Predictors for health improvement in patients with fibromyalgia: a 2-year follow-up study

Abstract

Fibromyalgia (FM) has a high impact on all aspects of health. The effect from interventions is usually small and characterized by uncertainty. Better insight in predictors for improved health is essential. The present study aimed to understand predictors for patient global impression of change and changes in overall health. Data from a longitudinal cohort of recently diagnosed FM patients (n = 203) were used. Within this cohort, patients were pre-randomized to either a multidisciplinary (n = 108) or an, aerobic exercise (n = 47) program, or usual care (n = 48). Only a limited number of patients started with the programs (n = 86) or participated fully, i.e., attended >70 % of the scheduled sessions (n = 68). Patients completed questionnaires covering all components of the International Classification of Functioning, Disability and Health (ICF) bio-psycho-social model of health, which was used as a framework to structure potential predictors. Principal component analysis was used to reduce the number of potential predictors. Regression analyses were used to explore associations with the outcome variables. Principal component analysis yielded five factors representing areas that covered different ICF components and chapters. "Being employed" and "full participation in a program" were independently associated with a better global impression of change. A longer duration of FM-related symptoms and more limitations in physical areas of body functions were independently associated with a worse impression of overall health. Higher levels of perceived limitations in physical and mental activities were associated with "starting to participate in a program" and with "full participation in a program." Recently diagnosed FM patients that report fewer physical limitations may experience more improvement in health if they are at work and have a positive attitude towards participating in an offered health-care intervention. These findings give support to an active rather than to a care-avoiding attitude of health-care workers in their contacts to these patients.

Are OMERACT recommendations followed in clinical trials on fibromyalgia? A systematic review of patient-reported outcomes and their measures

“…In summary, only 8.6% (9 studies) of the studies covered all mandatory domains as recommended by OMERACT [ 26 , 31 , 41 , 42 , 75 , 76 , 87 , 112 , 130 ] and only 6.7% (7 studies) covered all mandatory and optional domains [ 26 , 31 , 41 , 42 , 76 , 112 , 130 ]. Remarkably, although the OMERACT recommendations have been available since 2009 [ 5 ], only eight studies referred to those recommendations in the methods section or in the discussion [ 30 , 56 , 73 , 79 , 80 , 113 , 125 , 126 ]. Seven studies cited the OMERACT core set because they explicitly conformed to their recommendations [ 30 , 56 , 73 , 80 , 113 , 125 , 126 ].…”

“…Remarkably, although the OMERACT recommendations have been available since 2009 [ 5 ], only eight studies referred to those recommendations in the methods section or in the discussion [ 30 , 56 , 73 , 79 , 80 , 113 , 125 , 126 ]. Seven studies cited the OMERACT core set because they explicitly conformed to their recommendations [ 30 , 56 , 73 , 80 , 113 , 125 , 126 ].…”

“…It was reported in 15.2% of the studies, although only six studies (5.7%) presented it for all instruments administered in the study [ 32 , 60 , 61 , 110 , 122 , 124 ]. In four studies (3.8%) Cronbach’s alpha was calculated from the present study sample [ 58 , 74 , 97 , 125 ]. As another aspect of reliability, test–retest reliability was reported in 8 studies (7.6%).…”

The Applicability of the International Classification of Functioning, Disability, and Health to Study Lifestyle and Quality of Life of Colorectal Cancer Survivors

“…During data analyses, it will guide the choice of relevant exposure as well as health outcome measures, and will also guide the selection of potential confounders, effect modifiers and/or mediating factors to be taken into account when analyzing separate research questions. For example, structural equation modeling likely is an appropriate statistical technique to unravel the direction and dynamics of interrelationships depicted within our proposed ICF-based conceptual model, enabling identification of moderation, mediation and confounding effects and latent constructs (78). During data interpretation, the developed conceptual model will help us to interpret our findings and deepen our understanding of complex interrelations between lifestyle and other factors associated with the multidimensional construct of HRQoL in colorectal cancer survivors.…”

Proof of concept of prehabilitation: a combination of education and behavioural change, to promote physical activity in people with fibromyalgia

“…Although the level of evidence for the effectiveness of physical exercise in this disease was appraised as ‘strong for’ by the European League Against Rheumatism, 20 adherence to exercise programmes is often challenging 21 and rather low. 22 23 Behavioural barriers such as fear of movement, catastrophising, depression or low self-efficacy have been shown to reduce physical activity in people with FM. 24–26 As a result, avoidance of physical activity may then lead to physical and mental deconditioning 27 and can trigger a vicious circle of inactivity as a result of increasing pain and fear.…”