Community patient education and exercise for people with fibromyalgia: a parallel group randomized controlled trial

Abstract

Objective: To evaluate the effects of a community patient education -exercise programme, using a cognitive-behavioural approach, for people with fibromyalgia. Design: A randomized, parallel group trial with assessments at 0, 4 and 8 months. Setting: Community leisure centres. Subjects: People with fibromyalgia ( n=183) attending a rheumatology outpatient department at a large district general hospital. Interventions: Participants were randomized to a patient education-exercise group ( n=97) or relaxation (attention control) group ( n=86). Main measures: The Fibromyalgia Impact Questionnaire (0-80; lower score means better health). Secondary outcomes included: the Arthritis Self-Efficacy Scale(pain and other symptoms subscales: 1 -10 scale; higher scores mean greater self-efficacy) and self-reported improvement. Results: Fifty participants withdrew or were unable to attend and 133 completed and returned baseline questionnaires: patient education group ( n=71); relaxation group ( n=62); 120/133 participants were women. Average age was 48. 53 (SD 10.89) years. Follow-up ranged between 73 and 82% of questionnaires returned. At four months, there was a difference in average changes in total Fibromyalgia ImpactQuestionnaire scores between the two groups: patient education group -3.38 (SD 9.35); relaxation group 0.3 (SD 8.85); P=0.02. Arthritis Self-Efficacy Scale scores were significantly higher in the patient education group: pain 0.59 (SD 1.45)compared to the relaxation group’s -0.12 (SD 1.22); P=0.003; other symptoms (patient education group 0.72 (SD 1.33); relaxation group 0.03 (SD 1.16); P=0.002). At eight months these differences were no longer apparent. Forty-seven per cent in the patient education group self-reported improvement compared with 13% in the relaxation group (ϰ=13.65; P=0.0001). Conclusion: Short-term improvements resulted from the education -exercise programme but were not sustained. Appropriate selection may improve efficacy.