| Author, Year, Followup,a Pain Duration, Study Quality | Intervention | Population | Function and Pain Outcomes | Other Outcomes |
|---|---|---|---|---|
Amris, 2014262 5.5 months Duration of pain: median 10 to 11 years Fair | A. Multidisciplinary treatment (n=84): 3- 5 hours of education, sleep hygiene, group discussions, and physical therapy per day over 2 weeks B. Wait list (n=86) | A vs. B Age: 44 vs. 44 years Female: 100% vs. 100% Baseline Fibromyalgia Impact Questionnaire Total (FIQ, 0-100): 64.0 vs. 65.7 | A vs. B 5.5 months Change in FIQ total from baseline: −1.3 vs. −1.4, difference 0.1 (95% CI −3.6 to 3.8) Change in FIQ pain VAS from baseline: 0.1 vs. −0.1, difference 0.2 (95% CI −0.3 to 0.7) | A vs. B 5.5 months Change in Generalized Anxiety Disorder-10 from baseline (scale NR): −0.8 vs. −0.5, difference −0.2 (95% CI −2.0 vs. 1.5) Change in Major Depression Inventory from baseline (0-50): −1.7 vs. −0.5, difference −1.3 (95% CI −3.3 to 0.8) Change in SF-36 physical component score from baseline (0-100): 1.4 vs. 0.8, difference 0.6 (95% CI −1.0 to 2.1) Percent responders in SF-36 physical component score: 27% vs. 23% Change in SF-36 mental component score from baseline (0-100): 2.3 vs. 1.2, difference 1.1 (95% CI −1.5 to 3.8) Percent responders in SF-36 mental component score: 27% vs. 27% Change in SF-36 physical functioning from baseline (0-100): 1.1 vs. 1.6, difference −0.5 (95% CI −3.9 to 3.0) |
Castel, 2013263 Salvat, 2017267 3, 6 and 12 months Duration of pain: Mean 10.8 to 12.5 years Poor | A. Multidisciplinary treatment (n=53), conventional pharmacological treatment, 24 sessions of group CBT and physical therapy over 12 weeks. B. Usual care (n=35): conventional pharmacological treatment including analgesics, antidepressants, benzodiazepines, and nonbenzodiazepine hypnotics | A vs. B Age: 49 vs. 49 years Female: 100% vs. 100% Baseline FIQ (0-100): 64.6 vs. 66.6 Baseline pain NRS (0-10): 6.8 vs. 7.1 | A vs. B 3 months FIQ: 55.5 vs. 64.6, difference −9.1 (95% CI −14.9 to −3.3) Proportion with clinically significant FIQ improvement (≥14% change): 48% vs. 23%, OR 3.1 (95% CI 1.6 to 6.2) Pain NRS: 6.4 vs. 6.8, difference −0.40 (95% CI −0.98 to 0.18) Proportion with clinically significant NRS pain improvement (≥30% change): 14% vs. 11% 6 months FIQ: 55.8 vs. 67.8, difference −12.0 (95% CI −18.2 to −5.8) Proportion with clinically significant FIQ improvement (≥14% change): 42% vs. 19%, OR 3.1 (95% CI 1.5 to 6.4) Pain NRS: 6.4 vs. 7.0, difference −0.60 (95% CI −1.2 to 0) Proportion with clinically significant NRS pain improvement (≥30% change): 16% vs. 5%, OR 3.3 (95% CI 1.0 to 10.8) 12 months FIQ: 58.8 vs. 69.6, difference −10.8 (95% CI −16.8 to −4.8) Proportion with clinically significant FIQ improvement (≥14% change): 27% vs. 4%, OR 8.8 (95% CI 2.5 to 30.9) Pain NRS: 6.7 vs. 7.1, difference −0.40 (95% CI −0.94 to 0.14) Proportion with clinically significant NRS pain improvement (≥30% change): 8.6% vs. 0%, OR 0.5 (95% CI 0.4 to 0.6) | A vs. B 3 months HADS (0-42): 15.2 vs. 20.6, difference −5.4 (95% CI −8.2 to −2.6) MOS sleep scale (scale NR): 40.5 vs. 31.2, difference 9.3 (95% CI 6.1 to 12.5) WONCA, mean (95% CI): total score: 23.7 (22.5 to 25.0) vs. 26.5 (25.1 to 27.9), p<0.005; physical function: 2.71 (2.51 to 2.95) vs. 3.20 (2.95 to 3.41), p=NR; daily activities: 2.88 (2.70 to 3.05) vs. 3.20 (3.00 to 3.39), p=NR 6 months HADS: 16.2 vs. 21.5, difference −5.3 (95% CI −8.1 to −2.5) MOS sleep scale: 38.7 vs. 29.0, difference 9.7 (95% CI 6.6 to 12.8) WONCA, mean (95% CI): total score: 23.6 (22.4 to 24.9) vs. 27.3 (25.9 to 28.6), p<0.005; physical function: 2.69 (2.48 to 2.90) vs. 3.38 (3.12 to 3.60), p=NR; daily activities: 2.97 (2.80 to 3.15) vs. 3.28 (3.10 to 3.47), p=NR 12 months HADS: 17.1 vs. 22.8, difference −5.7 (95% CI −8.7 to −2.7) MOS sleep scale: 36.3 vs. 28.8, difference 7.5 (95% CI 4.3 to 10.7) WONCA, mean (95% CI): total score: 23.5 (22.1 to 24.8) vs. 26.4 (24.9 to 27.9), p<0.005; physical function: 2.72 (2.49 to 2.96) vs. 3.33 (3.05 to 3.62), p=NR daily activities: 2.87 (2.69 to 3.06) vs. 3.32 (3.10 to 3.55), p=NR |
Cedraschi, 2004265 6 months Duration of pain: Mean 8.4 to 9.5 years Poor | A. Multidisciplinary treatment (n=84): 12 group pool sessions of physiotherapy, relaxation exercises, and exercise over 6 weeks B. Usual care (n=80): Regular care, including physical therapy, drug treatment and, in some cases, psychotherapy. | A vs. B Age: 49 vs. 50 years Female: 93% vs. 93% Baseline FIQ total (0-10): 5.5 vs. 5.6 FIQ physical function (0-10): 4.2 vs. 4.5 Baseline FIQ pain (0-10): 6.3 vs. 6.0 | A vs. B 6 months FIQ total: 4.9 vs. 5.5, difference −0.6 (95% CI −1.1 to −0.09) FIQ physical function: 4.3 vs. 4.8, difference −0.5 (95% CI −1.3 to 0.3) FIQ pain: 6.1 vs. 6.6, difference −0.5 (95% CI −1.2 to 0.2) Regional Pain Score: 62.6 vs. 68.4, difference −5.8 (95% CI −12.1 to 0.5) | A vs. B 6 months Psychological General Wellbeing Index total (0-110): 51.1 vs. 43.8, difference 7.3 (95% CI 0.2 to 14.3) Psychological General Wellbeing Index anxiety (0-25): 13.0 vs. 10.3, difference 2.7 (95% CI 0.6 to 4.8) Psychological General Wellbeing Index depression (0-15): 9.0 vs. 7.7, difference 1.3 (95% CI −0.1 to 2.7) SF-36 physical function (0-100): 42.2 vs. 43.9, difference −1.7 (95% CI −8.6 to 5.2) FIQ depression (0-10): 4.6 vs. 6.1 FIQ anxiety (0-10): 5.1 vs. 6.7, difference −1.6 (95% CI −2.6 to −0.6) |
Martin, 2012266 6 months Duration of pain: Mean 14 to 15 years Poor | A. Multidisciplinary treatment (n=54): conventional pharmacological treatment, 12 sessions of CBT, education, and physiotherapy over 6 weeks B. Usual care (n=56): conventional pharmacological treatmentincluding amitriptyline, paracetamol, and tramadol | A vs. B Age: 49 vs. 52 years Female: 91% vs. 91% Baseline FIQ total (0-100): 76.3 vs. 76.2 Baseline FIQ physical functioning (0-10): 5.5 vs. 5.4 Baseline FIQ pain (0-10): 7.5 vs. 7.5 | A vs. B 6 months FIQ total: 70.3 vs. 76.8, difference −6.5 (95% CI −12.3 to −0.7) FIQ physical function: 5.2 vs. 5.9, difference −0.7 (95% CI −1.4 to −0.04) FIQ pain: 7.2 vs. 8.2, difference −1.0 (95% CI −1.7 to −0.3) | A vs. B 6 months Hospital Anxiety and Depression Scale anxiety (HADS, 0-21): 13.4 vs. 12.8, difference 0.66 (95% CI −1.02 to 2.34) HADS depression (0-21): 9.8 vs. 10.2, difference −0.43 (95% CI −2.00 to 1.14) |
Saral, 2016268 6 months; 4 months based on intervention groupb Duration of pain: 7.5 years Fair | A. Long term interdisciplinary group (n=22): educational program (1 full day), exercise program (1 full day), and CBT (1, 3-hour session per week for 10 weeks); plus home strengthening and stretching exercises and relaxation B. Short term interdisciplinary group (n=22): education, exercise, and CBT over 2 full days; plus home strengthening and stretching exercises and relaxation C. Usual care (n=22): Patients continued current medical treatments, normal daily living, and current physical activity levels | A vs. B vs. C Age, years: 38 vs. 43 vs. 44 Female: 100% vs. 100% vs. 100% Symptom duration, months: 69 vs. 113 vs. 88 Baseline FIQ (0-100): 71.6 vs. 67.7 vs. 65.5 Baseline pain VAS (0-10): 8.2 vs. 7.6 vs. 7.5 | A vs. C 4 monthsb FIQ: 53.9 vs. 65.5, difference −11.6 (95% CI −21.9 to −1.29) Percent change from baseline in FIQ: −22.1% vs. 3.2% Pain VAS: 5.1 vs. 7.6, difference −2.5 (95% CI −3.78 to −1.22) Percent change from baseline in VAS pain: −38.3% vs. 1.5% B vs. C 4 monthsb FIQ: 54.5 vs. 65.5, difference −11.0 (95% CI −19.5 to −2.5) Percent change from baseline in FIQ: −18.9% vs. 3.2% Pain VAS: 5.8 vs. 7.6, difference −1.8 (95% CI −2.6 to −1.0) Percent change from baseline in VAS pain: −22.8% vs. 1.5% | A vs. C 4 monthsb BDI: 16.6 vs. 18.7, difference −2.1 (95% CI −8.2 to 4.0) SF-36 PCS: 39.9 vs. 34.3, difference 5.6 (95% CI 0.61 to 10.6) SF-36 MCS: 40.7 vs. 37.6, difference 3.1 (95% CI −4.1 to 10.3) Sleep VAS: 3.0 vs. 4.9, difference −1.9 (95% CI −3.8 to −0.04) B vs. C 4 monthsb BDI: 15.0 vs. 18.7 (9.5), difference −3.7 (95% CI −10.2 to 2.8) SF-36 PCS: 39.6 vs. 34.3, difference 5.3 (95% CI −0.03 to 10.6) SF-36 MCS: 40.2 vs. 37.6, difference 2.6 (95% CI −4.0 to 9.2) Sleep VAS: 3.1 vs. 4.9 difference −1.8 (95% CI −3.6 to 0.02) |
Van Eijk-Hustings, 201396 18 months Duration of pain: Mean of 6.1 to 7.1 years Fair | A. Multidisciplinary intervention (n=108): 36 days of sessions of sociotherapy, physiotherapy, psychotherapy, and creative arts therapy over 12 weeks B. Aerobic exercise (n=47): 24 sessions over 12 weeks C. Usual care (n=48): education and lifestyle advice in addition to usual care | A vs. B vs. C Age: 41 vs. 39 vs. 43 years Female: 93% vs. 100% vs. 98% Baseline FIQ physical function (0-10): 4.2 vs. 3.6 vs. 3.4 Baseline FIQ total (0-100): 64.5 vs. 60.0 vs. 55.4 Baseline FIQ pain (0-10): 6.3 vs. 6.2 vs. 5.5 | A vs. Bc 18 months FIQ physical function: 3.6 vs. 3.6, difference 0 (95% CI −0.79 to 0.79) FIQ total: 50.9 vs. 52.0, difference −1.10 (95% CI −8.40 to 6.20) FIQ pain: 5.3 vs. 5.2, difference 0.10 (95% CI −0.67 to 0.87) A vs. C 18 months FIQ physical function: 3.6 vs. 3.9, ES 0.12 (−0.22 to 0.46) | A vs. Bc 18 months FIQ Depression: 3.9 vs. 5.0, difference −1.1 (95% CI −2.2 to 0.01) FIQ Anxiety: 4.7 vs. 5.0, difference −0.30 (95% CI −1.41 to 0.81) EQ-5D (−0.59 to 1): 0.6 vs. 0.5, difference 0.01 (95% CI −0.10 to 0.12) GP consultationsd: 0.9 vs. 1.0, difference −0.10 (95% CI −0.89 to 0.69) Medical specialist consultationsd: 0.3 vs. 0.4, difference −0.10 (95% CI −0.43 to 0.23) Physiotherapist consultationsd: 2.6 vs. 0.4, difference 2.20 (95% CI 0.69 to 3.71) Other paramedical professional consultationsd: 1.0 vs. 2.1, difference −1.10 (95% CI −2.21 to 0.01) A vs. C 18 months FIQ depression: 3.9 vs. 4.2, ES 0.10 (95% CI −0.24 to 0.44) FIQ anxiety: 4.7 vs. 4.8, ES 0.03 (95% CI −0.31 to 0.37 EQ-5D: 0.55 vs. 0.51, ES 0.12 (95% CI −0.22 to 0.46) GP consultationsd: 0.9 vs. 0.7, ES=−0.11 (95% CI −0.45 to 0.23) Medical specialist consultationsd: 0.3 vs. 0.2, ES=−0.14 (95% CI −0.48 to 0.20) Physiotherapist consultationsd: 2.6 vs. 2.8, ES=0.04 (95% CI −0.30 to 0.38) Other paramedical professional consultationsd: 1.0 vs. 0.2, ES=−0.28 (95% CI −0.62 to 0.06) |
BDI = Beck Depression Inventory; CBT = cognitive behavioral therapy; CI = confidence interval; ES = effect size; EQ-5D = EuroQol-5D; FIQ = Fibromyalgia Impact Questionnaire; GP = general practitioner; HADS = Hospital Anxiety and Depression Scale; MOS = Medical Outcomes Study; NR = not reported; NRS = Numeric Rating Scale; OR = odds ratio; SF-36 MCS = Short-Form 36 Mental Component Scale; SF-36 PCS = Short-Form 36 Physical Component Scale; VAS = visual analog scale; WONCA = World Organization of Family Docotors
Unless otherwise noted, followup time is calculated from the end of the treatment period
Long term multidisciplinary group was followed up at 4 months from end of intervention and the short term multidisciplinary and control groups were followed up at 6 months from end up intervention
Authors did not provide effect estimates for the comparison of multidisciplinary rehabilitation versus exercise; mean differences were calculated by the EPC
Total number of consultations over a period of 2 months prior to measurement
From: Results
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