AUTHOR=Nieves-Vázquez Cristina I. , Detrés-Marquéz Amanda C. , Torres-Reverón Annelyn , Appleyard Caroline B. , Llorens-De Jesús Astrid P. , Resto Ivana N. , López-Rodríguez Verónica , Ramos-Echevarría Paola M. , Castro Eida M. , Flores Idhaliz 

TITLE=Feasibility and acceptability of an adapted environmental enrichment intervention for endometriosis: A pilot study

JOURNAL=Frontiers in Global Women's Health

VOLUME=Volume 3 - 2022

YEAR=2023

URL=https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2022.1058559

DOI=10.3389/fgwh.2022.1058559

ISSN=2673-5059

ABSTRACT=Introduction: We have previously shown that Environmental Enrichment (EE)-consisting of social support, novelty, and open spaces—decreased disease progression and anxiety in a rat model of endometriosis. We developed a novel EE intervention to be tested in a pilot randomized clinical trial (RCT) in patients with endometriosis, a painful, stressful disease 
Objective: To translate and evaluate the feasibility and acceptability of an adapted EE intervention as adjuvant to standard-of-care for endometriosis patients.
Methods: Feasibility was assessed through recruitment, enrollment and adherence rates. Acceptability was evaluated through a post-intervention survey and focus group discussion 3-months after the end of the intervention.  
Results: Of the 103 subjects recruited, 64 were randomized to the intervention group and 39 to the control group. At the start of the intervention, the study groups consisted of 29 (intervention) and 27 (control) subjects. Enrollment rates were 45.3% and 69.2%, and adherence rates were 41.4% and 100% for the intervention and control groups, respectively. Enrollment and adherence were impacted by delays resulting from natural events (earthquakes, the COVID-19 pandemic). The most common reasons for missing an intervention were period pain (39.1%), and work-study (34.8%). There was high acceptability (>80%) of the intervention’s logistics. The majority (82.4%) of subjects would continue participating in support groups regularly, and 95.7% would recommend the intervention to other patients.
Conclusions: We showed that EE can be translated into an acceptable integrative multi-modal therapy perceived as valuable among participants who completed the intervention. High attrition/low adherence indicate that additional refinements would be needed to improve feasibility. Acceptability data indicate that EE has the potential to be integrated into the clinical management of patients with endometriosis and other inflammatory, painful disorders. Studies to assess the efficacy of EE in improving pain symptoms, mental health, and quality of life (QoL) are ongoing.