Lemstra Mark, Olszynski W P
College of Medicine, University of Saskatchewan, Saskatoon, Canada.
Clin J Pain. 2005 Mar-Apr;21(2):166-74. doi: 10.1097/00002508-200503000-00008.
To assess the effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia in comparison to standard medical care.
Seventy-nine men and women were randomly assigned to one of two groups. The intervention group consisted of a rheumatologist and physical therapist intake and discharge, 18 group supervised exercise therapy sessions, 2 group pain and stress management lectures, 1 group education lecture, 1 group dietary lecture, and 2 massage therapy sessions. The control group consisted of standard medical care with the patients' family physician. Outcome measures included self-perceived health status, pain-related disability, average pain intensity, depressed mood, days in pain, hours in pain, prescription and nonprescription medication usage, and work status. Outcomes were measured at the end of the 6-week intervention and at 15-month follow-up.
Thirty-five out of 43 patients from the intervention group and 36 out of 36 patients from the control group completed the study. There were no statistically significant differences between the 2 groups prior to intervention. Intention-to-treat analysis revealed that the intervention group, in comparison to the control group, experienced statistically significant changes at intervention completion in self-perceived health status, average pain intensity, pain related disability, depressed mood, days in pain, and hours in pain, but no significant differences in nonprescription drug use, prescription drug use, or work status. At 15 months, all health outcomes retained their significance except health status. Nonprescription and prescription drug use demonstrated significant reductions at 15 months. Binary logistic regression indicated that long-term changes in Pain Disability Index were influenced by long-term exercise adherence and income status.
Positive health-related outcomes in this mostly unresponsive condition can be obtained with a low-cost, group multidisciplinary intervention in a community-based, nonclinical setting.
评估多学科康复治疗与标准医疗护理相比，在治疗纤维肌痛方面的有效性。
79名男性和女性被随机分为两组。干预组包括由一名风湿病学家和一名物理治疗师进行的接诊和出院指导、18次小组监督下的运动治疗课程、2次小组疼痛和压力管理讲座、1次小组教育讲座、1次小组饮食讲座以及2次按摩治疗课程。对照组由患者的家庭医生提供标准医疗护理。结果指标包括自我感知的健康状况、与疼痛相关的残疾、平均疼痛强度、情绪低落、疼痛天数、疼痛小时数、处方药和非处方药的使用情况以及工作状态。在为期6周的干预结束时和15个月的随访时测量结果。
干预组的43名患者中有35名、对照组的36名患者完成了研究。干预前两组之间无统计学显著差异。意向性分析显示，与对照组相比，干预组在干预结束时自我感知的健康状况、平均疼痛强度、与疼痛相关的残疾、情绪低落、疼痛天数和疼痛小时数方面有统计学显著变化，但在非处方药使用、处方药使用或工作状态方面无显著差异。在15个月时，除健康状况外，所有健康结果仍具有显著性。非处方药和处方药的使用在15个月时显著减少。二元逻辑回归表明，疼痛残疾指数的长期变化受长期运动依从性和收入状况的影响。
在基于社区的非临床环境中，通过低成本的小组多学科干预，可以在这种大多无反应的疾病中获得与健康相关的积极结果。
