Multimodal, Multidisciplinary Treatment Program for Fibromyalgia
Multimodal, Multidisciplinary Treatment Program for Fibromyalgia
Patient outcome measures over time are presented for each individual with the use of longitudinal line graphs. Exploratory hypothesis testing comparing pre- and posttreatment scores were performed using Wilcoxon signed rank tests and are reported along with median and ranges. Tests were performed using SAS (version 9.2; SAS Institute, Cary, NC) and were evaluated at an alpha level of .05.
Six patients returned all questionnaires at 1 week, and 5 patients returned all questionnaires at 3 months. As shown in Figure 4, all patients indicated at least a small improvement in fibromyalgia symptoms as measured by the FIQ at both 1 week and 3 months.
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Figure 4.
Fibromyalgia Impact Questionnaire (FIQ) total scores for all patients at baseline, 1 week, and 3 months. Lower scores indicate improved symptoms.
Examining other measures, all but one patient showed improvements in self-efficacy as measured by the CPSS at both 1 week and 3 months (Fig. 5). Fatigue, as measured by the MFSI-SF, was improved in all patients at 1 week and all but one patient at 3 months (Fig. 6). Improvements were similarly noted on SF-36 physical component scores at 1 week and 3 months in all but one patient (Fig. 7). Patients did not demonstrate clear improvement on the SF-36 mental component at 1 week, but all patients reported improvement at 3 months (Fig. 8).
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Figure 5.
Chronic Pain Self-Efficacy Scale (CPSS) total scores for all patients at baseline, 1 week, and 3 months. Higher scores indicate increased self-efficacy.
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Figure 6.
Multidimensional Fatigue Symptom Inventory–Short Form (MFSI-SF) total scores for all patients at baseline, 1 week, and 3 months. Lower scores indicate improved symptoms of fatigue.
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Figure 7.
Short-Form Health Survey (SF-36) physical component scores for all patients at baseline, 1 week, and 3 months. Higher scores indicate improved quality of life.
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Figure 8.
Short-Form Health Survey (SF-36) mental component total scores for all patients at baseline, 1 week, and 3 months.
Compared with baseline, significant differences were noted for both the FIQ total impact (p = .03) and MFSI-SF total score (p = .03), with median improvements of 10 points (range 0.4–23.2) and 15.3 points (range 8.5–41), respectively, at 1 week. At 3 months, none of the scores were significantly different from baseline, but there was a trend for FIQ total score (p = .06), with a median improvement of 6.2 points (range 2.4–32.5), and SF-36 mental component score (p = .06), with a median improvement of 6.1 points (range 1.6–14.4).
Table 1 summarizes individual patient characteristics, including medications. Only minor medication changes were instituted during this clinical program, because our clinical experience suggests that taper of opioids and other pain medications are best instituted alongside, or following, longer periods of intensive physical and psychologic rehabilitation. As such, we made only minor medication adjustments while patients were with us in an attempt to demonstrate to patients that self-management strategies could help them lower their use of pain medications. Patients were educated to institute formal tapers of opioids and related medications as indicated with the help of their primary care physicians.
Outcome Summary
Patient outcome measures over time are presented for each individual with the use of longitudinal line graphs. Exploratory hypothesis testing comparing pre- and posttreatment scores were performed using Wilcoxon signed rank tests and are reported along with median and ranges. Tests were performed using SAS (version 9.2; SAS Institute, Cary, NC) and were evaluated at an alpha level of .05.
Six patients returned all questionnaires at 1 week, and 5 patients returned all questionnaires at 3 months. As shown in Figure 4, all patients indicated at least a small improvement in fibromyalgia symptoms as measured by the FIQ at both 1 week and 3 months.
(Enlarge Image)
Figure 4.
Fibromyalgia Impact Questionnaire (FIQ) total scores for all patients at baseline, 1 week, and 3 months. Lower scores indicate improved symptoms.
Examining other measures, all but one patient showed improvements in self-efficacy as measured by the CPSS at both 1 week and 3 months (Fig. 5). Fatigue, as measured by the MFSI-SF, was improved in all patients at 1 week and all but one patient at 3 months (Fig. 6). Improvements were similarly noted on SF-36 physical component scores at 1 week and 3 months in all but one patient (Fig. 7). Patients did not demonstrate clear improvement on the SF-36 mental component at 1 week, but all patients reported improvement at 3 months (Fig. 8).
(Enlarge Image)
Figure 5.
Chronic Pain Self-Efficacy Scale (CPSS) total scores for all patients at baseline, 1 week, and 3 months. Higher scores indicate increased self-efficacy.
(Enlarge Image)
Figure 6.
Multidimensional Fatigue Symptom Inventory–Short Form (MFSI-SF) total scores for all patients at baseline, 1 week, and 3 months. Lower scores indicate improved symptoms of fatigue.
(Enlarge Image)
Figure 7.
Short-Form Health Survey (SF-36) physical component scores for all patients at baseline, 1 week, and 3 months. Higher scores indicate improved quality of life.
(Enlarge Image)
Figure 8.
Short-Form Health Survey (SF-36) mental component total scores for all patients at baseline, 1 week, and 3 months.
Compared with baseline, significant differences were noted for both the FIQ total impact (p = .03) and MFSI-SF total score (p = .03), with median improvements of 10 points (range 0.4–23.2) and 15.3 points (range 8.5–41), respectively, at 1 week. At 3 months, none of the scores were significantly different from baseline, but there was a trend for FIQ total score (p = .06), with a median improvement of 6.2 points (range 2.4–32.5), and SF-36 mental component score (p = .06), with a median improvement of 6.1 points (range 1.6–14.4).
Table 1 summarizes individual patient characteristics, including medications. Only minor medication changes were instituted during this clinical program, because our clinical experience suggests that taper of opioids and other pain medications are best instituted alongside, or following, longer periods of intensive physical and psychologic rehabilitation. As such, we made only minor medication adjustments while patients were with us in an attempt to demonstrate to patients that self-management strategies could help them lower their use of pain medications. Patients were educated to institute formal tapers of opioids and related medications as indicated with the help of their primary care physicians.
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