Table 5

Design and outcomes of studies of self-management in patients with fibromyalgia only

Author (year)Design and sample (n); mean age; % women; arthritis durationRecruitment source; % drop-outIntervention; duration; comparison groupFacilitator training (Y/N)TheoryFollow-upSignificant outcomes: improved
Soares et al (2002)37RCT (n=53); 45 y; 100% women; duration of symptoms, 3.6 yearsPC; drop-out: not statedHospital-based:1 OT, 1 PT (NS) CP (Y)NS CBT2.5 and 6 mCC analysis:
(A) Education: individual sessions (2×2 h)+15×2 h group sessions over 10 weeks (pain, sleep, stress, fatigue/ergonomics, medication, body awareness). No booster. 34 h2.5 m: CBT: pain, function, pain coping, self-efficacy, sleep quality
(B) CBT: 5×1 h individual sessions and 15×2 h group CBT sessions over 10 weeks (relaxation, biofeedback, pain and stress management, negative thinking, problem-solving); no booster. 35 h wait list control6 m: sleep quality
King et al (2002)38RCT (n=152); 46 y; 100% women; duration, 9 yearsRheum;drop-out: 38%Community based:MDT (NS) and CP MDT (NS) and CP (Y)SCT3 and 6 mITT, CC and PP analyses:
(A) Supervised aerobic exercise (AE) 12 weeks (up to 40 min 3×/week 60–75% maximum heart rate). 36 hITT and CC, no differences
(B) SMP: 12×1.5–2 h/week: pain, fatigue, pacing, exercise benefits, alternative therapies, barriers to change). 24 h3 and 6 m: PP analysis onlyAE-SMP: self-efficacy, fitness
(C) AE-SMP (combined as above). 50 h
(D) Information leaflets
Cedraschi et al (2004)39RCT (n=129); 49 y; 76% women; duration of symptoms, 9 yearsRheum; drop-out: 21%Hospital based:MDT (NS) and CPNS6 mCC analysis:
(A) SMP and exercise: 12×1.5 h sessions for 6 weeks: land (×2) and warm-water (×8) exercise, managing daily activities, relaxation, personal relationships. No booster. 18 h6 m: SMP: pain, function, fatigue, psychological status; satisfaction with symptom control, stress reduction, memory
(B) Wait list control
Ziljstra et al (2005)40RCT (Zelen design) (n=134); 48 y; 93% women; duration of symptoms, 9 yearsRheum, CV; drop-out: 12 m, 5%Tunisia-hotel spa:HP (NS)SCT3, 6 and 12 mCC analysis:
(A) 2.5 weeks spa programme (SPA): 7×3 h thalassotherapy 7×1 h exercise (stretch, aerobic), 7×1.5 h education (role of emotions, pacing, stress handling, coping, medications and alternative therapies). No booster. 38.5 h3 m: SPA: pain, function, fatigue, psychological status; physical health, tender points, sleep
(B) Usual care6 m: SPA: fatigue
12 m: SPA: walk time
Lemstra et al (2005)41RCT (n=79); 49 y; 85% women; duration, 10 yearsPC; drop-out:Community based:MDT (NS) and CP (cognitive sessions)NS6 weeks and 15 m (uncontrolled)ITT analysis:
3 m, 9%(A) SMP and exercise (SMP-EX). Exercise: 18×3×1 h/week group exercise; SMP (6 weeks): FM information (3 h), pain and stress management (2×3 h); nutrition(3 h); 2×20 min individual massage. 28.7 h6 weeks: pain, function, global health, mood
15 m, 56%(B) Usual care15 m (uncontrolled): pain, function, mood
Hammond et al (2006)42RCT (n=183); 48.5 y; 90% women; duration, 2.7 years (symptoms 6.5 years)Rheum; drop-out: 8 m, 24%Community based:1 OT, 1 PT (Y)SCT; CBT4 and 8 mITT analysis:
(A) SMP (pain, fatigue and stress management, pacing, sleep, relaxation, exercise (Tai Chi, home walking programme, postural training, strengthening)) 10×2 h/week (over 12 weeks). No booster. 20 h4 m: SMP: pain, function, fatigue, psychological status; self-efficacy; perceived control; healthcare use
(B) Attention control group: relaxation programme 10×1 h/week for 10 weeks. 10 h8 m: exercise; self-reported ‘improved’ status
Rooks et al (2007)43Randomised parallel group study (n=207); 50 y; 100% women; duration, 6 yearsRheum; drop-out: 35%Community and hospital based:PM/HP? (Y)SCT6 mCC analysis:
(A) Aerobic exercise (AE: walking) 16×2×1 h/week+home programme 1×/week; 32 h6 m: STAE-FHSC: pain, function, fatigue, psychological status
(B) Strength and aerobic exercise (STAE) 16×2×1 h/week; 32 hAE: fatigue, mood;
(C) Fibromyalgia self-help course (FHSC) 7×2 h/fortnight (pain, relaxation, exercise, communication, fatigue, depression (FM-specific version of ASMP); no booster. 14 hSTAE: pain, function, fatigue, psychological status
(D) Combined STAE and FHSC; no booster. 46 hAll groups: self-efficacy
No control group
  • Diagnosis: FM, fibromyalgia.

  • Recruitment: CV, community volunteers; PC, primary care; Rheum, rheumatology outpatient departments.

  • Intervention: ASMP, the Arthritis Self-Management Programme; SMP, self-management programme.

  • Programme facilitator: CP, clinical psychologist; HP, health professionals; MDT, multidisciplinary team (nurse, physiotherapist (PT), occupational therapist (OT) (± rheumatologist, pharmacist); PM, trained peer/lay moderator.

  • Training: NS, not stated.

  • Theory: CBT, cognitive-behavioural theory; NS, not stated; SCT, Social Cognitive Theory.

  • Analysis: CC, case completers only; ITT, all cases included, imputation of missing values; PP, per protocol analysis.

  • m, months; RCT, randomised controlled trial; y, years.