Kroese Mariëlle E A L, Schulpen Guy J C, Sonneveld Henk M, Vrijhoef Hubertus J M
Department of Integrated Care, University Hospital Maastricht, Maastricht, The Netherlands.
J Eval Clin Pract. 2008 Apr;14(2):321-5. doi: 10.1111/j.1365-2753.2007.00862.x.
In this study, information was gathered from five disciplines on their usual management methods for fibromyalgia (FM) in order to asses whether treatment regimens have changed in the Netherlands during a period of 6 years. In addition, insight was gained into the therapeutic motives of the professionals.
A questionnaire was sent to a sample of 150 persons per discipline: general practitioners (GPs), rheumatologists (RMTs), rehabilitation specialists (RS), physical therapists and psychologists.
The overall response rate was 40.4%. The referral behaviour changed (significantly), especially between GPs and RMTs. An increased choice for aerobic exercise (RS: P = 0.023) and multidisciplinary therapy (RMT: P = 0.046) was found. RMTs and RS showed decreased medication prescribing (RMT: P = 0.024). Preferences of treatment for FM differ per discipline. The choice is principally made on the basis of subjective, professional group-bound factors. Particularly for GPs, dynamic patient factors are an important motive in the management of FM.
Despite the fact that most changes found are in conformity with the literature, the absolute application percentages of recommended therapies are still very low. The differences in practice between the several disciplines seem explicable on the basis of the factors that have a prominent role in the choice of a therapy for FM. This study underlines the need for further research into methods and processes of the management of FM, and their clinical effectiveness. An effective way of dissemination, especially of guidelines, is essential.
在本研究中，收集了五个学科关于纤维肌痛（FM）常用管理方法的信息，以评估荷兰在6年期间治疗方案是否发生了变化。此外，还深入了解了专业人员的治疗动机。
向每个学科的150人样本发放了问卷，这些学科包括全科医生（GPs）、风湿病学家（RMTs）、康复专家（RS）、物理治疗师和心理学家。
总体回复率为40.4%。转诊行为发生了（显著）变化，尤其是在全科医生和风湿病学家之间。有氧运动（RS：P = 0.023）和多学科治疗（RMT：P = 0.046）的选择有所增加。风湿病学家和康复专家的药物处方量减少（RMT：P = 0.024）。各学科对FM治疗的偏好不同。选择主要基于主观的、特定专业群体的因素。特别是对于全科医生来说，动态的患者因素是FM管理中的一个重要动机。
尽管发现的大多数变化与文献一致，但推荐疗法的绝对应用百分比仍然很低。几个学科之间在实践中的差异似乎可以根据在FM治疗选择中起突出作用的因素来解释。本研究强调需要进一步研究FM的管理方法和过程及其临床效果。一种有效的传播方式，特别是指南的传播方式至关重要。
