title: Patients with more severe symptoms benefit the most from an intensive multimodal programme in patients with fibromyalgia.
abstract: OBJECTIVE
  Patients with fibromyalgia (FM) experience symptoms over a long period of time impacting their quality of life (QoL). Patients are often treated in multimodal programmes that combine physical and cognitive treatment modalities. Purpose of this study was to identify prognostic factors of effectiveness of a multimodal programme.
  
  
  METHODS
  A prospective study was performed with a group of 87 patients with FM who had participated in a multimodal programme. The Revised Illness Perception Questionnaire (IPQ) and the Fibromyalgia Impact Questionnaire (FIQ) were used. Criterion for clinically relevant improvement was a decline in total FIQ score of 12.5 points or more after the treatment programme. Investigated determinants of improvement of QoL were patient characteristics, illness perceptions (IP) and QoL at baseline.
  
  
  RESULTS
  QoL of 34 patients with FM made a clinically relevant improvement after the programme. There was no difference in age, number of years with pain, number of years diagnosed or IP compared to the group that did not improve. The group of patients with an improved QoL after the programme reported severe impact on daily living, highest intensity of pain and most depression at baseline.
  
  
  CONCLUSIONS
  Total FIQ score on QoL, intensity of pain, morning tiredness and depression can be used as prognostic factors to pre-select patients with FM for a multimodal treatment. IP were not adequate to predict treatment outcome. An intensive multimodal programme seemed most suitable for patients with severe symptoms and limitations.
authors.affiliation: Research and Innovation Group in Health Care and Nursing, Hanze University Groningen, University of Applied Sciences, Groningen, The Netherlands. r.van.abbema@pl.hanze.nl
authors.forename: Renske
authors.initials: R
authors.lastname: Van Abbema
authors.forename: C Paul
authors.initials: CP
authors.lastname: Van Wilgen
authors.forename: Cees P
authors.initials: CP
authors.lastname: Van Der Schans
authors.forename: Miriam W
authors.initials: MW
authors.lastname: Van Ittersum
mesh_terms: D015928:Cognitive Behavioral Therapy / Q000458:organization & administration*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005356:Fibromyalgia / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D010147:Pain Measurement; D017060:Patient Satisfaction; D010808:Physical Examination; D026741:Physical Therapy Modalities / Q000458:organization & administration*; D011237:Predictive Value of Tests; D015397:Program Evaluation; D011446:Prospective Studies; D011594:Psychometrics; D011788:Quality of Life; D018570:Risk Assessment; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome