title: Ottawa Panel evidence-based clinical practice guidelines for strengthening exercises in the management of fibromyalgia: part 2.
abstract: OBJECTIVE
  The objective of this study was to create guidelines for the use of strengthening exercises in the management of adult patients (>18 years of age) with fibromyalgia (FM), as defined by the 1990 American College of Rheumatology criteria.
  
  
  METHODS
  Following Cochrane Collaboration methods, the Ottawa Methods Group found and synthesized evidence from comparative controlled trials and formed the Ottawa Panel, with nominated experts from key stakeholder organizations. The Ottawa Panel then developed criteria for grading the recommendations based on experimental design (I for randomized controlled trials, II for nonrandomized studies) and strength of evidence (A, B, C+, C, D+, D, or D-). From the rigorous literature search, 5 randomized controlled trials were selected. Statistical analysis was based on Cochrane Collaboration methods. Continuous data were calculated with weighted mean differences between the intervention and control groups, and dichotomous data were analyzed with relative risks. Clinical improvement was calculated using absolute benefit and relative difference in change from baseline. Clinical significance was attained when an improvement of 15% relative to a control was found.
  
  
  RESULTS
  There were 5 positive recommendations: 2 grade A and 3 grade C+. All 5 were of clinical benefit.
  
  
  CONCLUSIONS
  The Ottawa Panel recommends strengthening exercises for the management of fibromyalgia as a result of the emerging evidence (grades A, B, and C+, although most trials were rated low quality) shown in the literature.
authors.affiliation: Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada. Lucie.Brosseau@uottawa.ca
authors.forename: Lucie
authors.initials: L
authors.lastname: Brosseau
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
authors.forename: Peter
authors.initials: P
authors.lastname: Tugwell
authors.forename: Mary
authors.initials: M
authors.lastname: Egan
authors.forename: Keith G
authors.initials: KG
authors.lastname: Wilson
authors.forename: Claire-Jehanne
authors.initials: CJ
authors.lastname: Dubouloz
authors.forename: Lynn
authors.initials: L
authors.lastname: Casimiro
authors.forename: Vivian A
authors.initials: VA
authors.lastname: Robinson
authors.forename: Jessie
authors.initials: J
authors.lastname: McGowan
authors.forename: Angela
authors.initials: A
authors.lastname: Busch
authors.forename: Stéphane
authors.initials: S
authors.lastname: Poitras
authors.forename: Harvey
authors.initials: H
authors.lastname: Moldofsky
authors.forename: Manfred
authors.initials: M
authors.lastname: Harth
authors.forename: Hillel M
authors.initials: HM
authors.lastname: Finestone
authors.forename: Warren
authors.initials: W
authors.lastname: Nielson
authors.forename: Angela
authors.initials: A
authors.lastname: Haines-Wangda
authors.forename: Marion
authors.initials: M
authors.lastname: Russell-Doreleyers
authors.forename: Kim
authors.initials: K
authors.lastname: Lambert
authors.forename: Alison D
authors.initials: AD
authors.lastname: Marshall
authors.forename: Line
authors.initials: L
authors.lastname: Veilleux
mesh_terms: D000328:Adult; D002170:Canada; D019317:Evidence-Based Medicine; D005081:Exercise Therapy; D005356:Fibromyalgia / Q000534:rehabilitation*; D006801:Humans; D053580:Muscle Strength; D017410:Practice Guidelines as Topic