The Impact of a Group-Based Multidisciplinary Rehabilitation Program on the Quality of Life in Patients With Fibromyalgia

Results From the QUALIFIBRO Study

Herlinde Jacobs, MD; Martine Bockaert, MSc; Jan Bonte, MD; Mark D'Haese, MD; Jan Degrande, MD; Line Descamps, MSc; Ulrike Detaeye, MSc; Willem Goethals, MD; Jo Janssens, MSc; Koen Matthys, MD; Lieve Muller, MSc; Hilde Van deWalle, MSc; Ilse Viane, MSc; Barbara Vlieghe, MD; Michiel Grillet, MD; Rachael Asher, MSc; Bernard Grillet, MD, PhD,; Dirk De Bacquer, PhD

Disclosures

J Clin Rheumatol. 2020;26(8):313-319. 

In This Article

Abstract and Introduction

Abstract

Background and Objective: Patients with fibromyalgia (FM) have a substantially reduced health-related quality of life (HRQoL). Their management should preferably focus on multidisciplinary nonpharmacological interventions. However, the long-term impact of such multicomponent therapies is not fully established. Waiting lists for patients seeking medical treatment are long, making individual-based approaches often unfeasible. The aim of our pragmatic study was to evaluate long-term HRQoL benefits of a comprehensive 8-week group-based multidisciplinary rehabilitation program focusing on patients' coping ability and self-care.

Methods: A total of 94 patients with clinically confirmed FM agreed to participate in this study. Before entering the program based on group-based cognitive behavioral therapy and graded activity training, patients completed questionnaires to screen for comorbidities. Health-related quality of life was assessed at the start, at 8 weeks, 6 months, and 1 year using the 36-Item Short-Form Health Survey instrument. Changes in HRQoL scores were analyzed according to linear mixed regression modeling.

Results: Baseline findings confirmed the substantially low physical and mental HRQoL in FM patients as well as high levels of depression, anxiety, and burnout. Only 2 patients left the program prematurely; 89% participated in the 1-year assessment. By the end of the program, HRQoL was significantly improved in all domains. This effect was maintained at 6 months and 1 year for all subscales. Changes at 1 year were greater in younger patients and those with depressive feelings before the start of treatment.

Conclusions: Our group-based program offered to FM patients proved successful with significant improvements in their HRQoL both in the short and long term.

Introduction

Fibromyalgia (FM) is an incompletely understood syndrome characterized by chronic widespread pain and other symptoms such as fatigue, sleep disturbances, and cognitive problems.[1] Depending on the classification criteria applied, the prevalence of FM in the general population at middle age may be as high as 5%; the disease is associated with a substantial societal and economic burden.[1–3] Given their somatic and psychological complaints, FM patients report a reduced health-related quality of life (HRQoL).[4] It has been demonstrated that the HRQoL in FM patients is lower than that in patients with other chronic diseases such as rheumatoid arthritis.[5]

There is currently no criterion-standard treatment for FM. A comprehensive network meta-analysis came to the conclusion that the evidence about effective and clinically relevant pharmacological treatments for FM is scarse.[6] According to the recommendations of the European League Against Rheumatism, management of FM patients should primarily focus on nonpharmacological modalities.[7] There is indeed accumulated evidence demonstrating the value of nonpharmacological interventions such as cognitive behavioral therapy (CBT), patient education, aerobic exercise, and strength training for reducing pain and improving quality of life in these patients.[8–11] A meta-analysis has indicated that multicomponent treatment, based on a combination of at least 1 educational or other psychological therapy with at least 1 exercise therapy, may be beneficial in the management of FM.[12] However, there is conflicting evidence as to what extent the benefits of monotherapeutic or multicomponent therapies are sustained over the long term.[13,14] This may partly be due to the comorbid conditions seen in individuals with FM such as anxiety, depression, and burnout.

Because of its high prevalence, waiting lists for patients seeking medical treatment are long. Individually tailored programs usually require considerable time and effort. Group-based approaches have proven to be successful in chronic diseases such as diabetes and are potentially more cost-effective than strictly individualized treatment programs.[15] Through educational group sessions, patients may learn to better put the disease into perspective and develop appropriate skills for self-management, may feel empowered in coping with their condition, and benefit from peer support. According to a study of semistructured focus group interviews, FM patients participating in a group-based rehabilitation program indeed experienced the acceptance and support from peers as particularly beneficial for enhancing self-efficacy and their coping ability with the disease.[16]

The aim of our pragmatic study, carried out in real-world clinical practice, was to evaluate both the short- and long-term benefits of a comprehensive 8-week multidisciplinary rehabilitation program based on group-based CBT and graded activity training, in terms of the HRQoL of patients with confirmed FM. In addition, we investigated the role of psychosocial factors and personality traits on patients' HRQoL with a particular focus on pain coping mechanisms.

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