title: Spa treatment for primary fibromyalgia syndrome: a combination of thalassotherapy, exercise and patient education improves symptoms and quality of life.
abstract: OBJECTIVE
  To study the effect of a combination of thalassotherapy, exercise and patient education in people with fibromyalgia.
  
  
  METHODS
  Patients with fibromyalgia, selected from a rheumatology out-patient department and from members of the Dutch fibromyalgia patient association, were pre-randomized to receive either 2(1/2) weeks of treatment in a Tunisian spa resort, including thalassotherapy, supervised exercise and group education (active treatment) or treatment as usual (control treatment). Primary outcome measure was health-related quality of life, measured with the RAND-36 questionnaire. Secondary measures included the Fibromyalgia Impact Questionnaire, the McGill Pain Questionnaire, the Beck Depression Inventory, tender point score and a 6-min treadmill walk test.
  
  
  RESULTS
  Fifty-eight participants receiving the active treatment reported significant improvement on RAND-36 physical and mental component summary scales. For physical health, differences from the 76 controls were statistically significant after 3 months, but not after 6 and 12 months. A similar pattern of temporary improvement was seen in the self-reported secondary measures. Tender point scores and treadmill walk tests improved more after active treatment, but did not reach significant between-group differences, except for walk tests after 12 months.
  
  
  CONCLUSIONS
  A combination of thalassotherapy, exercise and patient education may temporarily improve fibromyalgia symptoms and health-related quality of life.
authors.affiliation: Department of Rheumatology, Medisch Spectrum Twente Hospital, Enschede, The Netherlands. t.r.zijlstra@worldonline.nl
authors.forename: T R
authors.initials: TR
authors.lastname: Zijlstra
authors.forename: M A F J
authors.initials: MA
authors.lastname: van de Laar
authors.forename: H J
authors.initials: HJ
authors.lastname: Bernelot Moens
authors.forename: E
authors.initials: E
authors.lastname: Taal
authors.forename: L
authors.initials: L
authors.lastname: Zakraoui
authors.forename: J J
authors.initials: JJ
authors.lastname: Rasker
mesh_terms: D000328:Adult; D013790:Climatotherapy; D003131:Combined Modality Therapy; D015444:Exercise; D005260:Female; D005356:Fibromyalgia / Q000523:psychology / Q000534:rehabilitation*; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D018579:Patient Selection; D011594:Psychometrics; D011788:Quality of Life; D016896:Treatment Outcome