Interdisciplinary treatment for fibromyalgia (FM) syndrome: clinical & statistical significance
By Turk DC, Okifuji A, Sinclair JD, Starz TW •
June 16, 1998
OBJECTIVES: The primary purposes of the study were to:
evaluate the treatment efficacy of an outpatient,
interdisciplinary treatment program for fibromyalgia syndrome
(FMS); examine whether treatment gains would be sustained for
6 months following the treatment; assess whether improvements
were clinically significant; and delineate the factors
associated with clinically significant improvement in pain
METHODS: Sixty-seven FMS patients completed a 4-week
outpatient program consisting of medical, physical,
psychologic, and occupational therapies. Six-month followup
data were available for 66% of treated patients.
Comparisons between pretreatment and posttreatment measures
revealed significant improvements in pain severity, life
interference, sense of control, affective distress,
depression, perceived physical impairment, fatigue, and
anxiety; however, there was no improvement in interpersonal
relationships or general activities. Clinically significant
improvement in pain severity, using the Reliable Change Index,
was obtained by 42% of the sample and was predicted by the
pretreatment levels of depression, activity, perceived
disability, solicitous responses of significant others, and
idiopathic onset. Pretreatment level of pain severity was not
a significant predictor of the degree of pain improvement.
Comparisons among pretreatment, posttreatment, and 6-month
followup data revealed that the patients maintained treatment
gains in pain, life interference, sense of control, affective
distress, and depression. However, the quadratic polynomial
analysis revealed that relapse occurred in the subjective
rating of fatigue.
CONCLUSIONS: The results suggest that,
overall, an outpatient interdisciplinary treatment program was
effective in reducing many FMS symptoms. Treatment gains
tended to be maintained for at least 6 months. However, there
were large individual differences in response to treatment.
These results suggest that identification of subgroups of FMS
patients and their specific clinical characteristics may be
useful for maximizing treatment efficacy.
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