Challenges in demonstrating the effectiveness of multidisciplinary treatment on quality of life, participation and health care utilisation in patients with fibromyalgia: a randomised controlled trial

Abstract

This study aimed to examine the effectiveness of a multidisciplinary intervention with aftercare (MD) compared to aerobic exercise (AE) and usual care (UC) in recently diagnosed patients with fibromyalgia (FM). In a Zelen-like design, eligible patients from the outpatient rheumatology clinics of three medical centres in the South of the Netherlands were consecutively recruited and pre-randomised to MD (n = 108), AE (n = 47) or UC (n = 48). MD consisted of a 12-week course of sociotherapy, physiotherapy, psychotherapy and creative arts therapy (three half days per week), followed by five aftercare meetings in 9 months. AE was given twice a week in a 12-week course. UC varied but incorporated at least education and lifestyle advice. Primary outcomes were health-related quality of life (HR-Qol), participation and health care utilisation. Secondary outcome was the Fibromyalgia Impact Questionnaire (FIQ). Total follow-up duration of the study was 21-24 months. As willingness to participate in AE was limited, this group has been analysed but interpretation of the data is considered arguable. Within the MD group, a statistically significantly improved HR-Qol and a statistically significant reduction in number of hours sick leave, number of contacts with general practitioners and number of contacts with medical specialists was found. Moreover, statistically significant improvements were found on the FIQ, which increased after the intervention. However, no statistically significant between-group differences were found at the endpoint of the study. MD seemed to yield positive effects, but firm conclusions with regard to effectiveness cannot be formulated due to small between-group differences and limitations of the study.

Resource utilisation and direct costs in patients with recently diagnosed fibromyalgia who are offered one of three different interventions in a randomised pragmatic trial

“…Since we previously failed to show any effects of the interventions on different aspects of health, including the 5-dimensional EuroQol (EQ-5D) [34] and FIQ as reported in our previous publication [26], a cost-minimisation study of the pragmatic trial could have been considered. However, a classical cost-minimisation study starts from the intervention onward and would have ignored the course of the costs incurred during diagnosis and therefore would have failed to show the large decrease in health care costs after the diagnostic phase and before the start of a specific intervention.…”

“…The study was approved by the Medical Ethical Committees of the participating medical centres. The precise procedures in this pragmatic trial, registration number ISRCTN32542621, have been published elsewhere [26]. …”

“…Previous analyses of a pragmatic trial among patients with recently diagnosed FM patients showed no consistent differences in relation to health outcomes between those that received a partially individualised multidisciplinary intervention with aftercare (MD), those receiving aerobic exercise (AE) and those receiving care as usual (UC) [26]. The present research aims to provide insight in resource utilisation and costs over 2 years in patients with FM after diagnosis and to understand whether the additional costs of specific interventions result in lower resource utilisation and costs.…”

Is There Evidence to Support Multidisciplinary Healthcare Working in Rheumatology? A Systematic Review of the Literature

“…For example, the management of rheumatoid arthritis typically referenced a significant contribution from doctors, nurses, physiotherapists, occupational therapists and podiatrists [Hagel et al, ; Hennell and Luqmani, ; Lambert et al, ; Li et al, ; MacKay et al, ; National Institute for Clinical Excellence (NICE), ; Stewart and Land, ; Taal et al, ; Vliet Vlieland and Hazes, ; Vliet Vlieland et al, ]. Conversely, the management of fibromyalgia typically referenced significant contribution from doctors, physiotherapists, social workers, psychologists and occupational therapists (Carville et al, ; Casanueva‐Fernandez et al, ; Castel et al, ; Manes et al, 2012; Hauser et al, ; Kroese et al, ; Lemstra and Olszynski, ; Sarzi‐Puttini et al, ; van Eijk‐Hustings et al, ). Therefore, while MDT working within rheumatology appears to be beneficial, overall it would appear that the MDT needs to be specifically tailored to suit differing conditions in order to achieve this.…”

Participation and social functioning in patients with fibromyalgia: development and testing of a new questionnaire

“…Van Eijk-Hustings et al [18] measure participation via time spent on unpaid tasks, paid work, chores, leisure activities and social activities. It is questionable as to whether the mere number of hours is a valid parameter for measuring participation restriction, as this perspective disregards subjectively-experienced difficulties associated with social activities and context factors (such as family and professional obligations).…”