Charles C. Engel, MD, MPH
Does tailored cognitive-behavioral therapy (CBT) plus exercise training (ET) improve physical and psychological outcomes in high-risk patients with fibromyalgia?
Cluster randomized controlled trial. ClinicalTrials.gov NCT00268606.
6 hospitals in the area of Nijmegen, The Netherlands.
158 patients ≥ 18 years of age (mean age 41 y, 94% women) who were diagnosed with fibromyalgia in the past 5 years and had high levels of distress (negative mood and/or anxiety) and dysfunction (pain, fatigue, functional disability, and effect on daily living). Exclusion criteria included severe physical or psychological comorbid conditions, current psychological treatments, fibromyalgia secondary to another rheumatic condition, and pregnancy.
CBT-ET, tailored to patients’ cognitive-behavioral pattern (pain persistence [PP] group, n = 39; pain avoidance [PA] group, n = 29) and given by cognitive-behavioral therapists and physiotherapists in 16 twice-weekly group sessions (CBT, 2 h, followed by ET, 2 h) with 1 booster session 3 months after treatment; or wait-list control (PP group, n = 45; PA group, n = 45).
Physical functioning, including pain (Impact of Rheumatic Diseases on General Health and Lifestyle [IRGL] pain scale), fatigue (Checklist Individual Strength fatigue scale), and functional disability (IRGL mobility scale); and psychological functioning, including negative mood (IRGL negative mood scale), anxiety (IRGL anxiety scale), and effect on daily life (Fibromyalgia Impact Questionnaire).
87% (intention-to-treat analysis).
Tailored CBT-ET reduced pain, fatigue, functional disability, negative mood, anxiety, and effect on daily living more than a wait-list condition (Table). The effect of CBT-ET for reducing pain was greater in the PA than in the PP group (P < 0.05 for interaction).
Tailored cognitive-behavioral therapy and exercise training improved physical and psychological functioning in fibromyalgia.
Tailored cognitive-behavioral therapy plus exercise training (CBT-ET) vs wait-list control (WLC) in high-risk patients with fibromyalgia†
†IRGL = Impact of Rheumatic Diseases on General Health and Lifestyle.
‡Positive effect size indicates decreased symptoms.
§For linear mixed-model analysis with posttreatment and 6-mo follow-up assessments as dependent variables.
||Author confirmed for posttreatment and 6-mo follow-up.
Charles C. Engel. Tailored cognitive-behavioral therapy plus exercise training improved clinical and functional outcomes in fibromyalgia. Ann Intern Med. 2011;154:JC4–8. doi: 10.7326/0003-4819-154-8-201104190-02008
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Published: Ann Intern Med. 2011;154(8):JC4-8.
Chronic Fatigue Syndrome/Fibromyalgia, Rheumatology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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