Efficacy of a multidisciplinary fibromyalgia treatment adapted for women with low educational levels: A randomized controlled trial

Abstract

Objective. Multidisciplinary treatments of fibromyalgia (FM) have demonstrated efficacy. Nevertheless, they have been criticized for not maintaining their benefits and for not being studied for specific populations. Our objectives were to determine the efficacy of a multidisciplinary treatment for FM adapted for patients with low educational levels and to determine the maintenance of its therapeutic benefits during a long-term followup period. Methods. Inclusion criteria consisted of female sex, a diagnosis of FM (using American College of Rheumatology criteria), age between 18 and 60 years, and between 3 and 8 years of schooling. Patients were randomly assigned to 1 of the 2 treatment conditions: conventional pharmacologic treatment or multidisciplinary treatment. Outcome measures were functionality, sleep disturbances, pain intensity, catastrophizing, and psychological distress. Analysis was by intent-totreat and missing data were replaced following the baseline observation carried forward method. Results. One hundred fifty-five participants were recruited. No statistically significant differences regarding pretreatment measures were found between the 2 experimental groups. Overall statistics comparison showed a significant difference between the 2 groups in all of the variables studied (P < 0.0001). Mixed linear model analysis demonstrated the superiority of the multidisciplinary treatment in all of the studied variables at posttreatment. The differences were maintained at 12-month followup in sleep disturbances (P < 0.0001), catastrophizing (P < 0.0001), and psychological distress (P < 0.01). Conclusion. Multidisciplinary treatment adapted for individuals with low educational levels is effective in reducing key symptoms of FM. Some improvements were maintained 1 year after completing the multidisciplinary treatment.

Impact of interdisciplinary treatment on physical and psychosocial parameters in patients with fibromyalgia: results of a randomised trial

“…We note that our findings are in accord with those of other studies that have also reported no improvement in anxiety and depressive symptoms . On the other hand, other researchers have found significant improvements in psychological distress , anxiety and depression . Overall, it seems that having anxiety and/or depressive symptoms does not prevent FM patients from improving in other respects, such as the impact of FM on HRQoL, as observed in our study and others .…”

Including a Range of Outcome Targets Offers a Broader View of Fibromyalgia Treatment Outcome: Results from a Retrospective Review of Multidisciplinary Treatment

“…Likewise, functional impact based on FIQ scores showed a significant improvement of 20%, which exceeds the amount needed to represent clinically important improvement (Bennett et al, ). This is similar to the previously reported FIQ improvements with drug and non‐drug treatment of about 26% (Castel, et al, ; Clauw et al, ). When directly rating typical functional activities and ADLs, significant improvements were seen in personal care, daily homemaking chores and occupation.…”

“…A large, 15‐week randomized trial with milnacipran 100–200 mg reported a mean VAS pain severity reduction from 65 by about 16 points ( p < 0.05) and a Fibromyalgia Impact Questionnaire (FIQ; range 0–100) improvement of 16 points from a baseline score of 62 ( p ≤ 0.01) (Clauw et al, ). Multidisciplinary outpatient treatment (12–24 sessions over 6–12 weeks) has also been shown in randomized studies to reduce pain and fibromyalgia impact significantly (Castel et al, ; Cedraschi et al, ). Pain relief with multidisciplinary care is also typically modest.…”

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

“…Due to the wide range of conditions investigated, and various outcome measures used, it is difficult to draw any consistent conclusions about the nature of the benefit from MDT working reported. However, where a positive effect was noted, generally sustained improvement in pain severity (Casanueva-Fernandez et al, 2012;Castel et al, 2013), sustained improvement in skills for managing health (Castel et al, 2013), improved emotional and psychological well-being (Castel et al, 2013;Lemstra and Olszynski, 2005) and reduction in inflammatory disease activity (Vliet Vlieland, 1996) were cited as key benefits from MDT involvement. For patients with scleroderma, improvement in pain was not observed, although specific improvements in grip strength and psychological wellbeing were noted (Schouffoer et al, 2011a(Schouffoer et al, , 2011b.…”

“…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.…”