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|Multidisciplinary treatment of fibromyalgia: does cognitive behavior therapy increase the response to treatment?|
|Lera S, Gelman SM, Lopez MJ, Abenoza M, Zorrilla JG, Castro-Fornieles J, Salamero M|
|Journal of Psychosomatic Research 2009 Nov;67(5):433-441|
|6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*|
OBJECTIVE: Multidisciplinary treatments (MTs) are usually recommended for reducing fibromyalgia (FM) symptoms and include physical exercise, drug management, education, and cognitive behavior therapy (CBT). However, there is no evidence that CBT adds efficacy to the other therapeutic components. This randomized controlled trial analyzed the response of FM patients to two MTs, with and without CBT, according to the presence of concurrent symptoms. METHODS: Eighty-three women with FM were randomly assigned to MT or combined MT and CBT. The MT included medical intervention, physical training, education, and discussion of the syndrome. The CBT focused on coping with stress, modifying lifestyles, and changing pain behaviors. Demographic and clinical data, information regarding tender points, and questionnaire responses about functional capability (Fibromyalgia Impact Questionnaire (FIQ)), health status (36-item Short Form Health Survey (SF-36)), and mental health (Symptom Checklist-90-Revised (SCL-90-R)) were obtained at the beginning, at the end of the 15-week treatment, and at 6-month follow-up. Subgroups are identified in relation to treatment response. RESULTS: Sixty-six women (80%) completed treatment. Although the variance of the total sample had changed at posttreatment (F = 2.67, p = 0.031), there was no significant effect for the time x treatment interaction (F = 1.65, p = 0.16). Univariate tests detected a significant fall in the FIQ score. The subgroup of patients with fatigue showed a better response with MT+CBT than with MT. At 6-month follow-up, the statistical differences had been maintained. Intention-to-treat analysis ratified these results. CONCLUSIONS: MT improves functional capability and reduces symptom impact. CBT increases mildly the effect of MT in patients with fatigue.