Karjalainen K, Malmivaara A, van Tulder M, Roine R, Jauhiainen M, Hurri H, Koes B
Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, Helsinki, Finland, FIN-00250.
Cochrane Database Syst Rev. 2000;1999(2):CD001984. doi: 10.1002/14651858.CD001984.
Non-malignant musculoskeletal pain is an increasing problem in western countries. Fibromyalgia syndrome is an increasing recognised chronic musculoskeletal disorder.
The objective of this systematic review was to determine the effectiveness of multidisciplinary rehabilitation for fibromyalgia and widespread musculoskeletal pain among working age adults.
An electronic search was conducted and included Medline from 1966, PsycLIT from 1967 and EMBASE from 1980 to April 1998. The Cochrane Musculoskeletal Group Trials Register was searched as well as, the Cochrane Controlled Trials Register (CCTR). The references of identified articles and reviews were checked, studies published in the Finnish medical database Medic from 1978 to 1998 screened and the Science Citation Index searched. Content experts were also contacted for additional or unpublished studies.
From all references found in our original search, we selected all randomized controlled trials (RCTs) and clinical controlled trials (CCTs). Trials had to assess the effectiveness of multidisciplinary rehabilitation for patients suffering from fibromyalgia and widespread musculoskeletal pain among working age adults. The rehabilitation program was required to be multidisciplinary; that is, it had to consist of a physician's consultation, plus a psychological, social or vocational intervention, or a combination of both.
Four reviewers independently selected the RCTs and CCTs that met the specified inclusion criteria. Two experts in the field of rehabilitation evaluated the relevance and applicability of the findings of the selected studies to actual clinical use. Two other reviewers extracted the data and assessed the main results and the methodological quality of the studies using standardized forms. Finally, a qualitative analysis was performed to evaluate the level of scientific evidence for the effectiveness of multidisciplinary rehabilitation.
After screening 1808 abstracts, and the references of 65 reviews, we found only seven relevant studies (1050 patients) that met our inclusion criteria. None of these were considered, methodologically, a high quality randomized controlled trial. Four of the included RCTs on fibromyalgia were graded low quality and suggest no quantifiable benefits. The three included RCTs on widespread musculoskeletal pain showed that based on limited evidence, overall, no evidence of efficacy was observed. However, behavioral treatment and stress management appear to be important components. Education combined with physical training showed some positive effects in long term follow up.
REVIEWER'S CONCLUSIONS: We conclude that there appears to be little scientific evidence for the effectiveness of multidisciplinary rehabilitation for these musculoskeletal disorders. However, multidisciplinary rehabilitation is a commonly used intervention for chronic musculoskeletal disorders, which cause much personal suffering and substantial economic loss to the society. There is a need for high quality trials in this field.
在西方国家，非恶性肌肉骨骼疼痛问题日益严重。纤维肌痛综合征是一种越来越被认可的慢性肌肉骨骼疾病。
本系统评价的目的是确定多学科康复对工作年龄成年人纤维肌痛和广泛性肌肉骨骼疼痛的有效性。
进行了电子检索，包括1966年以来的Medline、1967年以来的PsycLIT以及1980年至1998年4月的EMBASE。检索了Cochrane肌肉骨骼组试验注册库以及Cochrane对照试验注册库（CCTR）。检查了已识别文章和综述中的参考文献，筛选了1978年至1998年在芬兰医学数据库Medic中发表的研究，并检索了科学引文索引。还联系了内容专家以获取其他或未发表的研究。
从我们原始检索中找到的所有参考文献中，我们选择了所有随机对照试验（RCT）和临床对照试验（CCT）。试验必须评估多学科康复对工作年龄成年人中患有纤维肌痛和广泛性肌肉骨骼疼痛患者的有效性。康复计划必须是多学科的；也就是说，它必须包括医生咨询，加上心理、社会或职业干预，或两者的结合。
四位评审员独立选择符合指定纳入标准的RCT和CCT。两位康复领域专家评估了所选研究结果与实际临床应用的相关性和适用性。另外两位评审员提取数据，并使用标准化表格评估研究的主要结果和方法学质量。最后，进行了定性分析以评估多学科康复有效性的科学证据水平。
在筛选了1808篇摘要和65篇综述的参考文献后，我们仅发现七项符合我们纳入标准的相关研究（1050名患者）。从方法学角度来看，这些研究均未被视为高质量的随机对照试验。纳入的四项关于纤维肌痛的RCT质量较低，未显示出可量化的益处。纳入的三项关于广泛性肌肉骨骼疼痛的RCT表明，基于有限的证据，总体上未观察到疗效证据。然而，行为治疗和压力管理似乎是重要组成部分。教育与体育训练相结合在长期随访中显示出一些积极效果。
我们得出结论，对于这些肌肉骨骼疾病，多学科康复有效性的科学证据似乎很少。然而，多学科康复是慢性肌肉骨骼疾病常用的干预措施，这些疾病给个人带来很大痛苦，并给社会造成巨大经济损失。该领域需要高质量的试验。
