The Multidisciplinary Treatment of Fibromyalgia.

Study Overview
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Brief Summary
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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
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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.

Official Title
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The Unite Care of Fibromyalgia. The Experience of the Patients and the Professionals.

Conditions
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Fibromyalgia, Pain, Treatment, Quality of Life

Intervention / Treatment
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* Other: Multimodal treatment of patients with FM
* Other: Association of people with fibromyalgia


Participation Criteria
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Eligibility Criteria
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Eligibility Criteria inclusion intervention group: to be diagnosed with FM to be between 18 and 80 years old be a patient of the unit care of FM the patients have to participate in nine of the treatment sessions the patients have to make the first visit in the unit care of FM during 2016 Eligibility Criteria inclusion control group: to be diagnosed with FM to be between 18 and 80 years old to be a member of the FM Patient Association of Terres de l'Ebre Eligibility Criteria exclusion control intervention and group: not understanding Catalan or Spanish not providing correct contact data

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 90 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Association of people with fibromyalgia<br>Control group included people affiliated to the FM Patient Association of Terres de l'Ebre, Spain. | Other: Association of people with fibromyalgia<br>* 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.<br>|
| Multimodal treatment of patients with FM<br>The intervention group was made up of patients from the specialist FM Unit in the Hospital of Lleida, Spain. | Other: Multimodal treatment of patients with FM<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Fibromyalgia impact questionnaire-FIQ | FIQ has been validated for the Spanish population. It is a tool for evaluating the impact of FM on physical capacity and quality of life. FIQ scores range: 0 (best functional capacity and quality of life) to 100 (worst state of health). FIQ scores less than 39 are considered to represent a level of slight deterioration, those between 39 and 59 represent moderate deterioration, and scores greater than 59 imply a severe level of disability. The scale comprises 10 items. The first evaluates functional capacity on an ordinal scale from 0(always) to 3(never). The second and third items are numerical scales that evaluate the number of days that participants have been in a good state of health and the number of days in the week on which they have been able to go to do their normal paid work. The other seven items are rated on analogue scales from 0-10 that measure (i)capacity to do a job, (ii)pain, (iii)fatigue, (iv)morning stiffness, (v)muscular numbness, (vi)anxiety and (vii)depression. | At the begining of the enrolment and 10 weeks later | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sociodemographic measures | sex, age, civil status, number of children, employment status and level of education. The clinical variables analysed covered the consumption of medication, the number of years that patients had been suffering the symptoms of FMS and the number of years since they had been diagnosed with FMS. | At the begining of the enrolment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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fibromyalgia, pain, quality of life, multidomal treatment