The effects of long- and short-term interdisciplinary treatment approaches in women with fibromyalgia: a randomized controlled trial

Abstract

We investigated the effects of long- and short-term interdisciplinary treatment approaches for reducing symptoms and improving health-related quality of life (HRQoL) and physical functions of patients with fibromyalgia and compared the effects of two different interdisciplinary treatment approaches. We conducted a prospective, randomized, controlled trial involving 66 women with fibromyalgia eligible for the study at a university hospital setting. The patients were randomized into three groups (allocation ratio 1:1:1) using a computer-generated random numbers: a long-term interdisciplinary treatment group (LG, n = 22) that participated in 10 sessions (3-h once-weekly session for 10 weeks) of cognitive behavioral therapy (CBT) together with exercise training and other fibromyalgia related educational programs (two full days); a short-term interdisciplinary treatment group (SG, n = 22) that received two full days of educational, exercise, and CBT programs; and a control group (CG, n = 22). The patients were evaluated at baseline and 6 months after treatment using the visual analog scale (pain, fatigue, and sleep), Fibromyalgia Impact Questionnaire, Beck Depression Inventory, Short Form-36, tender point numbers, and pressure algometry as primary outcomes. The statistical analysis was confined to the 'per-protocol' set. No blinding was performed. The number of patients analyzed was 21 in the LG, 19 in the SG, and 19 in the CG. The intensity of pain (p < 0.001), severity of fatigue (p = 0.048), number of tender points (p = 0.002), and pressure pain threshold (p = 0.012) decreased significantly in both the LG and SG groups compared with controls. Moreover, physical functions (p = 0.017) and physical components of the HRQoL (p = 0.036) improved significantly in the intervention groups compared with the controls. However, there was no significant difference between intervention groups and the control group at the end of study in terms of quality of sleep (p = 0.055), severity of depressive symptoms (p = 0.696), and mental components of the HRQoL (p = 0.229). Finally, with the exception of the severity of fatigue and physical components of the HRQoL, there was no obvious significant difference between the efficacies of the two treatment approaches when compared with controls; the long-term treatment was found more effective in reducing pain than the short-term. Both, long- and short-term interdisciplinary treatments were effective in reducing the severity of some symptoms and disease activity in patients with fibromyalgia. The short-term program well meets the needs of women with fibromyalgia particularly in relation to pain and health status as measured using FIQ; however, a long-term program may be beneficial in reducing fatigue and improving physical function to a higher extent.

Group Psychotherapy With Fibromyalgia Patients: A Systematic Review

“…21,26,30,[40][41][42][54][55][56] In addition to the above findings, there are studies mentioned in this review which showed low or no treatment effect or insignificant group differences in terms of primary and/or secondary variables. 24,42,43 One should not disregard that all these may actually be related with five major methodological problems which are differences in number of sessions, employment of varying assessment tools, lack of (active) control group or RCTs, the absence and features of follow-up evaluations, and drop-out rates. Firstly, in terms of number of sessions, even though more intense and more frequent long-term interventions are suggested to enhance the effectiveness of the interventions, 57 there is a gradual increase in the number of interventions employing brief CBT modules because of its cost-effectiveness.…”

“…With respect to this two-fold classification in terms of outcomes and treatment modalities, this review overall delineates that CBT was the most frequently utilized psychotherapeutic modality of GP interventions, be it a MT or a U/GP. 21,24,25,29,[31][32][33][34][35][36][37][38][39][40][41][42][43][44] On the other hand, other few interventions including different psychotherapeutic approaches (which are mindbody intervention, mindfulness based therapy, short-term psychodynamic psychotherapy, acceptance commitment therapy) aside from CBT were also utilized. 23,[45][46][47][48] However, the results of the studies revealed some inconsistencies.…”

“…In addition to these reports, objective pain evaluations like pain area, tender points, and pressure pain threshold also improved significantly in some other studies. 29,42 Besides, some of these studies showed improvements with regard to medical consumption and healthcare utilization. 55,56 However, a closer look at the degree of improvements in terms of type of intervention and outcome variables made the way for one of the major findings of this review, which was not exactly in line with the above predictions ( Table 3).…”

“…Only a few studies used objective means such as tender point counts, morning tiredness, and cold pressures. 23,24,29,42,43 It will be of advantage to employ objective measures where possible. As a result, the proof of the effectiveness of any intervention is limited to the extent of the method of measurement.…”

Evidências sobre a abordagem interdisciplinar de equipes de saúde no tratamento da fibromialgia: uma revisão integrativa

“…A seguir, encontra-se um quadro com detalhamento com informações de acordo com o autor, ano de publicação, país de origem, objetivo e o delineamento da pesquisa (Quadro 1). 15 dor, fadiga, qualidade do sono, sintomas (2016) depressivos, melhoria da QVRS e de funções físicas. Avaliar, quantitativa e qualitativamente, Ensaio clínico 6 Bourgault P, Lacasse A, a eficácia de uma intervenção randomizado Marchand S, et al 16 Canadá interdisciplinar para o autogerenciamento.…”