Turcotte Kara, Oelke Nelly D, Whitaker Gina, Holtzman Susan, O'Connor Brian, Pearson Neil, Teo Michelle
Department of Nursing, Western University, London, ON, Canada.
Faculty of Health and Social Development, School of Nursing, The University of British Columbia, 3333 University Way, Kelowna, BC, V1V 1V7, Canada.
Rheumatol Int. 2023 Dec;43(12):2201-2210. doi: 10.1007/s00296-023-05403-5. Epub 2023 Aug 11.
Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances, mood disturbances, and cognitive impairment. Most individuals with fibromyalgia experience poorly managed symptoms and increased healthcare service use. Multicomponent therapies, with a focus on nonpharmacological modalities, are increasingly supported in the literature. However, given the limited resources available, implementation in smaller communities remains a challenge. This research tested a community-based multidisciplinary group intervention for individuals diagnosed with FM living in a small urban centre. The primary outcome was perceptions of quality of care and secondary outcomes included disease-related functioning, anxious and depressive symptoms, pain beliefs, and health service utilization. A pilot randomized control trial was conducted in which 60 patients diagnosed with fibromyalgia were randomized into a 10-week community-based multidisciplinary group intervention program or usual care. Treatment components included twice-weekly exercise sessions and weekly education sessions (e.g., pain education, cognitive behavioral strategies for stress, nutrition, peer support). The trial (NCT03270449) was registered September 1 2017. Statistically significant post-intervention improvements were found in the primary outcome, perceived quality of care (Cohen's d = 0.61, 0.66 for follow up care and goal setting, respectively). Secondary outcomes showing statistically significant improvements were disease-related daily functioning (Cohen's d = 0.70), depressive symptoms (Cohen's d = 0.87), and pain beliefs (Cohen's d = 0.61, 0.67, 0.82 for harm, disability and control, respectively). No adverse events were reported. Community-based multidisciplinary group interventions for fibromyalgia show promise for improving satisfaction with quality of care, disease-related functioning, and depression, and fostering more adaptive pain beliefs.
纤维肌痛的特征是广泛疼痛、疲劳、睡眠障碍、情绪障碍和认知障碍。大多数纤维肌痛患者症状控制不佳，医疗服务使用增加。文献中越来越支持以非药物治疗方式为重点的多组分疗法。然而，鉴于可用资源有限，在较小社区实施仍然是一项挑战。本研究对生活在一个小型城市中心、被诊断为纤维肌痛的个体进行了一项基于社区的多学科小组干预试验。主要结局是对护理质量的认知，次要结局包括疾病相关功能、焦虑和抑郁症状、疼痛信念以及医疗服务利用情况。进行了一项试点随机对照试验，将60名被诊断为纤维肌痛的患者随机分为一个为期10周的基于社区的多学科小组干预项目或常规护理组。治疗内容包括每周两次的锻炼课程和每周一次的教育课程（如疼痛教育、压力的认知行为策略、营养、同伴支持）。该试验（NCT03270449）于2017年9月1日注册。干预后在主要结局（即感知的护理质量，随访护理和目标设定的Cohen's d分别为0.61和0.66）方面发现了具有统计学意义的改善。显示出具有统计学意义改善的次要结局包括疾病相关的日常功能（Cohen's d = 0.70）、抑郁症状（Cohen's d = 0.87）和疼痛信念（伤害、残疾和控制方面的Cohen's d分别为0.61、0.67和0.82）。未报告不良事件。基于社区的多学科小组干预对纤维肌痛患者在提高对护理质量的满意度、疾病相关功能和抑郁程度以及培养更具适应性的疼痛信念方面显示出前景。
