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Logo of annrheumdAnnals of the Rheumatic DiseasesCurrent TOCInstructions for authors
Ann Rheum Dis. Mar 2004; 63(3): 290–296.
PMCID: PMC1754921

Fibromyalgia: a randomised, controlled trial of a treatment programme based on self management


Objective: To evaluate the efficacy of a treatment programme for patients with fibromyalgia (FM) based on self management, using pool exercises and education.

Methods: Randomised controlled trial with a 6 month follow up to evaluate an outpatient multidisciplinary programme; 164 patients with FM were allocated to an immediate 6 week programme (n = 84) or to a waiting list control group (n = 80). The main outcomes were changes in quality of life, functional consequences, patient satisfaction and pain, using a combination of patient questionnaires and clinical examinations. The questionnaires included the Fibromyalgia Impact Questionnaire (FIQ), Psychological General Well-Being (PGWB) index, regional pain score diagrams, and patient satisfaction measures.

Results: 61 participants in the treatment group and 68 controls completed the programme and 6 month follow up examinations. Six months after programme completion, significant improvements in quality of life and functional consequences of FM were seen in the treatment group as compared with the controls and as measured by scores on both the FIQ (total score p = 0.025; fatigue p = 0.003; depression p = 0.031) and PGWB (total score p = 0.032; anxiety p = 0.011; vitality p = 0.013,). All four major areas of patient satisfaction showed greater improvement in the treatment than the control groups; between-group differences were statistically significant for "control of symptoms", "psychosocial factors", and "physical therapy" No change in pain was seen.

Conclusion: A 6 week self management based programme of pool exercises and education can improve the quality of life of patients with FM and their satisfaction with treatment. These improvements are sustained for at least 6 months after programme completion.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum. 1990 Feb;33(2):160–172. [PubMed]
  • Wolfe F, Ross K, Anderson J, Russell IJ. Aspects of fibromyalgia in the general population: sex, pain threshold, and fibromyalgia symptoms. J Rheumatol. 1995 Jan;22(1):151–156. [PubMed]
  • Goldenberg DL. An overview of psychologic studies in fibromyalgia. J Rheumatol Suppl. 1989 Nov;19:12–14. [PubMed]
  • Burckhardt CS, Clark SR, Bennett RM. Fibromyalgia and quality of life: a comparative analysis. J Rheumatol. 1993 Mar;20(3):475–479. [PubMed]
  • Henriksson C, Gundmark I, Bengtsson A, Ek AC. Living with fibromyalgia. Consequences for everyday life. Clin J Pain. 1992 Jun;8(2):138–144. [PubMed]
  • Burckhardt CS, Bjelle A. Perceived control: a comparison of women with fibromyalgia, rheumatoid arthritis, and systemic lupus erythematosus using a Swedish version of the Rheumatology Attitudes Index. Scand J Rheumatol. 1996;25(5):300–306. [PubMed]
  • Martinez JE, Ferraz MB, Sato EI, Atra E. Fibromyalgia versus rheumatoid arthritis: a longitudinal comparison of the quality of life. J Rheumatol. 1995 Feb;22(2):270–274. [PubMed]
  • Sandstrom MJ, Keefe FJ. Self-management of fibromyalgia: the role of formal coping skills training and physical exercise training programs. Arthritis Care Res. 1998 Dec;11(6):432–447. [PubMed]
  • Alarcón GS, Bradley LA. Advances in the treatment of fibromyalgia: current status and future directions. Am J Med Sci. 1998 Jun;315(6):397–404. [PubMed]
  • Richards S, Cleare A. Treating fibromyalgia. Rheumatology (Oxford) 2000 Apr;39(4):343–346. [PubMed]
  • Mengshoel AM, Førre O, Komnaes HB. Muscle strength and aerobic capacity in primary fibromyalgia. Clin Exp Rheumatol. 1990 Sep-Oct;8(5):475–479. [PubMed]
  • Bennett RM, Clark SR, Goldberg L, Nelson D, Bonafede RP, Porter J, Specht D. Aerobic fitness in patients with fibrositis. A controlled study of respiratory gas exchange and 133xenon clearance from exercising muscle. Arthritis Rheum. 1989 Apr;32(4):454–460. [PubMed]
  • Burckhardt CS, Bjelle A. Education programmes for fibromyalgia patients: description and evaluation. Baillieres Clin Rheumatol. 1994 Nov;8(4):935–955. [PubMed]
  • Clark SR. Prescribing exercise for fibromyalgia patients. Arthritis Care Res. 1994 Dec;7(4):221–225. [PubMed]
  • Burckhardt CS, Mannerkorpi K, Hedenberg L, Bjelle A. A randomized, controlled clinical trial of education and physical training for women with fibromyalgia. J Rheumatol. 1994 Apr;21(4):714–720. [PubMed]
  • Bennett RM, Burckhardt CS, Clark SR, O'Reilly CA, Wiens AN, Campbell SM. Group treatment of fibromyalgia: a 6 month outpatient program. J Rheumatol. 1996 Mar;23(3):521–528. [PubMed]
  • Wigers SH, Stiles TC, Vogel PA. Effects of aerobic exercise versus stress management treatment in fibromyalgia. A 4.5 year prospective study. Scand J Rheumatol. 1996;25(2):77–86. [PubMed]
  • Deluze C, Bosia L, Zirbs A, Chantraine A, Vischer TL. Electroacupuncture in fibromyalgia: results of a controlled trial. BMJ. 1992 Nov 21;305(6864):1249–1252. [PMC free article] [PubMed]
  • Baumgartner E, Finckh A, Cedraschi C, Vischer TL. A six year prospective study of a cohort of patients with fibromyalgia. Ann Rheum Dis. 2002 Jul;61(7):644–645. [PMC free article] [PubMed]
  • Perneger TV, Leplège A, Etter JF, Rougemont A. Validation of a French-language version of the MOS 36-Item Short Form Health Survey (SF-36) in young healthy adults. J Clin Epidemiol. 1995 Aug;48(8):1051–1060. [PubMed]
  • Burckhardt CS, Clark SR, Bennett RM. The fibromyalgia impact questionnaire: development and validation. J Rheumatol. 1991 May;18(5):728–733. [PubMed]
  • Lautenschlager J, Seglias J, Bruckle W, Muller W. Comparisons of spontaneous pain and tenderness in patients with primary fibromyalgia. Clin Rheumatol. 1991 Jun;10(2):168–173. [PubMed]
  • Finckh A, Morabia A, Deluze C, Vischer T. Validation of questionnaire-based response criteria of treatment efficacy in the fibromyalgia syndrome. Arthritis Care Res. 1998 Apr;11(2):116–123. [PubMed]
  • Potts MK, Silverman SL. The importance of aspects of treatment for fibromyalgia (fibrositis). Differences between patient and physician views. Arthritis Care Res. 1990 Mar;3(1):11–18. [PubMed]
  • Gowans SE, deHueck A, Voss S, Richardson M. A randomized, controlled trial of exercise and education for individuals with fibromyalgia. Arthritis Care Res. 1999 Apr;12(2):120–128. [PubMed]
  • Mannerkorpi K, Nyberg B, Ahlmén M, Ekdahl C. Pool exercise combined with an education program for patients with fibromyalgia syndrome. A prospective, randomized study. J Rheumatol. 2000 Oct;27(10):2473–2481. [PubMed]
  • Buskila D, Abu-Shakra M, Neumann L, Odes L, Shneider E, Flusser D, Sukenik S. Balneotherapy for fibromyalgia at the Dead Sea. Rheumatol Int. 2001 Apr;20(3):105–108. [PubMed]
  • Jentoft ES, Kvalvik AG, Mengshoel AM. Effects of pool-based and land-based aerobic exercise on women with fibromyalgia/chronic widespread muscle pain. Arthritis Rheum. 2001 Feb;45(1):42–47. [PubMed]
  • Pincus T, Wolfe F. An infrastructure of patient questionnaires at each rheumatology visit: improving efficiency and documenting care. J Rheumatol. 2000 Dec;27(12):2727–2730. [PubMed]
  • Tugwell P, Bombardier C, Buchanan WW, Goldsmith CH, Grace E, Hanna B. The MACTAR Patient Preference Disability Questionnaire--an individualized functional priority approach for assessing improvement in physical disability in clinical trials in rheumatoid arthritis. J Rheumatol. 1987 Jun;14(3):446–451. [PubMed]
  • Verhoeven AC, Boers M, van der Liden S. Validity of the MACTAR questionnaire as a functional index in a rheumatoid arthritis clinical trial. The McMaster Toronto Arthritis. J Rheumatol. 2000 Dec;27(12):2801–2809. [PubMed]
  • Naughton MJ, Wiklund I. A critical review of dimension-specific measures of health-related quality of life in cross-cultural research. Qual Life Res. 1993 Dec;2(6):397–432. [PubMed]
  • Barsky AJ, Borus JF. Functional somatic syndromes. Ann Intern Med. 1999 Jun 1;130(11):910–921. [PubMed]
  • Katon W, Sullivan M, Walker E. Medical symptoms without identified pathology: relationship to psychiatric disorders, childhood and adult trauma, and personality traits. Ann Intern Med. 2001 May 1;134(9 Pt 2):917–925. [PubMed]
  • Kalauokalani D, Cherkin DC, Sherman KJ, Koepsell TD, Deyo RA. Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Spine (Phila Pa 1976) 2001 Jul 1;26(13):1418–1424. [PubMed]
  • Earnshaw SM, MacGregor G, Dawson JK. Fibromyalgia-monotheories, monotherapies and reductionism. Rheumatology (Oxford) 2001 Mar;40(3):348–349. [PubMed]

Figures and Tables

Figure 1
Flow diagram of the participants in the randomised trial.

Articles from Annals of the Rheumatic Diseases are provided here courtesy of BMJ Group


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