Community patient education and exercise for people with Fibromyalgia: A parallel group randomized controlled trial.

Journal: Clinical Rehabilitation. 2006 October;20(10):835-46. Authors and Affiliation: Hammond A, Freeman K. Rheumatology Department, Derbyshire Royal Infirmary, Derby, UK. Address correspondence to PMID: 17008336

Objective: To evaluate the effects of a community patient education-exercise program, using a cognitive-behavioral approach, for people with Fibromyalgia. Design: A randomized, parallel group trial with assessments at 0, 4, and 8 months. Setting: Community leisure centers. Subjects: People with Fibromyalgia (n=183) attending a rheumatology outpatient department at a large district general hospital.

Interventions: Participants were randomized to a patient education-exercise group (n=97) or relaxation (attention control) group (n=86). Main Measures: The Fibromyalgia Impact Questionnaire (0-80; lower score means better health). Secondary outcomes included: the Arthritis Self-Efficacy Scale(pain and other symptoms subscales: 1 -10 scale; higher scores mean greater self-efficacy) and self-reported improvement.

Results: Fifty participants withdrew or were unable to attend and 133 completed and returned baseline questionnaires: patient education group (n=71); relaxation group (n=62); 120/133 participants were women. Average age was 48. 53 (SD 10.89) years. Follow-up ranged between 73 and 82% of questionnaires returned. At four months, there was a difference in average changes in total Fibromyalgia ImpactQuestionnaire scores between the two groups: patient education group -3.38 (SD 9.35); relaxation group 0.3 (SD 8.85); P=0.02. Arthritis Self-Efficacy Scale scores were significantly higher in the patient education group: pain 0.59 (SD 1.45)compared to the relaxation group's -0.12 (SD 1.22); P=0.003; other symptoms (patient education group 0.72 (SD 1.33); relaxation group 0.03 (SD 1.16); P=0.002). At eight months these differences were no longer apparent. Forty-seven percent in the patient education group self-reported improvement compared with 13% in the relaxation group (varkappa=13.65; P=0.0001).

Conclusion: Short-term improvements resulted from the education-exercise programe but were not sustained. Appropriate selection may improve efficacy.

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