Intervention Review

Multidisciplinary rehabilitation for fibromyalgia and musculoskeletal pain in working age adults

  1. Kaija A Karjalainen1,*,
  2. Antti Malmivaara2,
  3. Maurits W van Tulder3,
  4. Risto Roine4,
  5. Merja Jauhiainen5,
  6. Heikki Hurri6,
  7. Bart W Koes7

Editorial Group: Cochrane Musculoskeletal Group

Published Online: 26 JUL 1999

Assessed as up-to-date: 10 MAY 1999

DOI: 10.1002/14651858.CD001984


How to Cite

Karjalainen KA, Malmivaara A, van Tulder MW, Roine R, Jauhiainen M, Hurri H, Koes BW. Multidisciplinary rehabilitation for fibromyalgia and musculoskeletal pain in working age adults. Cochrane Database of Systematic Reviews 1999, Issue 3. Art. No.: CD001984. DOI: 10.1002/14651858.CD001984.

Author Information

  1. 1

    Finnish Institute of Occupational Health, Occupational Medicine, Helsinki, Finland

  2. 2

    Finnish Office for Health Care Technology Assessment, Occupational Medicine, Helsinki, Finland

  3. 3

    Faculty of Earth & Life Sciences, VU University, Department of Health Economics & Health Technology Assessment, Institute of Health Sciences, Amsterdam, Netherlands

  4. 4

    Helsinki and Uusimaa Hospital Group, Assessment of Technologies, HUS, Finland

  5. 5

    Finnish Institute of Occupational Health, Knowledge Transfer Team, Helsinki, Finland

  6. 6

    ORTON Rehabilitation Centre, Rehabilitation Centre, Helsinki, Finland

  7. 7

    Erasmus MC - University Medical Center Rotterdam, Department of General Practice, Rotterdam, Zuid-Holland, Netherlands

*Kaija A Karjalainen, Occupational Medicine, Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, Helsinki, FIN-00250, Finland. kaija.karjalainen@invalidiliitto.fi.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 26 JUL 1999

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Non-malignant musculoskeletal pain is an increasing problem in western countries. Fibromyalgia syndrome is an increasing recognised chronic musculoskeletal disorder.

Objectives

The objective of this systematic review was to determine the effectiveness of multidisciplinary rehabilitation for fibromyalgia and widespread musculoskeletal pain among working age adults.

Search methods

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.

Selection criteria

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.

Data collection and analysis

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.

Main results

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.

Authors' 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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Multidisciplinary rehabilitation for fibromyalgia and musculoskeletal pain in working age adults

Non-malignant musculoskeletal pain is an increasing problem in western countries. Fibromyalgia syndrome is an increasingly recognised chronic musculoskeletal disorder. The main purpose of this systematic review was to determine the effectiveness of multidisciplinary rehabilitation for fibromyalgia and wide spread musculoskeletal pain among working age adults. Patients included in the controlled trials in this review ranged in age from 18-65 years. Seven studies, with 1050 patients were included. The effectiveness of multidisciplinary rehabilitation was graded limited, showing no quantifiable benefit for both fibromyalgia and widespread musculoskeletal pain.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

多專業團隊復健於工作年齡成人之纖維肌痛症候群及骨骼肌肉疼痛

非惡性腫瘤之骨骼肌肉疼痛在西方國家是個增加中的問題。纖維肌痛症候群是逐漸被認識的慢性骨骼肌肉疼痛。

目標

本系統性回顧主要分析多專業團隊復健於工作年齡成人之纖維肌痛症候群及廣泛骨骼肌肉疼痛之有效性。

搜尋策略

搜尋包括MEDLINE由1966, PsycLIT自 1967及EMBASE自1980到1998年4月。Cochrane Musculoskeletal Group Trials Register及Cochrane Controlled Trials Register (CCTR)及Medic自1978到1998及搜尋Science Citation Index。同時手動搜尋所選文章之參考文獻及徵詢專家有關未發表文獻。

選擇標準

收錄隨機對照控制臨床研究及臨床控制研究,分析多專業團隊復健於工作年齡成人之纖維肌痛症候群及廣泛骨骼肌肉疼痛之有效性。多專業團隊意為團隊包括醫師會診、加上心理、社會、及或職能介入。

資料收集與分析

四位作者獨立進行資料摘錄。二位復建專家評估臨床相關及可用性,另二位專家以標準形式評估研究方法的品質。最後定性分析多專業團隊復健科學證據的等級之有效性。

主要結論

7個研究共1050病例符合納入條件包含於分析中,其中無一被認為是高等級隨機對照控制研究。4篇纖維肌痛症候群隨機對照控制研究被評為低品質。3篇廣泛骨骼肌肉疼痛隨機對照控制研究,基於有限的證據,並未觀察到有效性之證據。但行為治療及壓力處理似乎是重要成分。教育合併物理訓練有些正面效果。

作者結論

多專業團隊復健於工作年齡成人之纖維肌痛症候群及廣泛骨骼肌肉疼痛之有效性似乎少有科學證據。但多專業團隊復健常用於骨骼肌肉疼痛之復健,造成個人及社會經濟損失。此領域需進一步高品質研究。

翻譯人

本摘要由林口長庚醫院余光輝翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

非惡性腫瘤之骨骼肌肉疼痛的問題在西方國家逐漸增加。纖維肌痛症候群是逐漸被認識的慢性骨骼肌肉疼痛。本系統性回顧主要分析多專業團隊復健於工作年齡成人之纖維肌痛症候群及廣泛骨骼肌肉疼痛之有效性。本回顧對照試驗所納入的病人年齡為18 – 65歲。共7個研究,1050位病人被納入。多專業團隊復健的療效有限,對於纖維肌痛症候群與廣泛骨骼肌肉疼痛沒有呈現出可量化的療效。