title: Multidisciplinary rehabilitation for fibromyalgia and musculoskeletal pain in working age adults.
abstract: BACKGROUND
  Non-malignant musculoskeletal pain is an increasing problem in western countries. Fibromyalgia syndrome is an increasing recognised chronic musculoskeletal disorder.
  
  
  OBJECTIVE
  The objective of this systematic review was to determine the effectiveness of multidisciplinary rehabilitation for fibromyalgia and widespread musculoskeletal pain among working age adults.
  
  
  METHODS
  An electronic search was conducted and included Medline from 1966, PsycLIT from 1967 and EMBASE from 1980 to April 1998. The Cochrane Musculoskeletal Group Trials Register was searched as well as, the Cochrane Controlled Trials Register (CCTR). The references of identified articles and reviews were checked, studies published in the Finnish medical database Medic from 1978 to 1998 screened and the Science Citation Index searched. Content experts were also contacted for additional or unpublished studies.
  
  
  METHODS
  From all references found in our original search, we selected all randomized controlled trials (RCTs) and clinical controlled trials (CCTs). Trials had to assess the effectiveness of multidisciplinary rehabilitation for patients suffering from fibromyalgia and widespread musculoskeletal pain among working age adults. The rehabilitation program was required to be multidisciplinary; that is, it had to consist of a physician's consultation, plus a psychological, social or vocational intervention, or a combination of both.
  
  
  METHODS
  Four reviewers independently selected the RCTs and CCTs that met the specified inclusion criteria. Two experts in the field of rehabilitation evaluated the relevance and applicability of the findings of the selected studies to actual clinical use. Two other reviewers extracted the data and assessed the main results and the methodological quality of the studies using standardized forms. Finally, a qualitative analysis was performed to evaluate the level of scientific evidence for the effectiveness of multidisciplinary rehabilitation.
  
  
  RESULTS
  After screening 1808 abstracts, and the references of 65 reviews, we found only seven relevant studies (1050 patients) that met our inclusion criteria. None of these were considered, methodologically, a high quality randomized controlled trial. Four of the included RCTs on fibromyalgia were graded low quality and suggest no quantifiable benefits. The three included RCTs on widespread musculoskeletal pain showed that based on limited evidence, overall, no evidence of efficacy was observed. However, behavioral treatment and stress management appear to be important components. Education combined with physical training showed some positive effects in long term follow up.
  
  
  CONCLUSIONS
  We conclude that there appears to be little scientific evidence for the effectiveness of multidisciplinary rehabilitation for these musculoskeletal disorders. However, multidisciplinary rehabilitation is a commonly used intervention for chronic musculoskeletal disorders, which cause much personal suffering and substantial economic loss to the society. There is a need for high quality trials in this field.
authors.affiliation: Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, Helsinki, Finland, FIN-00250. Kaija.Karjalainen@occuphealth.fi
authors.forename: K
authors.initials: K
authors.lastname: Karjalainen
authors.forename: A
authors.initials: A
authors.lastname: Malmivaara
authors.forename: M
authors.initials: M
authors.lastname: van Tulder
authors.forename: R
authors.initials: R
authors.lastname: Roine
authors.forename: M
authors.initials: M
authors.lastname: Jauhiainen
authors.forename: H
authors.initials: H
authors.lastname: Hurri
authors.forename: B
authors.initials: B
authors.lastname: Koes
mesh_terms: D000328:Adult; D002908:Chronic Disease; D005356:Fibromyalgia / Q000534:rehabilitation*; D006801:Humans; D009140:Musculoskeletal Diseases / Q000150:complications / Q000534:rehabilitation; D010146:Pain / Q000209:etiology; D059408:Pain Management