Design and outcomes of studies of self-management in patients with fibromyalgia only
| Author (year) | Design and sample (n); mean age; % women; arthritis duration | Recruitment source; % drop-out | Intervention; duration; comparison group | Facilitator training (Y/N) | Theory | Follow-up | Significant outcomes: improved |
|---|---|---|---|---|---|---|---|
| Soares et al (2002)37 | RCT (n=53); 45 y; 100% women; duration of symptoms, 3.6 years | PC; drop-out: not stated | Hospital-based: | 1 OT, 1 PT (NS) CP (Y) | NS CBT | 2.5 and 6 m | CC 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 h | 2.5 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 control | 6 m: sleep quality | ||||||
| King et al (2002)38 | RCT (n=152); 46 y; 100% women; duration, 9 years | Rheum;drop-out: 38% | Community based: | MDT (NS) and CP MDT (NS) and CP (Y) | SCT | 3 and 6 m | ITT, CC and PP analyses: |
| (A) Supervised aerobic exercise (AE) 12 weeks (up to 40 min 3×/week 60–75% maximum heart rate). 36 h | ITT and CC, no differences | ||||||
| (B) SMP: 12×1.5–2 h/week: pain, fatigue, pacing, exercise benefits, alternative therapies, barriers to change). 24 h | 3 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)39 | RCT (n=129); 49 y; 76% women; duration of symptoms, 9 years | Rheum; drop-out: 21% | Hospital based: | MDT (NS) and CP | NS | 6 m | CC 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 h | 6 m: SMP: pain, function, fatigue, psychological status; satisfaction with symptom control, stress reduction, memory | ||||||
| (B) Wait list control | |||||||
| Ziljstra et al (2005)40 | RCT (Zelen design) (n=134); 48 y; 93% women; duration of symptoms, 9 years | Rheum, CV; drop-out: 12 m, 5% | Tunisia-hotel spa: | HP (NS) | SCT | 3, 6 and 12 m | CC 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 h | 3 m: SPA: pain, function, fatigue, psychological status; physical health, tender points, sleep | ||||||
| (B) Usual care | 6 m: SPA: fatigue | ||||||
| 12 m: SPA: walk time | |||||||
| Lemstra et al (2005)41 | RCT (n=79); 49 y; 85% women; duration, 10 years | PC; drop-out: | Community based: | MDT (NS) and CP (cognitive sessions) | NS | 6 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 h | 6 weeks: pain, function, global health, mood | |||||
| 15 m, 56% | (B) Usual care | 15 m (uncontrolled): pain, function, mood | |||||
| Hammond et al (2006)42 | RCT (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; CBT | 4 and 8 m | ITT 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 h | 4 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 h | 8 m: exercise; self-reported ‘improved’ status | ||||||
| Rooks et al (2007)43 | Randomised parallel group study (n=207); 50 y; 100% women; duration, 6 years | Rheum; drop-out: 35% | Community and hospital based: | PM/HP? (Y) | SCT | 6 m | CC analysis: |
| (A) Aerobic exercise (AE: walking) 16×2×1 h/week+home programme 1×/week; 32 h | 6 m: STAE-FHSC: pain, function, fatigue, psychological status | ||||||
| (B) Strength and aerobic exercise (STAE) 16×2×1 h/week; 32 h | AE: 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 h | STAE: pain, function, fatigue, psychological status | ||||||
| (D) Combined STAE and FHSC; no booster. 46 h | All 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.