Effectiveness of the interactional and interdisciplinary school of fibromyalgia: a long-term randomized control study

Souza, Juliana Barcellos de; Bourgault, Patricia; Charest, Jacques; Marchand, Serge

doi:10.5935/2595-0118.20200019

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ORIGINAL ARTICLE • BrJP 3 (2) • Jan-Mar 2020 • https://doi.org/10.5935/2595-0118.20200019 copy

Effectiveness of the interactional and interdisciplinary school of fibromyalgia: a long-term randomized control study

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND AND OBJECTIVES:

This study assessed long-term efficacy of an interdisciplinary group intervention of patients with fibromyalgia as compared with standard medical care.

METHODS:

A partially randomized controlled study with two groups and repeated measures. Variables were measured at baseline; immediately after the program; 4 months and 1 year later. Fibromyalgia patients were recruited by newspaper ads or physician references from two Quebec regions. Sixty women suffering from fibromyalgia were randomized to the experimental group (ISF) or the control group CG. The program, called Interactional School of Fibromyalgia (ISF), consists of nine sessions with eight participants and two clinicians. Five variables were measured: Fibromyalgia Impact Questionnaire (FIQ), Physical and Mental components summary of Short Form Health Survey 36 (SF-36), Clinical pain, and pressure pain threshold at tender points.

RESULTS:

Efficacy analyses from completers, as well as intent-to-treat analyses, showed a treatment effect on measures even one year after the end of the program. The experimental group experienced lower FIQ scores (p<0.01), less clinical pain (p<0.05), higher pressure-pain thresholds (p<0.01), and higher physical component summary scores on the SF-36 (p<0.05).

CONCLUSION:

This interdisciplinary group intervention of patients with fibromyalgia demonstrated better long-term outcomes compared with standard medical care.

Keywords:
Coping; Exercise therapy; Fibromyalgia; Pain management

Meeting	Theme
1. Therapeutic contract	During this session a contract is made with each patient to clarify their personal goals and to establish the minimal change acceptable. "Regarding your ability to manage your FM, what would be the smallest improvement - between 5 and 20% - that you would consider important enough to justify your efforts during the ISF"? This session also introduces patients to techniques of breathing.
2. Symptoms management	At this session the patients share their personal strategies for managing their FM symptoms (i.e.: pain, fatigue, sleep, stress).
3. Physical force	This session prepares the patients for their personalized physical exercise program that they will perform at home (moderate exercise routine with stretching and strength training – 15 minutes, 6 days per week; and 30-minute walk with intensity between 40 and 60% of maximal heart frequency, 3 days per week).
4. Mental force	Among a possibility of three relaxation techniques, each patient chooses one to practice 3 times per week.
5. Energy management	During this session the patients discussed different ways to refuse, accept, or delegate a task.
6. Nutrition	This theme emphasizes the importance of a healthy diet to maintain energy.
Two weeks break	Patients have two weeks without ISF sessions. This break is to encourage individuals to integrate the strategies learned in ISF.
7. Chronicity	This theme includes the impact of FM on sexuality and on their mood (suicidal thoughts).
8. Treatment	Here different possible treatments (pharmacological and non-pharmacological) are discussed.
9. Retrospective	At the last session, the clinicians assure that the improvements obtained during the ISF are attributed to the patient, by asking a question such as: "What could you do to put yourself back into your initial condition, before you started the ISF"?

Variables	ISF group	Control group	Independent t-test
Age (years)	47.9±6.6	51.3±7.5	t_{58, 5%} =-1.855; p=.07
Symptoms of chronic pain (years)	13.2±8.8	11.6±8.6	t_{58, 5%} =.704; p=.48
Fibromyalgia diagnosis (years)	5.9±5.6	7.3±4.9	t_{58, 5%} =-1.019; p=.31
Depression (self-reported)	43% (n=13)	40% (n=12)	c²= 0.322; p=0.57
Fibromyalgia Impact Questionnaire (FIQ) (0-80)	51.7±12.0	52.8±9.9	t_{58, 5%} =-.404; p=.69
Health outcome measures (SF-36)
Mental Component Summary	39.3±12.9	38.3±11.1	t _{58, 5%} =.323; p=.75
Physical Component Summary	30.8±6.4	30.3±5.4	t_{58, 5%} =.345; p=.73
Clinical pain
Intensity	44.8±19.8	53.4±20.0	t _{53, 5%} =-1.607; p=.11
Unpleasantness	41.8±21.9	50.0±23.1	t_{58, 5%} =-1.349; p=.18

Variables	Completers (n=24)	Dropouts (n=6)	Independent t-test
Age (years)	48.75±5.80	44.50±8.83	t_{28, 5%} =1.445; p=.159
Symptoms of chronic pain (years)	12.19±7.14	17.17±13.76	t_{28, 5%} =.858=.220
Fibromyalgia diagnosis (years)	4.94±3.25	9.58±10.5	t_{28, 5%} =1.071; p=.331
Depression (self-reported)	42 (n=10)	50% (n=3)	c²= 0.136; p=0.713
FIQ (0-80)	49.81±12.02	59.04±9.73	t_{28, 5%} =-1.736; p=.094
Health outcome measures (SF-36)
Mental Component Summary	42.77±11.51	25.55±8.14	t _{28, 5%} =3.435; p=.002
Physical Component Summary	30.80±6.77	30.98±4.93	t_{28, 5%} =-.061; p=.952
Clinical pain
Intensity	39.96±16.20	63.92±22.48	t _{28, 5%} =-3.002; p=.006
Unpleasantness	35.89±17.25	65.54±23.98	t_{28, 5%} =-3.487; p=.002

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[1] Correspondence to: Rua Deputado Antônio Edu Vieira, 58, 88040-000 Florianópolis, SC, Brasil. E-mail: juliana.barcellos.de.souza@gmail.com