Efficacy of a multidisciplinary fibromyalgia treatment adapted for women with low educational levels: a randomized controlled trial.
OBJECTIVE
Multidisciplinary treatments of fibromyalgia (FM) have demonstrated efficacy. Nevertheless, they have been criticized for not maintaining their benefits and for not being studied for specific populations. Our objectives were to determine the efficacy of a multidisciplinary treatment for FM adapted for patients with low educational levels and to determine the maintenance of its therapeutic benefits during a long-term followup period.


METHODS
Inclusion criteria consisted of female sex, a diagnosis of FM (using American College of Rheumatology criteria), age between 18 and 60 years, and between 3 and 8 years of schooling. Patients were randomly assigned to 1 of the 2 treatment conditions: conventional pharmacologic treatment or multidisciplinary treatment. Outcome measures were functionality, sleep disturbances, pain intensity, catastrophizing, and psychological distress. Analysis was by intent-to-treat and missing data were replaced following the baseline observation carried forward method.


RESULTS
One hundred fifty-five participants were recruited. No statistically significant differences regarding pretreatment measures were found between the 2 experimental groups. Overall statistics comparison showed a significant difference between the 2 groups in all of the variables studied (P < 0.0001). Mixed linear model analysis demonstrated the superiority of the multidisciplinary treatment in all of the studied variables at posttreatment. The differences were maintained at 12-month followup in sleep disturbances (P < 0.0001), catastrophizing (P < 0.0001), and psychological distress (P < 0.01).


CONCLUSIONS
Multidisciplinary treatment adapted for individuals with low educational levels is effective in reducing key symptoms of FM. Some improvements were maintained 1 year after completing the multidisciplinary treatment.
Hospital Universitari de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, and Universitat Rovira i Virgili, Tarragona, Spain. antonicastel.hj23.ics@gencat.cat
Antoni
A
Castel
Ramon
R
Fontova
Salvador
S
Montull
Rocío
R
Periñán
Maria José
MJ
Poveda
Iris
I
Miralles
Rosalia
R
Cascón-Pereira
Pilar
P
Hernández
Natalia
N
Aragonés
Isabel
I
Salvat
Sonia
S
Castro
Sonia
S
Monterde
Anna
A
Padrol
José
J
Sala
Cristóbal
C
Añez
Maria
M
Rull
D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D004522:Educational Status; D005260:Female; D005356:Fibromyalgia / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D010353:Patient Education as Topic / Q000379:methods*; D026741:Physical Therapy Modalities; D016896:Treatment Outcome
D000700:Analgesics; D000928:Antidepressive Agents