title: Including a range of outcome targets offers a broader view of fibromyalgia treatment outcome: results from a retrospective review of multidisciplinary treatment.
abstract: BACKGROUND
  Fibromyalgia is associated with substantial functional disability. Current drug and non-drug treatments result in statistically significant but numerically small improvements in typical numeric measures of pain severity and fibromyalgia impact.
  
  
  OBJECTIVE
  The aim of the present study was to evaluate additional measures of pain severity and functional outcome that might be affected by fibromyalgia treatment.
  
  
  METHODS
  This retrospective review evaluated outcomes from 274 adults with fibromyalgia who participated in a six-week, multidisciplinary treatment programme. Pain and function were evaluated on the first and final treatment visit. Pain was evaluated using an 11-point numerical scale to determine clinically meaningful pain reduction (decrease ≥ 2 points) and from a pain drawing. Function was evaluated by measuring active range of motion (ROM), walking distance and speed, upper extremity exercise repetitions, and self-reports of daily activities.
  
  
  RESULTS
  Numerical rating scores for pain decreased by 10-13% (p < 0.01) and Fibromyalgia Impact Questionnaire (FIQ) scores decreased by 20% (p < 0.001). More substantial improvements were noted when using alternative measures. Clinically meaningful pain relief was achieved by 37% of patients, and the body area affected by pain decreased by 31%. ROM showed significant improvements in straight leg raise and cervical motion, without improvements in lumbar ROM. Daily walking distance increased fourfold and arm exercise repetitions doubled.
  
  
  CONCLUSIONS
  Despite modest albeit statistically significant improvements in standard measures of pain severity and the FIQ, more substantial pain improvement was noted when utilizing alternative measures of pain and functional improvement. Alternative symptom assessment measures might be important outcome measures to include in drug and non-drug studies to better understand fibromyalgia treatment effectiveness.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Dawn A
authors.initials: DA
authors.lastname: Marcus
authors.forename: Cheryl D
authors.initials: CD
authors.lastname: Bernstein
authors.forename: Adeel
authors.initials: A
authors.lastname: Haq
authors.forename: Paula
authors.initials: P
authors.lastname: Breuer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005081:Exercise Therapy; D005260:Female; D005356:Fibromyalgia / Q000503:physiopathology / Q000534:rehabilitation / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010353:Patient Education as Topic; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D013131:Spine / Q000503:physiopathology; D016896:Treatment Outcome; D055815:Young Adult
keywords: Activities of daily living; clinically meaningful; pain drawing; repetitions; walking