant to succeed in incorporating healthy habits. 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 main objective in this three week program is to find

alternative ways to augment medication or reduce it. The second objective is to affect positive

change so research will benefit.

Moreover, the time issue, 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. It would take more

than the three weeks, maybe months.


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FIBROMYALGIA AND FATIGUE 9Frankfort-Nachmias & Nachmias explained that certain aspects need to be assessed to avoid

threats to the validity of the study.

1) The intrinsic factors, history, all the events that occurred during

the study maturation. 2) Psychological, biological, and social

processes that produce changes. 3) Experimental mortality, which

refers to dropout problems. 4) Instrumentation, changes in the

measuring instruments pretest to posttest. 5) Testing; also,

reactivity of measurement may be a threat in some studies, but this

negative reactivity would be minimal since it is a non-evasive and

nondrug quasiexperimental design. 6) Regression is another

possibility which individuals have been assigned to the experimental

group on the basis of their high scores on the pretest.

For example, if the researcher would place the people that said they had extreme fatigue in

the treatment group. It may skewer the results. The question is whether meditation alleviates

fatigue. Not whether it alleviates extreme fatigue, which may be due to other physical factors, as

well. Selection would be based on whether the person had fibromyalgia and fatigue.

Furthermore, the validity would increase by having the group being treated with the

meditation guided through the experience twice each day for thirty minutes. Recommend a

quantitative plan for your research proposal. A quasiexperimental design recommended because

of the easy access to research participants. Also, it would be able to be fully supervised which in a

normal home environment could not. A true experimental proposal would not be recommended

since it could not have the easy access to participants. The participants would have to be found


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FIBROMYALGIA AND FATIGUE 10from the general population which would be difficult. 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. For designs that the researcher did not want, state why each one is not

appropriate for the research questions, hypotheses, and variables. Support your work with

references to the literature. The classic experimental design would be too impersonal for a small

quasiexperimental design with meditation. 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.

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. Meditation has been known to

help alleviate chronic pain. Morone, Lynch, et al. found in a qualitative, narrative study several

themes, which were well-being, better pain coping, direct pain reduction, improved attention

skills, improved sleep latency, quality of sleep, mood elevation, and improved quality of life

(2008). Even though this was a pain related research it relates to fatigue. Pain and chronic

fatigue are often co-morbid; Marcus & Deodhar found in a survey of 2,447 randomly selected

adults in a Dutch community sample, chronic fatigue was increasingly common among those with

more intense and widespread pain (p 75-78, 2011). This study will eliminate the possibility of

forgetting to log in the journal since it will be supervised. That was a factor in the qualitative

research that will be resolved in this quantitative supervised research with adults. Another study

significantly found that yoga reduces fatigue in fibromyalgia patients.

Tucker discovered:

Compared with controls, significant improvements were seen

in the yoga group on the visual analog scale and the Pain


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FIBROMYALGIA AND FATIGUE 11Rating Index on ranked values, both for pain; the

Multidimensional Assessment ofFatigue scale; the

Pittsburgh Sleep Quality Index; and the Fibromyalgia Health Assessment

Questionnaire. (2005, p. 72)

Moreover, must someone with fibromyalgia meditate? The medical benefits of meditation

has been widely documented and continues to grow in quality and quantity. In 2007, there were

more than 70 scientific articles published on mindfulness meditation practice (Fortney & Taylor,

2010). Furthermore, it is found that fatigue has been diagnosed in over 70 percent of Chronic

Fatigue Syndrome patients, suggesting that these overlap syndromes are very closely related or

share a common pathogenesis [origination and development of a [the] disease](Lapp, 2003).

Meditation is also a nondrug and noninvasive method. It has no undesirable side effects. The

design is quasiexperimental using narrow boundaries. This necessitates monitoring, helping

participants in proper meditative practice and ensuring journal use twice daily. Using this design

and management can verify statistical accuracy.

Literature Review Summary

The studies have shown that fatigue is a common issue in patients with Fibromyalgia. It is

commonly comorbid with Chronic Fatigue Syndrome which is a concerning issue. This study will

focus on Fibromyalgia and the fatigue that often occurs with it. The Quasi-experimental study

design has been validated by using strict controls in relation to documentation and training. It has

also been validated by other Quasi-experimental Fibromyalgia studies. This study will further

clarify the need for further studies and inform on Fibromyalgia and its overwhelming fatigue, and

a meditative method to conceivably lower it.


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FIBROMYALGIA AND FATIGUE 12Measurements and Instruments

The nominal and ordinal levels of measurement will be used for this study. Walliman

calculated the nominal level of measurement will distribute the data into different categories that

can be compared with each other (2011, p. 96). Walliman similarly asserted the ordinal level of

assessment can be rank ordered (2011, p. 97). This ordinal scale will be used because the level of

fibromyalgia fatigue is rank ordered. The scale measurements will be a Likert scale from a level

of one to 10, one being no fatigue to 10, being extreme fatigue. This numerical data then can be

divided into categories that can be compared with each other. The data can then be rank ordered

to allow comparison from before treatment to after treatment.

Consequently, the validity needs be ensured, the content, empirical, and construct validity.

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. The

construct validity will be ensured by a daily fatigue and participation diary for the subjects. The

subjects will also be surveyed initially to find out if they have a problem with fatigue and

fibromyalgia. If they do not, they will be screened out. Empirical validity will be ensured by using

a Likert scale measuring fatigue before the three week study and after. The measurements will be

on a one to 10 level of fatigue.

Likewise, the reliability will be confirmed by replicating the research for another three

weeks with different participants. Since the studys 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. Hopkins defined this as test-retest reliability (2000, p. 1). It will also use change
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FIBROMYALGIA AND FATIGUE 13in the mean, typical error, andretest correlation (Hopkins, 2000, p. 1) Change in the mean is

the difference in the mean from the first test to the second test. The typical error is that random

Figure 1 Standard Deviation

variation of the scores. Hopkins quantified it as the standard deviation in each participant's

measurements between tests, after any shifts in the mean have been taken into account(2000, p.

1).

Moreover, 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 (Frankfort-

Nachmias & Nachmias, 2008, p. 422) Frankfort-Nachmias & Nachmias clarified that the Likert

Scale assembles a list of scale items, administers these items to the subjects, computes a total

score for each subject, determines the discriminate power of the items, selects the scale items,

and then tests the scales reliability (2008, p. 424) Secondly, 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, 2008, p. 156). The
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FIBROMYALGIA AND FATIGUE 14split half reliability will be used to ensure reliability in the process of measuring fatigue in

fibromyalgia subjects. The split half test

Figure 2 Spearman Brown

utilizes the Spearman Brown prophecy formula. (Lewis, Bryman, & Liao, 2004, p. 953)

The strength of the instrument is ease of participant understanding. It only asks one or two

questions regarding fatigue. The treatment is being done in a medical facility. The questions will

be asked before and after treatment. A thorough explanation of how to do meditation will be

explained before starting treatment (meditation).

Barnette alleged:

The limitations [likert scale] were the reading level, item reactivity, length or

number of items, mode of delivery, number of responses, using an odd or even

number of responses, labeling of a middle response, the direction of the response

categories, dealing with missing data, the lack of attending behaviors, acquiescence

bias, central tendency bias, social desirability bias, the use of parametric methods

or nonparametric methods when comparing scale indicators of the median or

mean, use of negatively worded items(2010, p. 714).

All of these have the potential for influencing score reliability and validity.


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FIBROMYALGIA AND FATIGUE 15Figure 3 Standard of Error Measurement

Reliability assured via the split-half methods for estimating score reliability.

Figure 4 Chronbach's Alpha

In order to interpret test scores accurately, researchers need to take unreliability into

consideration, which is gauged by the square root of the errors of measurement variance, or

standard error of measurement (E) (Chen & Cross, 2004, p. 953).

Additionally, Fabrigar & Wood specified:

The limitations of the Likert series are that it creates a scale that is object specific,

assumes unidimensionality, and classifies individuals on a single element of

favorability. Also, 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. (2007).

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. This is simply using the scale to help the participants put a number on their


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FIBROMYALGIA AND FATIGUE 16fatigue. Then, the statistical scores can be measures using a one tail t test illustrated by figure 5

below.

Salkind believed:

The ttest is one of the most popular of all inferential tests, since the comparison it

does between two groups is such a common comparison. This study determined

the effects of conflict resolution and related social skill development on students'

metacognitive competencies. The study was conducted over a 5-year period with

fourth and fifth graders. 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 .05. (2007).

Figure 5 t Test

(2007, p. 991).


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The t test in this study will calculate the difference between fatigue before treatment and

fatigue after treatment using SPSS. One formula for computing the t value: X1 is the mean for

Group 1, X2 is the mean for Group 2, n1 is the number of participants in Group 1, n2 is the

number of participants in Group 2 (Salkind, 2007, p. 991).

In summary, the reliability and validity of this experiment with meditation and fatigue

levels in fibromyalgia patients will be confirmed by, at a minimum, four types of statistical tests

and one scale. The scale that is going to be used is the Likert scale. The mean and mode will be

calculated first, then the statistical tests Spearman Brown Prophecy Formula (fig.2), the

Chronbachs Alpha Coefficient (fig.4), Standard of Error Measurement (fig. 3) and the t test

(fig.5).

Population

The quantitative sampling strategy will first determine the effect size. The sample

determines effect size. The effect size is the number of participants that need to participate to

obtain a useable statistic or result. To achieve the effect size divide the mean difference by the

standard deviation (Burkholder, n.d.). Creswell stated even more clearly, effect size identifies

the strengths of the conclusions about group differences or the relationships among variables in

[these] quantitative studies (2009). Simply stated, sample size in this quantitative analysis relates

to the number of participants in the study.


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FIBROMYALGIA AND FATIGUE 18Furthermore, an example of how effect size is gauged in this basic design is similar to the

two group design.

Cortina & Nouri found:

One group of people is exposed to, or possesses one level of a dichotomous

variable, while a different group of people is exposed to or possesses the other

level of the variable. Of greatest interest is the difference in the dependent variable

scores between the two groups. (2000).

In this study, the sample is composed of two small groups of 20 fibromyalgia participants.

Cortina & Nouri also declared:

The effect size can also be found using information normally conveyed from

ANOVAs. 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).

ANOVA example of effect size calculation:

sp = {[(N1 - 1) s21 + (N2 - 1) s22]/ [N1 +N2 - 2]}.

Figure 1 Cohen's d

Cohens d statistic is also a way to find effect size: Thereafter, the sample size will be

determined by the participant pool. The sample size will be determined on how the pain rehab

participants respond on the survey. The fibromyalgia subjects will be screened and put into two


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FIBROMYALGIA AND FATIGUE 19different groups, the meditation group and the relaxation group. The estimated sample size will

be 20 in each group. The study will be repeated twice in the course of six weeks with four sets of

participants. Logically, this is the soundest sample plan because it recruits fibromyalgia patients

who are in a Pain Rehabilitation Program. A convenience nonprobability sample design is being

used. The population being screened have fibromyalgia and are in a Pain Rehabilitation Program

in Rochester, Minnesota at the Pain Rehabilitation Clinic. Participants willing to be in this

fibromyalgia study would be comparatively straightforward, in comparison to employing

advertising methods. The advantages of convenience samples are that they are inexpensive and,

by definition, easy to access (Convenience Sample, null). Convenience sampling becomes more

appropriate and acceptable when the population of interest is difficult to determine to provide any

valid form of random sampling. It is also deemed more authentic when gaining access to the

population of interest is difficult (Convenience Sample, null).

Additionally, the 40 participant fibromyalgia sample will be drawn by survey method

screening. Potential fibromyalgia participants will be screened for fatigue, depression, anxiety,

fibromyalgia, diabetes, cancer, rheumatoid arthritis, etc. Also, a Likert type scale measuring

anxiety and depression and yes or no whether a candidate has fibromyalgia will be employed.

Sample size needs to be sufficient to determine the effect of treatment. The study will take into

account these extraneous variables. Sample size goal is 20 participants in each group.

Osborn stated:

The rationale that a small sample size is good is that the population of interest is

small. People suffering from rare diseases or conditions will of course be a small

group from which to get a sample, but they are nevertheless essential to consider.

Research conducted on a small size is convenient for regional analysis and


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FIBROMYALGIA AND FATIGUE 20practitioner feedback (i.e., classroomlevel action research). Given that there is

some justification possible for using a small sample, let's consider four components

of the rationale that require particular care when using them: (a) defining the

research design, (b) defining the population, (c) defining the context, and (d) using

cautious language (2008).

Correspondingly, the small sample size is employed because the Pain Rehabilitation

Program is three weeks. Also, to take into account, the participants will be from different areas of

the nation. This sample will represent the population more than just a local pool. Furthermore,

the sample size will be small because of convenience in relation to population size. McCready

remarked that is the elements of the sample, the sample quality that is required regarding sample

size. It is also necessary to remember that bigger is not necessarily better. 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). After a certain number of people, the

range of precision goes down, but it is usually not worth the added cost of obtaining the

additional cases (McCready, 2006). This convenience sample will include quality subjects who

have been screened. Finding additional cases would not be cost effective. The disadvantages

would be to find the number of subjects that have fibromyalgia within the three week time frame.

Additionally, the screening would have to take into account extraneous variables, such as fatigue

due to other conditions. Nevertheless, this fibromyalgia fatigue study will be a preliminary report

to spearhead other notable studies.

Summary

References


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