ContentList volumes - List articles in this issue
Effect of a fibromyalgia rehabilitation programme in warm versus cold climate: A randomized controlled study
OBJECTIVE: To study the long-term effects on symptoms and physical function of a 4-week rehabilitation programme for patients with fibromyalgia, and to determine whether there are any differences if this programme is applied in a warm or cold climate.
METHODS: A total of 132 patients with fibromyalgia were randomized to a rehabilitation programme in a warm or cold climate, or to a control group without intervention. Assessments were performed before and after intervention, and after 3 and 12 months. The main outcome measures were pain, measured by tender point count (TPC), and physical function, measured with the 6-min walk test (6MWT).
RESULTS: There was no difference in any outcome variables at baseline. Persistent reduction in pain measured by TPC occurred only in the warm climatic setting. Mean difference (95% confidence interval (CI)) in TPC between warm and cold climate groups 1 year after the intervention was –1.7 (–2.9 to –0.5) and between the warm climate and the control group –2.2 (–3.3 to –1.0). Three months after the intervention the mean difference between the warm and cold climate groups in pain distribution (McGill mannequin) was –12 (–20 to –5) and between the warm climate and the control group –11 (–18 to –3). There were comparable improvements in physical function (6MWT) between the 2 intervention groups and the control group. The mean difference (95% CI) in 6MWT 1 year after the intervention between the warm climate and the control group was 33 (7–59) m. The corresponding value between the cold climate and the control group was 29 (3–55) m. Grip Strength (95% CI) was increased by 4.6 kg (2.3–6.4) in the warm climate and by 3.2 kg (0.9–5.5) in the cold climate compared with the control group 1 year after the intervention.
CONCLUSION: A rehabilitation programme for fibromyalgia may have a long-term effect on pain, as measured by TPC and pain distribution, when applied in a warm climatic setting, and may improve physical function regardless of the climatic setting.
Anne-Cathrine Clarke-Jenssen, Anne Marit Mengshoel, Yndis Staalesen Strumse, Karin Øien Forseth
Department of Orthopedics, Oslo University Hospital, Rikshospitalet, NO Oslo, Norway. E-mail: email@example.com
2. Mannerkorpi K, Svantesson U, Broberg C. Relationships between performance-based test and patients’ rating of activity limitations, Self-efficacy and pain in fibromyalgia. Arch Phys Med Rehabil 2006; 87: 259–264.
3. Staud R. Biology and therapy of fibromyalgia: pain in fibromyalgia syndrome. Arthrit Res Ther 2006; 8: 208–215.
4. Carville SF, Arendt-Nielsen S, Bliddal H, Blotman F, Branco JC, Buskila D, et al. EULAR evidence-based recommendations for the management of fibromyalgia. Ann Rheum Dis 2008; 67: 536–541.
5. Burckhardt CS. Multidisciplinary approaches for management of fibromyalgia. Curr Pharmaceut Des 2006; 12: 59–66.
6. Häuser W, Bernardy K, Arnold B, Offenbächer M, Schiltenwolf M. Efficacy of multicomponent treatment in fibromyalgia syndrome: a meta-analysis of randomized controlled clinical trials. Arthritis Care Res 2009; 61: 216–224.
7. Forseth K, Hafstøm I, Husby G, Opava C. Comprehensive rehabilitation of patients with rheumatic diseases in warm climate. A literature review. J Rehabil Med 2010; 4: 897–902.
8. Hafstrøm I, Hallengren M. Physiotherapy in subtropics climate improves functional capacity and health related quality in Swedish patients with rheumatoid arthritis and spondylarthropaties after 6 months. Scand J Rheumatol 2003; 32: 108–113.
9. Aikman H. The association between arthritis and the weather. Int J Biometeorol 1997; 40: 192–199.
10. Zijlstra TR, van de Laar MA, Bernelot Moens HJ, Taal E, Zakraoui L, Rasker JJ. Spa treatment for primary fibromyalgia syndrome: a combination of thalassotherapy, exercise and patient education improves symptoms and quality of life. Rheumatol (Oxford) 2005; 44: 539–546.
11. Forseth KO, Mengshoel AM. Multidimensional therapy in warm climate for patients with fibromyalgia syndrome – a pilot study. J Musculoskel Pain 2004; 15: 47.
12. Aalen O. [Statistical methods in medicine and health science.] Oslo: Gyldendal Norske Forlag; 2006 (in Norwegian).
13. Perera S, Mody S, Woodman R, Studenski S. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc 2006; 54: 743–749.
14. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 Criteria for the Classification of Fibromyalgia. Report of the Multicenter Criteria Committee. Arthritis Rheum 1990; 33: 160–172.
15. Mengshoel AM, Vøllestad NK, Førre Ø. Pain and fatigue induced by exercise in fibromyalgia patients and sedentary healthy subjects. Clin Exp Rheumatol 1995; 477–482.
16. van Santen M, Bolwijn P, Landewe R, Verstappen F, Bakker C, Hidding A, et al. High or low intensity aerobic fitness training in fibromyalgia: does it matter? J Rheumatol 2002; 29: 582–587.
17. Busch AJ, Schachter CL, OverendT J, Peloso PM, Barber KA. Exercise for fibromyalgia: a systematic review. J Rheumatol 2008; 35: 1130–1144.
18. Dadabhoy D, Crofford L, Spaeth M, Russell IJ, Clauw DJ. Evidence-based biomarkers for fibromyalgia syndrome. Arthrit Res Ther 2008; 10: 211–229.
19. Carville S, Choy E. Systematic review of discriminating power of outcome measure used in clinical trials of fibromyalgia. J Rheumatol 2008; 35: 2094–2105.
20. American Thoracic Society. ATS Statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166: 111–117.
21. Staalesen Strumse Y, Nordvåg B-Y, Stanghelle J, Røisland M, Winter A, Pajunen P-A, et al. The efficacy of rehabilitation for patients with rheumatoid arthritis: comparison between a 4 week rehabilitation programme in warm and cold climate. Scand J Rheumatol 2009; 38: 28–37.
22. King J, Wessel J, Bhambhani Y, Maikala D, Sholter D, Maksymowych W. Validity and reliability of the 6 minute walk in persons with fibromyalgia. J Rheumatol 1999; 26: 2233–2237.
23. Pankoff B, Overend T, Lucy S, White K. Reliability of the six minutes walk test for people with fibromyalgia. Arthritis Care Res 2000; 13: 291–295.
24. Burckhardt CS, Clark SR, Bennett RM. The Fibromyalgia Impact Questionnaire: development and validation. J Rheumatol 1991; 18: 728–734.
25. Hedin P, Hamne C, Burckhardt C, Engstöm-Laurent A. The Fibromyalgia Impact Questionnaire, a Swedish translation of a new tool for evaluation of the fibromyalgia patient. Scand J Rheumatol 1995; 24: 69–75.
26. Melzack R. The short-form McGill Pain Questionnaire. Pain 1987; 30: 191–197.
27. van den Hoven, LH, Gorter K, Picavet S. Measuring musculoskeletal pain by questionnaires: the manikin versus written questions. Eur J Pain 2009; 14: 335–338.
28. Lorig K, Chastain RL, Ung E, Shoor S, Holman HR. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum 1989; 32: 37–44.
29. Lomi C, Burckhardt C, Nordholm L, Bjelle A, Ekdahl C. Evaluation of a Swedish version of the Arthritis Self-efficacy Scale in people with fibromyalgia. Scand J Rheumatol 1995; 24: 282–287.
30. Ware JE, Sherbourne CD. The SF-36 health status survey: I. Conceptual framework and item selection. Med Care 1992; 30: 473–483.
31. Mease PJ. Fibromyalgia syndrome: review of clinical presentation, pathogenesis, outcome measures and treatment. J Rheumatol 2005; 32: 6–21.
32. Zigmond A, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67: 361–370.
33. Gill D, Reddon J, Renney C, Stefanyk W. Hand dynamometer: effect of trials and sessions. Perpet Motor Skill 1985; 61: 195–198.
34. Mannerkorpi K, Hernelid C. Leisure time physical activity instrument and physical activity at home and work instrument. Development, face validity, construct validity and test-retest reliability for subjects with fibromyalgia. Disabil Rehabil 2005; 27: 695–701.
35. Philadelphia Panel Members. Philadelphia Panel Evidence-Based Clinical Practice Guidelines on Selected Interventions: overview and methodology. Phys Ther 2001; 81: 1629–1640.
36. Strusberg I, Mendelberg RC, Serra HA, Strusberg AM. Influence of weather conditions on rheumatic pain. J Rheumatol 2002; 29: 335–338.
37. Straube S, Moore A, Derry S, McQuay H. Vitamin D and chronic pain. Pain 2009; 141: 10–13.
38. du Bois R, Weycker D, Albera C, Bradford W, Costabel U, Kartashov A, et al. Six-minute-walk test in idiopathic pulmonary fibrosis: test validation and minimal clinical important difference. Am J Respir Crit Care Med 2011; 183: 1231–1237.
39. Haskell W, Lee I, Pate R, Powell K, Blair S, Franklin B, et al. Physical activity and public health. Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 2007; 116: 1081–1093.
40. Gowans SE, deHueck A. Effectiveness of exercise in management of fibromyalgia. Curr Opin Rheumatol 2004; 16: 138–142.
41. Wood L, Egger M, Gluud L, Schulz K, Jüni P, Altman D, et al. Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: a meta-epidemiological study. BMJ 2008; 336: 601–605.
View at PubMed