The Multidisciplinary Treatment of Fibromyalgia.
Condition: Fibromyalgia; Pain; Treatment; Quality of Life
MeSH terms: Fibromyalgia; Myofascial Pain Syndromes
Study type: Observational [Patient Registry]

Summary: 
      Background Fibromyalgia is a pathology characterised by chronic pain that harms people's
      quality of life. This pathology requires an MRT that combines pharmacological and
      non-pharmacological treatments. Currently, FPAs are important to society not only by offering
      activities that improve fibromyalgia symptomatology but also by increasing public awareness
      of the disease. The present study compares the effectiveness of a multimodal rehabilitation
      treatment (MRT) with that of the activities of a fibromyalgia patient association (FPA), and
      identifies the patient characteristics that can interfere with the success of interventions.

      Methods The quasi-experimental study selected forty-six older adults with fibromyalgia. The
      intervention group (n = 23) received pharmacological treatment, physical exercise, education,
      psychological therapies and Caycedian sophrology, while the control group (n = 23) carried
      out group psychological sessions and handicraft-based activities. Data collection included
      sociodemographic measures and responses to the Fibromyalgia Impact Questionnaire (FIQ).
      Participants were assessed pre- and post-intervention.
    

Detailed description: 
      A descriptive analysis of the sociodemographic characteristics of the intervention and
      control groups was done. Qualitative variables were expressed as percentages, and
      quantitative variables were summarised as the median and interquartile range.

      Shapiro-Wilk tests indicated that the dependent variables were not normally distributed (p <
      .05), so non-parametric statistical analyses were subsequently performed. The difference
      between the medians of the two patient groups was examined with the Mann-Whitney U test.
      Qualitative variables were compared with the chi-squared or Fisher's exact test, as
      appropriate.

      Being a quasi-experimental study, without randomization of patients, the existence of initial
      pre-intervention differences in the dimensions evaluated by the FIQ scale between the two
      patient groups was tested with the Mann-Whitney U test. For the dimensions that showed
      significant pre-intervention group differences, the medians of the post- and pre-intervention
      differences between the two patient groups were tested. For those dimensions of the FIQ that
      showed no pre-intervention differences, the post-intervention values were compared. The
      changes in the FIQ score and its dimensions before and after the intervention in both groups
      were assessed using the Wilcoxon test.

      Additionally, we carried out univariate and multivariate logistic regression analyses to
      identify the relationships between the independent variables studied and the improvement
      variable (increase, or not, of at least 8.1 points in the FIQ score after the intervention).

      Finally, the sample was stratified by educational level (primary versus secondary/university
      studies) and age (younger than 60 years or 60+ years). The pre- and post-intervention scores
      were compared using the Mann-Whitney U test and the differences in each group were analysed
      with the Wilcoxon test.
    

Intervention name(s): Multimodal treatment of patients with FM; Association of people with fibromyalgia
Intervention type(s): Other; Other
Intervention description(s): The intervention group took part in 2.5-hour sessions of MRT once a week for 10 weeks. This intervention combined physical exercise with stretching. Health education was geared towards pain management, the pathology itself, healthy habits, insomnia, postural correction and ergonomics. The psychological approaches used in the MRT were problem-solving therapy, cognitive behavioural therapy and sophrology. Given the diversity of the sessions, they were directed by a rheumatologist, a nurse, a psychologist, and a physiotherapist. If the patient needed their pharmacological treatment to be altered, they were offered an appointment with the rheumatologist.; The control group attended the activities organised by the association of people with FMS. These consisted of a weekly 1-hour session of group psychology and a weekly 2-hour session of handicrafts for 10 weeks.
Observational model: Other
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        The sample size was calculated on the basis of accepting an alpha risk of less than 0.05
        and a beta risk of less than 0.20. The calculation indicated that 23 subjects each in the
        intervention and control groups were needed to detect a minimum clinically significant
        difference greater than or equal to 8.1 points in the FIQ score. A common standard
        deviation of 9.6 was assumed, and a rate of loss to follow-up of 0% was estimated, since
        there were no losses during sample recruitment.

        The chosen standard deviation was that used by Lera (2009)
      
Keywords: fibromyalgia; pain; quality of life; multidomal treatment