Efficacy of a multidisciplinary treatment program in patients with severe fibromyalgia

Abstract

The purpose of this study was to evaluate the efficacy of a multidisciplinary treatment program in patients severely affected by fibromyalgia. Thirty-four fibromyalgia patients were randomly divided into two groups. The control group: 17 women who continued their medical treatment and participated in four educational sessions and the experimental group that included 17 patients who besides the former medical treatment also underwent a weekly 1-h session program for 8 weeks including massage therapy, ischemic pressure on the 18 tender points, aerobic exercise and thermal therapy. At the beginning of the program, there were no significant differences between the two groups in any of the parameters. At the end of treatment, there was a significant improvement in the experimental group in the following items: vitality, social functioning, grip strength and the 6-min walk test. At 1 month after the end of treatment, the experimental group showed significant differences in overall health perception, social functioning, grip strength and the 6-min walk test. At that time, considering the threshold for clinical efficacy set at an improvement of 30% or above for the analyzed variables, 25% of the patients met the requirement for improvement of the following: number of symptoms: Visual Analogic Scale for fatigue, Fibromyalgia Impact Questionnaire and Beck Anxiety Inventory. In conclusion, patients with severe manifestations of fibromyalgia can obtain improvement with a short-term, low-cost and simple-delivery multidisciplinary program. However, additional studies including higher numbers of patients are needed to confirm the beneficial effect of this treatment program.

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

“…Additionally, the benefit of MDT working was reportedly reduced in those conditions typically managed well pharmacologically, such as gout (Zhang et al, ), and increased in those managed with allied health professional support, such as fibromyalgia (Carville et al, ; Casanueva‐Fernandez et al, ; Lemstra and Olszynski, ; Sarzi‐Puttini et al, ; van Koulil et al, ).…”

“…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.…”

“…The importance of easy access to the MDT for long-term condition management was also frequently cited (Cox, 2004;Davies et al, 2010;Esselens et al, 2009;Li et al, 2008;MacKay et al, 2008;Oliver, 2008) . Additionally, the benefit of MDT working was reportedly reduced in those conditions typically managed well pharmacologically, such as gout (Zhang et al, 2006), and increased in those managed with allied health professional support, such as fibromyalgia (Carville et al, 2008;Casanueva-Fernandez et al, 2012;Lemstra and Olszynski, 2005;Sarzi-Puttini et al, 2011;van Koulil et al, 2009).…”

“…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.…”

Use of physiotherapy resources for patients with fibromyalgia

“…The effectiveness of a multidisciplinary treatment applied in fibromyalgia patients was evaluated by Casanueva-Fernandez et al (38) in a randomized controlled prospective, double-blind. The protocol consisted of massage, pressure on tender points, cardio and thermotherapy through the infrared.…”