Pain Research and Management

Pain Research and Management / 2017 / Article

Review Article | Open Access

Volume 2017 |Article ID 7261468 | https://doi.org/10.1155/2017/7261468

Emanuele Maria Giusti, Gianluca Castelnuovo, Enrico Molinari, "Differences in Multidisciplinary and Interdisciplinary Treatment Programs for Fibromyalgia: A Mapping Review", Pain Research and Management, vol. 2017, Article ID 7261468, 19 pages, 2017. https://doi.org/10.1155/2017/7261468

Differences in Multidisciplinary and Interdisciplinary Treatment Programs for Fibromyalgia: A Mapping Review

Academic Editor: Manfred Harth
Received16 Feb 2017
Accepted19 Apr 2017
Published23 May 2017

Abstract

Fibromyalgia is a multifaceted chronic pain syndrome and the integration of different health disciplines is strongly recommended for its care. The interventions based on this principle are very heterogeneous and the difference across their structures has not been extensively studied, leading to incorrect conclusions when their outcomes are pooled. The objective of this mapping review was to summarize the characteristics of these programs, with particular focus on the integration of their components. We performed a search of the literature about treatments for fibromyalgia involving multiple disciplines on PubMed and Scopus. Starting from 560 articles, we included 22 noncontrolled studies, 10 controlled studies, and 17 RCTs evaluating the effects of 38 multidisciplinary or interdisciplinary interventions. The average quality of the studies was low. Their outcomes were usually pain intensity, quality of life, and psychological variables. We created a map of the programs based on the degree of integration of the included disciplines, which ranged from a juxtaposition of few components to a complex harmonization of different perspectives obtained through teamwork strategies. The rehabilitation programs were then thoroughly described with regard to the duration, setting, therapeutic components, and professionals included. The implications for future quantitative reviews are discussed.

1. Introduction

Fibromyalgia is a chronic pain condition of unknown etiology which affects mainly women and is characterized by stiffness, fatigue, disturbed sleep, cognitive impairment, and psychological distress, posing a significant threat to the quality of life of affected individuals [13]. The complex features of the syndrome and its various symptoms are partially explained by central sensitization processes that interact with psychological and social factors, leading to a phenomenon where the impact of each component is multiplied and acts in a synergic manner [4, 5]. Given its multifaceted nature and the poor efficacy of standard medical interventions, the integration of different health disciplines for its understanding and for the development of specific treatments has long been advocated [610]. As a result, a large number of interventions combining techniques drawn from different fields (e.g., medicine, psychology, and physical therapy) have been developed and have proven to be effective for the improvement of the various symptoms of the syndrome [1115]. Nonetheless, these programs are very heterogeneous in terms of duration, objectives, setting, format, therapeutic components, and professionals involved. This great variability is reflected by different organizational frameworks of the pain treatment facilities and casts some doubt on the possibility of pooling the results of trials evaluating their interventions [16, 17]. The composition of the rehabilitation teams and the integration between their members seem to be especially important in distinguishing the various programs, since there is a wide difference with regard to how their various disciplines are harmonized, combined, or juxtaposed. Conversely, terms such as “multimodal,” “multicomponent,” “multidisciplinary,” and “interdisciplinary” are often used as synonyms [18, 19]. From a theoretical point of view, the difference between these concepts is substantial. The terms “multimodal” and “multicomponent” have not received yet a clear definition. Multimodality generally refers to the combination of multiple therapeutic components, not necessarily provided by different operators. The expression “multicomponent treatments” indicates the presence of interventions provided by different team members, without clarifying how they are integrated [20]. Conversely, the other two terms define how these components are combined. Multidisciplinarity refers to the addition of the competencies of multiple professionals who stay within the boundaries of their fields, whereas interdisciplinarity denotes that the various disciplines are coordinated toward a common and coherent approach [19]. Multidisciplinary and interdisciplinary treatments are therefore conceptually different and this difference should be reflected in their structures. Especially in the case of programs addressing a complex disorder, such as the fibromyalgia syndrome, this issue must be taken into account for the sake of a critical appraisal of the literature, which can be a preliminary step for quantitative synthesis. The objective of this review of the literature is therefore to describe, map, and summarize the characteristics of treatments for fibromyalgia involving multiple health disciplines, with a focus on how these disciplines are integrated.

2. Methods

A mapping review of the literature was performed. Mapping reviews usually aim to retrieve, catalog, and map all the evidence about a research topic [21, 22]. We adapted their methodological design in order to use rehabilitation programs as units of analysis. Therefore, instead of investigating the characteristics and the results of the included papers, we focused on the information about the interventions that were described.

We conducted a comprehensive search in PubMed and Scopus of all the available original research reports describing and evaluating multidisciplinary, interdisciplinary, or multicomponent interventions for fibromyalgia up to April 2016. We used these keywords in both databases: fibromyalgia, multidisciplinary, interdisciplinary, multicomponent, and integrated treatments. The studies were scanned according to the inclusion (description and evaluation of a multicomponent intervention involving at least two operators from different disciplines, fibromyalgia as primary diagnosis, and English language) and exclusion (review as publication type, single-case studies, and workplace interventions) criteria. Since our aim was to describe the various treatment programs and we were not interested in a quantitative evaluation of their outcomes, we included both RCTs, nonrandomized trials and noncontrolled trials. We also included studies evaluating outcome predictors, if they provided data about the effects of the interventions. A first scanning was based only on the titles and the abstracts of the retrieved research articles. After this first step, the full text of the remaining papers was accessed and we assessed the methodological quality of the studies. Since we included both controlled and noncontrolled trials, we adapted the SIGN checklist for randomized controlled trials [23] adding four items from the Downs and Black Checklist [24] (i.e., use of appropriate analyses, assessment of confounders, use of a representative sample, and intervention integrity) (Table 1). We used its scores to rate the studies as of “high,” “medium,” “low,” and “insufficient” quality. Questions from 2 to 6 were not considered during the evaluation of noncontrolled studies.


(1)The study addresses an appropriate and clearly focused question.
(2)The assignment of subjects to treatment groups is randomized.
(3)An adequate concealment method is used.
(4)The design keeps subjects and investigators “blind” about treatment allocation.
(5)The treatment and control groups are similar at the start of the trial.
(6)The only difference between groups is the treatment under investigation.
(7)All relevant outcomes are measured in a standard, valid, and reliable way.
(8)Were the statistical tests used to assess the main outcomes appropriate?
(9)Were those subjects who were prepared to participate representative of the entire population from which they were recruited?
(10)What percentage of the individuals recruited into each treatment arm of the study dropped out before the study was completed?
(11)Are all the subjects analyzed in the groups to which they were randomly allocated (application of an intention-to-treat analysis)?
(12)Where the study is carried out at more than one site, results are comparable for all sites.
(13)Are the distributions of principal confounders in each group of subjects to be compared clearly described?
(14)How well was the study done to minimize bias?
(15)Is the overall effect due to the study intervention?

Note. During the assessment of noncontrolled studies, items from (2) to (6) were not considered.

We then employed a specifically created data extraction sheet to retrieve all the available information about number of study participants, dropout, professionals involved in the treatment, group/individual setting, inpatient/outpatient format, duration, components of the interventions, and treatment outcomes. When possible, we tried to locate and report the information about how the different disciplines are integrated with each other, in order to provide a brief outline of the program. In case of unclear or missing information, we initially tried to locate other descriptions consulting other studies of the same authors. If no other relevant studies were found, we tried to contact the authors of the articles and we asked them for additional information. All the data about the treatments were finally inserted in a MS Excel spreadsheet and were used to map the included interventions.

3. Results

3.1. Study Selection and Characteristics

The initial database search identified 560 records, of which 90 were selected for a full-text examination. The final database included 49 papers describing 38 different interventions that were administered to a total of 6013 subjects (Figure 1).

We found 22 papers describing noncontrolled studies, 10 describing controlled studies, and 17 describing RCTs (Table 2). The majority of the articles mainly reported the effects of a multicomponent treatment, whereas six papers mainly reported analyses on outcome predictors, one trial compared two multidisciplinary treatments, and three trials evaluated the effects of adding a treatment component to existing multidisciplinary treatments. The average methodological quality of the studies was low; 3 noncontrolled trials, 5 controlled trials, and 10 RCTs were rated as of medium quality and 6 studies were rated as of high quality. Their outcomes were usually pain intensity, psychological variables (such as anxiety, depression, distress, pain catastrophizing, coping skills, and self-efficacy), quality of life, and improvement in the overall score of the Fibromyalgia Impact Questionnaire.


ReferenceCountryDesignType of studyComparison groupSubjects (dropout)OutcomesOverall quality

Åkerblom et al., 2015 [25]SwedenNoncontrolled studyOutcome predictorsN/A409 (145)Pain, psychological factors, pain interferenceMedium
Amris et al., 2014 [26]NetherlandsRCTComparison with controlWL191 (21)QOL, pain, psychological factors, FIQ, movementHigh
Anderson and Winkler, 2006 [27]USControlled trialComparison with controlTAU98 (5)QOL, pain, psychological factors, FIQ, tender pointsLow
Angst et al., 2006 [28] SwitzerlandNoncontrolled studyComparison with controlTAU225 (100)QOL, pain, pain interference, psychological factorsLow
Angst et al., 2009 [29]Controlled trialPre-post evaluationTAU331 (121)QOL, pain, psychological factorsLow
Bailey et al., 1999 [30]CanadaNoncontrolled studyPre-post evaluationN/A149 (43)Pain, pain interference, psychological factors, FIQ, physical fitnessLow
Bourgault et al., 2015 [31]CanadaRCTComparison with controlWL58 (15)QOL, pain, psychological factors, pain interference, FIQ, perception of improvementMedium
Carbonell-Baeza et al., 2011 [32] SpainControlled trialComparison with controlTAU + education75 (10)Tender points count, pain threshold, physical fitness, BMIMedium
Carbonell-Baeza et al., 2011 [33]Controlled trialComparison with controlTAU + education75 (10)QOL, pain, psychological factors, FIQMedium
Carbonell-Baeza et al., 2012 [34]Controlled trialComparison with additional treatmentBiodanza38 (7)QOL, pain, psychological factors, FIQ, physical fitness, tender pointsMedium
Casanueva-Fernández et al., 2012 [35]SpainRCTComparison with controlTAU + education34 (6)QOL, pain, psychological factors, FIQ, fatigue, sleep, tender points count, pain threshold, physical fitnessMedium
Castel et al., 2013 [36]SpainRCTComparison with controlTAU155 (28)Pain, psychological factors, FIQ, sleepHigh
Cedraschi et al., 2004 [37]SwitzerlandRCTComparison with controlWL164 (35)QOL, pain, psychological factors, FIQ, tender points count, satisfactionHigh
De Rooij et al., 2013 [38]NetherlandsNoncontrolled studyOutcome predictorsN/A138 (18)Pain, psychological factors, pain interference, perception of improvementLow
Gustafsson et al., 2002 [39]SwedenControlled trialComparison with controlTAU43 (2)Movement, pain drawings, pain, QOL, pain interferenceLow
Hammond and Freeman, 2006 [40]UKRCTComparison with controlRelaxation training183 (80)FIQ, psychological factors, physical activity, healthcare use, perception of improvementMedium
Hamnes et al., 2012 [41]NorwayRCTComparison with controlWL147 (29)Psychological factors, FIQ, care-management skillsMedium
Hooten et al., 2007 [42] USNoncontrolled studyComparison between male and femaleN/A66 (7)QOL, pain, psychological factors, pain interference, drug usageLow
Hooten et al., 2007 [43]Noncontrolled studyPre-post evaluationN/A159 (17)QOL, pain, pain interference, activity, psychological factorsLow
Kas et al., 2015 [44]USControlled trialComparison with additional treatmentMultidisciplinary + increased exercise79 (0)FIQMedium
Keel et al., 1998 [45]SwitzerlandRCTComparison with controlRelaxation training32 (5)Pain, psychological factors, sleep, changes in drug treatment, satisfactionLow
Kroese et al., 2009 [46]NetherlandsNoncontrolled studyPre-post evaluationN/A105 (5)FIQ, QOL, satisfactionLow
van Eijk-Hustings et al., 2013 [47]RCTComparison with controlAerobic exercise and TAU203 (69)QOL, activity, FIQ, healthcare use, sick leaveMedium
Lemstra and Olszynski, 2005 [48]CanadaRCTComparison with controlFamily physician79 (8)Pain, pain interference, psychological factorsHigh
Lera et al., 2009 [49]SpainRCTComparison with additional treatmentMultidisciplinary + CBT83 (27)QOL, FIQ, psychological factors, tender points countHigh
Marcus et al., 2014 [50]USNoncontrolled studyPre-post evaluationN/A274 (67)Pain, ADL, movement, FIQLow
Martìn et al., 2012 [51] SpainRCTComparison with controlPharmacotherapy180 (70)QOL, pain, psychological factors, pain interference, FIQ, satisfactionMedium
Martìn et al., 2014 [52]RCTComparison with controlPharmacotherapy180 (70)FIQ, psychological factors, satisfactionMedium
Martìn et al., 2014 [53]RCTComparison with controlPharmacotherapy180 (70)FIQMedium
Martìn et al., 2014 [54]RCTComparison with controlPharmacotherapy180 (70)Pain, FIQMedium
Martins et al., 2014 [55]BrazilControlled trialComparison with controlTAU27 (0)QOL, pain, psychological factors, FIQ, sleepLow
Mengshoel et al., 1995 [56]NorwayNoncontrolled studyPre-post evaluationN/A16 (3)Pain, fatigue, sleep, adjustments of daily lifeLow
Michalsen et al., 2013 [57]GermanyControlled trialComparison with additional treatmentOther multidisciplinary treatments48 (6)Pain, psychological factors, FIQ, sleep, BMIMedium
Nielson and Jensen, 2004 [58]CanadaNoncontrolled studyOutcome predictorsN/A253 (55)QOL, pain, psychological factors, pain interference, activityMedium
Persson et al., 2012 [59]SwedenNoncontrolled studyPre-post evaluationN/A813 (304)Pain, psychological factors, pain interference, activityLow
Ripley et al., 2003 [60]USNoncontrolled studyPre-post evaluationN/A21 (0)Pain, psychological factors, FIQ, fatigue, sleep, comorbiditiesLow
Romeyke et al., 2014 [61]AustriaControlled trialComparison with controlMultidisciplinary + hyperthermia104 (0)Pain, chronic pain stage, severity of symptoms, pain interferenceLow
Salgueiro et al., 2013 [62]SpainNoncontrolled studyOutcome predictorsN/A72 (0)Pain, FIQ, QOL, psychological factorsLow
Saral et al., 2016 [63]TurkeyRCTComparison with controlLong term versus short term versus no treatment66 (7)QOL, pain, psychological factors, FIQ, fatigue, sleep, tender points count, pain threshold, physical functioningMedium
Stein and Miclescu, 2013 [64]SwedenNoncontrolled studyPre-post evaluationN/A59 (8)Pain, psychological factors, QOL, sick leave duration, healthcare use, drug usageLow
Suman et al., 2009 [65]ItalyNoncontrolled studyPre-post evaluationN/A25 (0)Pain, psychological factors, tender points count, pain thresholdLow
Turk et al., 1998 [66]USNoncontrolled studyPre-post evaluationN/A70 (3)Pain, psychological factors, pain interference, FIQ, disability, marital satisfactionMedium
Van Koulil et al., 2011 [67]NetherlandsRCTComparison with controlWL158 (45)Physical fitnessHigh
van Wilgen et al., 2007 [68]NetherlandsNoncontrolled studyPre-post evaluationN/A65 (0)QOL, pain, psychological factors, FIQ, physical fitnessLow
Wennemer et al., 2006 [69]USNoncontrolled studyPre-post evaluationN/A23 (3)QOL, FIQ, movementLow
Worrel et al., 2001 [70] USNoncontrolled studyPre-post evaluationN/A100 (26)Pain, psychological factors, FIQ, pain interference, sleep, fatigueLow
Pfeiffer et al., 2003 [71]Noncontrolled studyPre-post evaluationN/A100 (22)QOL, FIQ, psychological factorsLow
Oh et al., 2010 [72]Noncontrolled studyPre-post evaluationN/A984 (463)QOL, FIQ, satisfactionLow
Vincent et al., 2013 [73]Noncontrolled studyPre-post evaluationN/A7 (0)QOL, FIQ, psychological factors, fatigueLow

3.2. Multidisciplinary and Interdisciplinary Programs

Among the studies included in the review, the terms “multimodal” and “multicomponent” were rarely employed and were never used as primary descriptors of the structure of the interventions, whereas 25 treatments were defined as “multidisciplinary” and 11 as “interdisciplinary.” However, there was not a clear distinction between these concepts. In some cases, the terms were used interchangeably or were incorrectly employed (e.g., [71, 73] or [62]). More generally, the programs were very heterogeneous with regard to the strategies that were employed to integrate the different perspectives of the operators and can be mapped in a continuum which starts with multidisciplinary treatments involving few disciplines whose components are simply added and ends with more complex interventions that are based on a coordinated assessment and care (see Figure 2).

Most of the treatments were based on various components that were juxtaposed, so that the patient met the different health operators in different moments of the program in a standardized manner. A few interventions were more flexible and allowed the operators to tailor the programs, in terms of number and intensity of the therapeutic components, to the needs and characteristics of the patients. More integrated approaches were organized so that some or the majority of the treatment sessions were led by two or more professionals jointly. In other cases, weekly team meetings were planned to discuss the patients, allowing a constant dialog between the operators. This could be added to other strategies, such as providing education about interdisciplinary work or tailoring the various components to the patients, in order to provide more effective integration of the different disciplines.

3.3. Description of the Interventions

The main characteristics of the interventions are reported in Table 3. Most of the programs were based on an outpatient setting; only five intensive treatments were provided in hospital inpatient services. Only four programs were mainly administered individually, six interventions included both group and individual activities, and the other 28 treatments were mainly group-based. There was a great variety with regard to the duration and the intensity of the interventions. The median duration was 7 weeks, but there were both very brief treatments lasting for less than a week (e.g., [70]) and very long treatments lasting for one year (e.g., [27]). With regard to the intensity, there were both intensive programs (e.g., [28]) and interventions including less than twelve hours of therapies (e.g., [70]), with a median of 42 hours of treatment.


ReferenceApproachFormatSettingWeeksHoursProfessionalsTherapeutic componentsNotes

Åkerblom et al., 2015 [25]MultidisciplinaryGroupOutpatient5126Psychologist, physician, physiotherapist, occupational therapist, social workerEducation, exercise, CBT, pain management techniques, relaxation, occupational therapyProgram for chronic pain rehabilitation based on a CBT framework. The group sessions are jointly conducted. The patient’s caregiver is involved. Includes a follow-up intervention.

Amris et al., 2014 [26]InterdisciplinaryGroupOutpatient235Psychologist, physician, nurse, physiotherapist, occupational therapistEducation, exercise, group discussion, pain management techniquesScheduled team conferences, with a session jointly conducted by the psychologist and the rheumatologist.

Anderson and Winkler, 2006 [27]MultidisciplinaryIndividualOutpatient48N/APsychologist, physician, nurse, physiotherapist, dietitian, aquatic fitness instructorEducation, land and pool exercise, auricular therapy, microcurrent therapy, CBT, massage, nutritional counselingProgram based on three phases with different treatment intensities. The various components are juxtaposed.

Angst et al., 2006 [28] 
Angst et al., 2009 [29]
InterdisciplinaryBothInpatient4100Psychologist, physician, nurse, physiotherapist, occupational therapist, Qi-gong instructor, creative and humor therapistsEducation, exercise, group discussion, CBT, pain management techniques, Qi-gong, humor therapyBased on the integration of traditional and Chinese medicine, exercise and physiotherapy, and different psychotherapeutic methods. The team received education on interdisciplinary work and participates in weekly meetings.

Bailey et al., 1999 [30]InterdisciplinaryGroupOutpatient1272Physiotherapist, occupational therapist, social worker. The team is supported by pharmacist, dietitian, kinesiologistEducation, exercise, discussion, pain management techniquesBased on exercise and education, performed by an interdisciplinary group and a supporting group; patients can access the members of the teams.

Bourgault et al., 2015 [31]InterdisciplinaryGroupOutpatient1122,5Physician, facilitator expert in the psychological area and facilitator expert in the physical areaEducation, exercise, group discussion, pain management techniques based on CBTBased on interactive sessions jointly conducted by the two operators, who are described as “facilitators.” The exercises and psychological components are tailored to the single patient.

Carbonell-Baeza et al., 2011 [32] 
Carbonell-Baeza et al., 2011 [33] 
MultidisciplinaryGroupOutpatient12 45 Psychologist, physiotherapist, fitness specialistEducation, exercise, Acceptance and Commitment Therapy, pain management techniques, massageThe program is based on exercise and education; the exercise sessions are supervised by both a physiotherapist and a fitness specialist.
Carbonell-Baeza et al., 2012 [34]1660

Casanueva-Fernández et al., 2012 [35]MultidisciplinaryIndividualOutpatient88The team is not describedEducation, exercise, ischemic pressure, massage, thermal therapyThe medical treatment is associated with a program of education and physical treatments.

Castel et al., 2013 [36]MultidisciplinaryGroupOutpatient1248Psychologist, physiotherapistExercise, CBTThe pharmacologic treatment is accompanied by CBT and physical therapy.

Cedraschi et al., 2004 [37]MultidisciplinaryGroupOutpatient618Physician, physiotherapist, occupational therapistEducation, pool and land exercise, group discussion, pain management techniquesThe program is based on the patient’s self-management of his/her symptoms. The educational sessions are conducted by the whole multidisciplinary team.

De Rooij et al., 2013 [38]MultidisciplinaryBothOutpatient749Psychologist, physician, physiotherapist, occupational therapist, social workerEducation, exercise, CBT, pain management techniquesThe program is tailored to the patient’s goals and regular meetings are scheduled to facilitate team discussions.

Gustafsson et al., 2002 [39]MultidisciplinaryGroupOutpatient12104Physician, nurse, physiotherapist, occupational therapist, social workerEducation, exercise, group discussion, pain management techniquesThe education component is jointly administered by the nurse and the physiotherapist. At the end of the program, the team members meet at a conference the patient, his employer, and the local insurance officer to discuss the treatment plan.

Hammond and Freeman, 2006 [40]Education-exercise programGroupOutpatient1020Physiotherapist, occupational therapistEducation, exerciseEducation is also based on self-management. The program is administered by either the physiotherapist or the occupational therapist, whereas the other one acts as a supervisor.

Hamnes et al., 2012 [41]MultidisciplinaryGroupInpatient170Physician, nurse, physiotherapist, occupational therapist, social worker, dietitianEducation, exercise, group discussion, pain management techniques based on cognitive-behavioral principles, nutritional counselingComplex and intensive treatment based on self-management, with involvement of the patient’s partner. The different therapeutic components are juxtaposed.

Hooten et al., 2007 [42] 
Hooten et al., 2007 [43]
MultidisciplinaryBothOutpatient3150Psychologist, mental health therapist, physician, physiotherapist, occupational therapist, nurse, chemical dependency counselorsEducation, exercise, CBT, pain management techniques based on a cognitive-behavioral framework, biofeedback, relaxation, opioid discontinuationDescription of the treatment found in the research by Townsend et al., 2008 [74]. The team includes a large number of operators from various disciplines. Gradual withdrawal from opioids under the supervision of the physician.

Kas et al., 2015 [44]MultidisciplinaryIndividualOutpatient1025–40Psychologist, physician, physiotherapist, occupational therapistAerobic and strengthening exercise, CBT/Acceptance and Commitment Therapy, biofeedback, occupational therapyThe study evaluates the effects of adding strength exercises to an existing multidisciplinary treatment. The various components are juxtaposed.

Keel et al., 1998 [45]Integrated treatmentGroupOutpatient1530Physiotherapist, psychologist, psychiatristExercise, education, pain management strategies, relaxation, discussionIntegrated psychological group treatment based on self-management. The sessions are jointly led by the operators.

Kroese et al., 2009 [46] MultidisciplinaryGroupOutpatient12 108 Psychologist, physiotherapist, occupational therapistEducation, exercise, group discussion, pain management techniques, sociotherapy, creative arts therapyPhysicians are not involved in order to prevent the medicalization of the syndrome. Five aftercare meetings are scheduled to prevent relapses. Based on the patient’s needs, more intensive therapeutics could be added.
van Eijk-Hustings et al., 2013 [47]12 + aftercare108

Lemstra and Olszynski, 2005 [48]MultidisciplinaryGroupOutpatient624Physician, psychologist, physiotherapist, massage therapist, dietitianExercise, pain management techniques, education, massageThe program includes rheumatologist and physical therapist intake, group exercise and education, individual massage therapy sessions, and rheumatologist and physical therapist discharge.

Lera et al., 2009 [49]MultidisciplinaryGroupOutpatient1614Physician, physiotherapist, rehabilitation practitioner, additional group: psychologistEducation, exercise, additional group: CBTSupported by an individual medical treatment, four of the fourteen sessions are jointly conducted by the rheumatologist and a rehabilitation practitioner.

Marcus et al., 2014 [50]MultidisciplinaryGroupOutpatient636–48Psychologist, physician, physiotherapist, occupational therapistEducation, exercise, CBT, pain management techniquesMainly based on education, exercise, and the development of pain management skills.

Martìn et al., 2012 [51] 
Martìn et al., 2014 [52] 
Martìn et al., 2014 [53] 
Martìn et al., 2014 [54]
InterdisciplinaryGroupOutpatient621Psychologist, physician, physiotherapistEducation, exercise, CBT, pain management techniques, massageThe psychological, medical, educational, and physiotherapeutic approaches are coordinated; however, there is no information about this process.

Martins et al., 2014 [55]InterdisciplinaryGroupOutpatient1212Psychologist, physician, physiotherapist, occupational therapist, social workerEducation, exercise, pain management techniques based on cognitive-behavioral principlesIt is unclear how the operators are integrated.

Mengshoel et al., 1995 [56]MultidisciplinaryGroupOutpatient1020Physician, physiotherapist, dietitianEducation, exercise, group discussionBased on lessons and exercise sessions jointly conducted by two team members.

Michalsen et al., 2013 [57]MultidisciplinaryGroupInpatient2N/APsychologist, physician, physiotherapistLand and pool exercise, thermal therapy, CBT, education, additional group: fasting and nutritional therapyIntensive programs; the components are juxtaposed.

Nielson and Jensen, 2004 [58]MultidisciplinaryBothOutpatient4N/APsychologist, physician, physiotherapist, occupational therapistEducation, exercise, CBT, occupational therapy, opioid taperingAimed at improving pain management skills and physical and psychological functioning, based on a cognitive-behavioral model.

Persson et al., 2012 [59]InterdisciplinaryBothOutpatient5150Psychologist, physician, nurse, physiotherapist, occupational therapist, social workerEducation based on cognitive-behavioral principles, exercise, group discussion, biofeedback, pain management techniquesBased on teamwork, each operator is educated about the tools of all the disciplines and about cognitive-behavioral techniques. Includes team-based lectures; the operators participate in weekly meetings. The treatment is tailored to the patient during the first week. In the first and last weeks, individual sessions are scheduled and a final meeting with the patient, his/her caregiver, his/her employer, and the local insurance officer is planned. The team visits the patient’s workplace and his/her caregiver is involved. Follow-up meeting two months after discharge.

Ripley et al., 2003 [60]MultidisciplinaryIndividualOutpatient24N/APsychologist, physician, nurse, occupational therapistEducation, dietary modification, pain management techniques, nutraceuticalsInitial screening made by a physician with a social worker who evaluates with the family whether the patient is able and willing to complete the program and recommends if needed to add to the treatment also psychological counseling, group sessions, or other strategies. The treatment is tailored to the patient’s needs and based on the response to the different therapeutic components.

Romeyke et al., 2014 [61]InterdisciplinaryGroupInpatient2N/APsychologist, physician, nurse, physiotherapist, naturopathy specialist, ergonomic specialistHyperthermia, exercise, CBT, pain management techniques, massageThe nurses supervise the treatment and act as process coordinators. Weekly team meetings are scheduled.

Salgueiro et al., 2013 [62]MultidisciplinaryBothOutpatient460Psychologist, physician, nurse, occupational therapistPharmacotherapy, CBT, exercise, pain management techniques, occupational therapy, educationComplex intervention including pharmacotherapy, CBT, physical and occupational therapy, and education, with focus on tackling the patient’s misconception about the syndrome.

Saral et al., 2016 [63]InterdisciplinaryGroupOutpatient1046Psychologist, physician, physiotherapistEducation, exercise, CBTThe long-term program includes a full day of education led by the investigators and then a group CBT along with a program of physical therapy with prescription of home exercises. The short-term program includes the same therapeutic components administered in two days.

Stein and Miclescu, 2013 [64]MultidisciplinaryGroupOutpatient660Psychologist, physician, physiotherapist, occupational therapistEducation, exercise, CBTInterdisciplinary assessment and discussion during the intake; at the end, two or three operators in representation of the whole team meet the patient and his/her family members. There is the possibility for the patient to individually contact the operators. The patient meets again the whole team at the end of the treatment; his/her employer and other key figures are invited.

Suman et al., 2009 [65]MultidisciplinaryIndividualInpatient375Psychologist, physician, physiotherapistEducation, exercise, CBTAcademic setting; at each weekend, the patient returns to his/her home and tries to practice pain management skills. The treatment components are juxtaposed.

Turk et al., 1998 [66]InterdisciplinaryGroupOutpatient424Psychologist, physician, physiotherapist, occupational therapistEducation, exercise, CBT, pain management techniquesEach half-day session includes medical, physical, psychologic, and occupational components. Team meetings are planned; the treatment is supervised by a rheumatologist.

Van Koulil et al., 2011 [67]MultidisciplinaryGroupOutpatient832Psychologist, physiotherapist, social workerExercise, CBT, pain management techniquesThe treatment is mainly based on CBT and exercise; the intervention is tailored to the patient.

van Wilgen et al., 2007 [68]MultidisciplinaryGroupOutpatient17N/APhysiotherapist, occupational therapist, social worker, trainerEducation, exercise, relaxationMainly based on education and physical therapy, provided by trainers and physical therapists.

Wennemer et al., 2006 [69]MultidisciplinaryGroupOutpatient848Physician, physiotherapist, occupational therapistEducation, Feldenkrais or Tai-Chi exercise, relaxation, occupational therapyProgressive program incorporating education, exercise, and stress reduction techniques.

Worrel et al., 2001 [70] 
Pfeiffer et al., 2003 [71] 
Oh et al., 2010 [72]
Interdisciplinary Group Outpatient<18Physician, nurse, physical and occupational therapistEducation, exercise, group discussion, pain management techniquesDuring the first day, the nurse is responsible for the assessment phase, leads the first education session, and facilitates a group discussion. The day after, physical and occupational therapists complete the program with lectures and exercises. Other professionals are involved if necessary. The participation of the patient’s family is encouraged.
Vincent et al., 2013 [73]142Psychologist, physician, nurse, physiotherapist, occupational therapistPatient education, family education, pain management techniquesModified version of the FTP treatment. The program is implemented in one week and includes the same components plus planned involvement of the family members and follow-up contacts with the nurse.

The number and the choice of the disciplines that were integrated in the various interventions were very variable, as well as their relative importance. As a consequence, it was not possible to categorize the programs creating clusters based on the professionals included. Physicians, physical therapists, and psychologists were the most employed operators, followed by occupational therapists, nurses, social workers, dietitians, and other professionals such as Qi-gong instructors, kinesiologists, and massage therapists.

The main therapeutic components included in the various rehabilitation programs were education about fibromyalgia and physical exercise, which were present in 36 out of 38 programs. Education was generally based on group lectures about the syndrome, its symptoms, its prognosis, and the biopsychosocial factors influencing its long-term progression and its daily course. The prescribed physical activity was various and included aerobic, pool, and strengthening exercises. 19 programs provided some psychotherapy sessions under the cognitive-behavioral approach, generally focused on symptom management. Both the educational lectures and the psychotherapeutic sessions could also be focused on teaching the patients to self-manage their symptoms and on enhancing group discussions among the participants. Besides these common therapeutic components, other forms of interventions were usually provided. These include, for instance, occupational therapies, biofeedback, massage therapies, relaxation, Acceptance and Commitment Therapy sessions, and dietary counseling.

4. Discussion

The objective of this review was to describe the characteristics of the available integrated interventions for fibromyalgia, focusing on how the different disciplines are integrated with each other. Our study, therefore, is embedded in two lines of inquiry, that is, the discussion about multidisciplinarity and interdisciplinarity in the healthcare and the evaluation of multicomponent treatment for chronic pain conditions.

With regard to the first, our study is in line with and finds support for the predominant theoretical perspective which describes multidisciplinarity and interdisciplinarity as two parts of the same continuum [18, 19]. Employing the original perspective of analyzing how the integration of the different disciplines is provided by the various programs, we found that the possible organizational frameworks are multiple and are characterized by different degrees of complexity. On the one hand, less integrated programs provide a juxtaposition of two or more different disciplines, which are simply added. These programs can be seen as the prototype of multidisciplinary interventions, since every operator works independently, there is no overlap between the different treatment modalities, and the program is generally organized in a vertical manner [75]. However, we found that there are multidisciplinary programs which use a more flexible and integrated framework, which allows us to modify the treatment and to involve the patient in the decisions about his/her care. In more cohesive programs, some or the majority of the education or pain management sessions are jointly conducted by different operators, allowing the professionals to build a shared perspective regarding the various topics. Prototypical interdisciplinary models seem however to be based on weekly team discussions about the patients, which can be accompanied by other strategies, such as education about interdisciplinary work, a coordinated assessment, or providing sessions jointly conducted by the operators. The presence of team meetings seems to be considered by the authors of the studies included in this review as the main characteristic which defines their treatment as “interdisciplinary,” partly overlooking other components such as creating common goals, making team conferences with the patient and his/her family, and providing shared leadership and a comprehensive assessment [75, 76].

With regard to the evaluation of the multicomponent interventions for fibromyalgia, our study represents a first step for conducting a quantitative synthesis of the literature. As we had hypothesized, we found that the programs included in our review were very heterogeneous in terms of number, type, and integration of the components and professionals, as well as in terms of duration and intensity. Previous analyses of the literature did not successfully address this diversity. Hauser and colleagues [20] performed a meta-analysis on 7 RCTs evaluating multicomponent treatments for fibromyalgia, finding support for their short-term efficacy. The author conducted a sensitivity analysis based only on the methodologic quality and the duration of the programs. A previous Cochrane review [77] attempted to include all the interventions which contained both a medical and a psychological, social, or vocational component, finding four RCTs and showing that these interventions did not provide quantifiable benefits. Different from our study, the authors did not address the differences with regard to format, setting of the program, and integration of operators and therapeutic components. More recently, Papadopoulou et al. [11] evaluated all the pharmacological and nonpharmacological interventions for fibromyalgia, finding support for multidisciplinary treatments based on 8 RCTs, which were not described. Similarly, other reviews focusing on various chronic pain conditions found that multicomponent programs are effective for the treatment of fibromyalgia but did not address their heterogeneity [12, 78]. Our study was not aimed at a quantitative evaluation of the outcomes of these programs but provides a detailed description of the various programs identifying some key characteristics that must be taken into account by future systematic reviews and meta-analyses. In particular, the most varying factors were the duration and the intensity of the programs, the treatment components, and the strategies of integration of the operators. It is needed that future quantitative reviews separately analyze studies evaluating treatments with different structures and assess the moderator effect of the temporal characteristics of the programs.

Some important remarks need to be made. On the one hand, we focused only on studies which included multiple disciplines performed by multiple operators. Therefore, we excluded the papers which did not state clearly that multiple professionals were present and we focused on programs performed by rehabilitation teams. As a consequence, our description is limited to these treatments and it is possible that some multidisciplinary programs were excluded due to poor descriptions of their structure. In addition, our findings are based on brief reports included in scientific papers, and it is possible that important characteristics of the evaluated interventions were missing and that the whole of the multidisciplinary and interdisciplinary rehabilitation programs is misrepresented by our sample. Finally, our electronic search was limited to two databases and to papers written in English language, limiting the comprehensiveness of the review.

However, to our knowledge, this is the first study which attempts to map the characteristics of multicomponent interventions for fibromyalgia. In addition, performing this mapping review allowed us to create a comprehensive database of studies that can be used for further analyses and that is available upon request. We are persuaded that the integration of the various disciplines is a key factor for the treatment of such a condition. It is possible that the more the perspectives of the various professionals are integrated, the more the patients are able to comprehend the complexity of their syndrome and can be conscious about how the different biological, psychological, and social factors affect its course.

5. Conclusions

Multidisciplinary and interdisciplinary treatments must be considered as two ends of the same continuum. The degrees of integration of their component do not depend only on the juxtaposition or on the overlap between the various competences but rely on the possibility of tailoring the programs to the patients or on the presence of co-led sessions, team meetings, and a coordinate assessment. The various studies are very heterogeneous with regard to most of the variables described in our review. This diversity will need to be taken into account by future quantitative reviews of the literature.

Conflicts of Interest

The authors declare that there are no conflicts of interest regarding the publication of this paper.

Acknowledgments

The authors would like to thank Dr. Giorgio Cruccu for comments that greatly improved the manuscript.

References

  1. H. S. Smith, R. Harris, and D. Clauw, “Fibromyalgia: an afferent processing disorder leading to a complex pain generalized syndrome,” Pain Physician, vol. 14, no. 2, pp. E217–E245, 2011. View at: Google Scholar
  2. A. Rahman, M. Underwood, and D. Carnes, “Fibromyalgia,” The British Medical Journal, vol. 348, Article ID g1224, 2014. View at: Publisher Site | Google Scholar
  3. D. J. Clauw, “Fibromyalgia and related conditions,” Mayo Clinic Proceedings, vol. 90, no. 5, pp. 680–692, 2015. View at: Publisher Site | Google Scholar
  4. M. B. Yunus, “Central sensitivity syndromes: a new paradigm and group nosology for fibromyalgia and overlapping conditions, and the related issue of disease versus illness,” Seminars in Arthritis and Rheumatism, vol. 37, no. 6, pp. 339–352, 2008. View at: Publisher Site | Google Scholar
  5. G. Cassisi, P. Sarzi-Puttini, R. Casale et al., “Pain in fibromyalgia and related conditions,” Reumatismo, vol. 66, no. 1, pp. 72–86, 2014. View at: Publisher Site | Google Scholar
  6. J. Ablin, M. A. Fitzcharles, D. Buskila, Y. Shir, C. Sommer, and W. Häuser, “Treatment of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines with special emphasis on complementary and alternative therapies,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 485272, 7 pages, 2013. View at: Publisher Site | Google Scholar
  7. D. L. Goldenberg, “Management of fibromyalgia syndrome,” Rheumatic Disease Clinics of North America, vol. 15, no. 3, pp. 499–512, 1989. View at: Google Scholar
  8. D. L. Goldenberg, “Fibromyalgia, chronic fatigue syndrome, and myofascial pain syndrome,” Current Opinion in Rheumatology, vol. 9, no. 2, pp. 135–143, 1997. View at: Publisher Site | Google Scholar
  9. W. Hauser, J. Ablin, M. A. Fitzcharles et al., “Fibromyalgia,” Nature Reviews Disease Primers, vol. 1, Article ID 15022, 2015. View at: Publisher Site | Google Scholar
  10. G. Castelnuovo, E. M. Giusti, G. M. Manzoni et al., “Psychological considerations in the assessment and treatment of pain in neurorehabilitation and psychological factors predictive of therapeutic response: evidence and recommendations from the italian consensus conference on pain in neurorehabilitation,” Frontiers in Psychology, vol. 7, p. 468, 2016. View at: Publisher Site | Google Scholar
  11. D. Papadopoulou, A. Fassoulaki, C. Tsoulas, I. Siafaka, and A. Vadalouca, “A meta-analysis to determine the effect of pharmacological and non-pharmacological treatments on fibromyalgia symptoms comprising OMERACT-10 response criteria,” Clinical Rheumatology, vol. 35, no. 3, pp. 573–586, 2016. View at: Publisher Site | Google Scholar
  12. L. Scascighini, V. Toma, S. Dober-Spielmann, and H. Sprott, “Multidisciplinary treatment for chronic pain: a systematic review of interventions and outcomes,” Rheumatology, vol. 47, no. 5, pp. 670–678, 2008. View at: Publisher Site | Google Scholar
  13. G. Castelnuovo, E. M. Giusti, G. M. Manzoni et al., “Psychological treatments and psychotherapies in the neurorehabilitation of pain: evidences and recommendations from the italian consensus conference on pain in neurorehabilitation,” Frontiers in Psychology, vol. 7, p. 115, 2016. View at: Publisher Site | Google Scholar
  14. E. Nüesch, W. Häuser, K. Bernardy, J. Barth, and P. Jüni, “Comparative efficacy of pharmacological and non-pharmacological interventions in fibromyalgia syndrome: network meta-analysis,” Annals of the Rheumatic Diseases, vol. 72, no. 6, pp. 955–962, 2013. View at: Publisher Site | Google Scholar
  15. S. Tamburin, M. R. Lacerenza, G. Castelnuovo et al., “Pharmacological and non-pharmacological strategies in the integrated treatment of pain in neurorehabilitation. Evidence and recommendations from the italian consensus conference on pain in neurorehabilitation,” European Journal of Physical and Rehabilitation Medicine, vol. 52, no. 5, pp. 741–752, 2016. View at: Google Scholar
  16. S. R. Fashler, L. K. Cooper, E. D. Oosenbrug et al., “Systematic review of multidisciplinary chronic pain treatment facilities,” Pain Research and Management, vol. 2016, Article ID 5960987, 19 pages, 2016. View at: Publisher Site | Google Scholar
  17. P. Peng, J. N. Stinson, M. Choiniere et al., “Role of health care professionals in multidisciplinary pain treatment facilities in Canada,” Pain Research & Management, vol. 13, no. 6, pp. 484–488, 2008. View at: Publisher Site | Google Scholar
  18. C. M. Scott and A. T. Hofmeyer, “Acknowledging complexity: critically analyzing context to understand interdisciplinary research,” Journal of Interprofessional Care, vol. 21, no. 5, pp. 491–501, 2007. View at: Publisher Site | Google Scholar
  19. B. C. Choi and A. W. Pak, “Multidisciplinarity, interdisciplinarity and transdisciplinarity in health research, services, education and policy: 1. Definitions, objectives, and evidence of effectiveness,” Clinical and Investigative Medicine, vol. 29, no. 6, pp. 351–364, 2006. View at: Google Scholar
  20. W. Hauser, K. Bernardy, B. Arnold, M. Offenbacher, and M. Schiltenwolf, “Efficacy of multicomponent treatment in fibromyalgia syndrome: a meta-analysis of randomized controlled clinical trials,” Arthritis & Rheumatology, vol. 61, no. 2, pp. 216–224, 2009. View at: Publisher Site | Google Scholar
  21. M. J. Grant and A. Booth, “A typology of reviews: an analysis of 14 review types and associated methodologies,” Health Information & Libraries Journal, vol. 26, no. 2, pp. 91–108, 2009. View at: Publisher Site | Google Scholar
  22. K. L. James, N. P. Randall, and N. R. Haddaway, “A methodology for systematic mapping in environmental sciences,” Environmental Evidence, vol. 5, no. 1, pp. 1–13, 2016. View at: Publisher Site | Google Scholar
  23. SIGN, “Methodology checklist 2: randomised controlled trials,” http://www.sign.ac.uk/methodology/checklists.html. View at: Publisher Site | Google Scholar
  24. S. H. Downs and N. Black, “The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions,” Journal of Epidemiology and Community Health, vol. 52, no. 6, pp. 377–384, 1998. View at: Publisher Site | Google Scholar
  25. S. Åkerblom, S. Perrin, M. Rivano Fischer, and L. M. McCracken, “The mediating role of acceptance in multidisciplinary cognitive-behavioral therapy for chronic pain,” The Journal of Pain, vol. 16, no. 7, pp. 606–615, 2015. View at: Publisher Site | Google Scholar
  26. K. Amris, E. E. Wæhrens, R. Christensen, H. Bliddal, and B. Danneskiold-Samsøe, “Interdisciplinary rehabilitation of patients with chronic widespread pain: primary endpoint of the randomized, nonblinded, parallel-group IMPROvE trial,” Pain, vol. 155, no. 7, pp. 1356–1364, 2014. View at: Publisher Site | Google Scholar
  27. F. J. Anderson and A. E. Winkler, “Benefits of long-term fibromyalgia syndrome treatment with a multidisciplinary program,” Journal of Musculoskeletal Pain, vol. 14, no. 4, pp. 11–25, 2006. View at: Publisher Site | Google Scholar
  28. F. Angst, R. Brioschi, C. J. Main, S. Lehmann, and A. Aeschlimann, “Interdisciplinary rehabilitation in fibromyalgia and chronic back pain: a prospective outcome study,” The Journal of Pain, vol. 7, no. 11, pp. 807–815, 2006. View at: Publisher Site | Google Scholar
  29. F. Angst, M. L. Verra, S. Lehmann, R. Brioschi, and A. Aeschlimann, “Clinical effectiveness of an interdisciplinary pain management programme compared with standard inpatient rehabilitation in chronic pain: a naturalistic, prospective controlled cohort study,” Journal of Rehabilitation Medicine, vol. 41, no. 7, pp. 569–575, 2009. View at: Publisher Site | Google Scholar
  30. A. Bailey, L. Starr, M. Alderson, and J. Moreland, “A comparative evaluation of a fibromyalgia rehabilitation program,” Arthritis Care and Research, vol. 12, no. 5, pp. 336–340, 1999. View at: Publisher Site | Google Scholar
  31. P. Bourgault, A. Lacasse, S. Marchand et al., “Multicomponent interdisciplinary group intervention for self-management of fibromyalgia: a mixed-methods randomized controlled trial,” PLoS ONE, vol. 10, no. 5, Article ID 0126324, 2015. View at: Publisher Site | Google Scholar
  32. A. Carbonell-Baeza, V. A. Aparicio, P. Chillón, P. Femia, M. Delgado-Fernández, and J. R. Ruiz, “Effectiveness of multidisciplinary therapy on symptomatology and quality of life in women with fibromyalgia,” Clinical and Experimental Rheumatology, vol. 29, no. 6, supplement 69, pp. S97–S103, 2011. View at: Google Scholar
  33. A. Carbonell-Baeza, V. A. Aparicio, F. B. Ortega et al., “Does a 3-month multidisciplinary intervention improve pain, body composition and physical fi tness in women with fibromyalgia?” British Journal of Sports Medicine, vol. 45, no. 15, pp. 1189–1195, 2011. View at: Publisher Site | Google Scholar
  34. A. Carbonell-Baeza, J. R. Ruiz, V. A. Aparicio et al., “Multidisciplinary and biodanza intervention for the management of fibromyalgia,” Acta Reumatologica Portuguesa, vol. 37, no. 3, pp. 240–250, 2012. View at: Google Scholar
  35. B. Casanueva-Fernández, J. Llorca, J. B. I. Rubió, B. Rodero-Fernández, and M. A. González-Gay, “Efficacy of a multidisciplinary treatment program in patients with severe fibromyalgia,” Rheumatology International, vol. 32, no. 8, pp. 2497–2502, 2012. View at: Publisher Site | Google Scholar
  36. A. Castel, R. Fontova, S. Montull et al., “Efficacy of a multidisciplinary fibromyalgia treatment adapted for women with low educational levels: a randomized controlled trial,” Arthritis Care & Research, vol. 65, no. 3, pp. 421–431, 2013. View at: Publisher Site | Google Scholar
  37. C. Cedraschi, J. Desmeules, E. Rapiti et al., “Fibromyalgia: a randomised, controlled trial of a treatment programme based on self management,” Annals of the Rheumatic Diseases, vol. 63, no. 3, pp. 290–296, 2004. View at: Publisher Site | Google Scholar
  38. A. De Rooij, M. Van Der Leeden, L. D. Roorda, M. P. M. Steultjens, and J. Dekker, “Predictors of outcome of multidisciplinary treatment in chronic widespread pain: an observational study,” BMC Musculoskeletal Disorders, vol. 14, 2013. View at: Publisher Site | Google Scholar
  39. M. Gustafsson, J. Ekholm, and L. Broman, “Effects of a multiprofessional rehabilitation programme for patients with fibromyalgia syndrome,” Journal of Rehabilitation Medicine, vol. 34, no. 3, pp. 119–127, 2002. View at: Publisher Site | Google Scholar
  40. A. Hammond and K. Freeman, “Community patient education and exercise for people with fibromyalgia: a parallel group randomized controlled trial,” Clinical Rehabilitation, vol. 20, no. 10, pp. 835–846, 2006. View at: Publisher Site | Google Scholar
  41. B. Hamnes, P. Mowinckel, I. Kjeken, and K. B. Hagen, “Effects of a one week multidisciplinary inpatient self-management programme for patients with fibromyalgia: a randomised controlled trial,” BMC Musculoskeletal Disorders, vol. 13, 2012. View at: Publisher Site | Google Scholar
  42. W. M. Hooten, C. O. Townsend, C. D. Sletten, B. K. Bruce, and J. D. Rome, “Treatment outcomes after multidisciplinary pain rehabilitation with analgesic medication withdrawal for patients with fibromyalgia,” Pain Medicine, vol. 8, no. 1, pp. 8–16, 2007. View at: Publisher Site | Google Scholar
  43. W. M. Hooten, C. O. Townsend, and P. A. Decker, “Gender differences among patients with fibromyalgia undergoing multidisciplinary pain rehabilitation,” Pain Medicine, vol. 8, no. 8, pp. 624–632, 2007. View at: Publisher Site | Google Scholar
  44. T. Kas, M. Colby, M. Case, and D. Vaughn, “The effect of extremity strength training on fibromyalgia symptoms and disease impact in an existing multidisciplinary treatment program,” Journal of Bodywork and Movement Therapies, vol. 20, no. 4, pp. 774–783, 2015. View at: Publisher Site | Google Scholar
  45. P. J. Keel, C. Bodoky, U. Gerhard, and W. Müller, “Comparison of integrated group therapy and group relaxation training for fibromyalgia,” Clinical Journal of Pain, vol. 14, no. 3, pp. 232–238, 1998. View at: Publisher Site | Google Scholar
  46. M. Kroese, G. Schulpen, M. Bessems, F. Nijhuis, J. Severens, and R. Landewé, “The feasibility and efficacy of a multidisciplinary intervention with aftercare meetings for fibromyalgia,” Clinical Rheumatology, vol. 28, no. 8, pp. 923–929, 2009. View at: Publisher Site | Google Scholar
  47. Y. van Eijk-Hustings, M. Kroese, F. Tan, A. Boonen, M. Bessems-Beks, and R. Landewé, “Challenges in demonstrating the effectiveness of multidisciplinary treatment on quality of life, participation and health care utilisation in patients with fibromyalgia: a randomised controlled trial,” Clinical Rheumatology, vol. 32, no. 2, pp. 199–209, 2013. View at: Publisher Site | Google Scholar
  48. M. Lemstra and W. P. Olszynski, “The effectiveness of multidisciplinary rehabilitation in the treatment of fibromyalgia: A randomized controlled trial,” Clinical Journal of Pain, vol. 21, no. 2, pp. 166–174, 2005. View at: Publisher Site | Google Scholar
  49. S. Lera, S. M. Gelman, M. J. López et al., “Multidisciplinary treatment of fibromyalgia: does cognitive behavior therapy increase the response to treatment?” Journal of Psychosomatic Research, vol. 67, no. 5, pp. 433–441, 2009. View at: Publisher Site | Google Scholar
  50. D. A. Marcus, C. D. Bernstein, A. Haq, and P. Breuer, “Including a range of outcome targets offers a broader view of fibromyalgia treatment outcome: Results from a retrospective review of multidisciplinary treatment,” Musculoskeletal Care, vol. 12, no. 2, pp. 74–81, 2014. View at: Publisher Site | Google Scholar
  51. J. Martín, F. Torre, A. Padierna et al., “Six-and 12-month follow-up of an interdisciplinary fibromyalgia treatment programme: results of a randomised trial,” Clinical and Experimental Rheumatology, vol. 30, supplement 74, pp. S103–S111, 2012. View at: Google Scholar
  52. J. Martín, F. Torre, U. Aguirre et al., “Evaluation of the interdisciplinary PSYMEPHY treatment on patients with fibromyalgia: a randomized control trial,” Pain Medicine, vol. 15, no. 4, pp. 682–691, 2014. View at: Publisher Site | Google Scholar
  53. J. Martín, F. Torre, A. Padierna et al., “Impact of interdisciplinary treatment on physical and psychosocial parameters in patients with fibromyalgia: results of a randomised trial,” International Journal of Clinical Practice, vol. 68, no. 5, pp. 618–627, 2014. View at: Publisher Site | Google Scholar
  54. J. Martín, F. Torre, A. Padierna et al., “Interdisciplinary treatment of patients with fibromyalgia: improvement of their health-related quality of life,” Pain Practice, vol. 14, no. 8, pp. 721–731, 2014. View at: Publisher Site | Google Scholar
  55. M. R. I. Martins, C. C. Gritti, R. dos Santos Junior et al., “Randomized controlled trial of a therapeutic intervention group in patients with fibromyalgia syndrome,” Revista Brasileira de Reumatologia, vol. 54, no. 3, pp. 179–184, 2014. View at: Publisher Site | Google Scholar
  56. A. M. Mengshoel, K. Ø. Forseth, M. Haugen, R. Walle-Hansen, and Ø. Førre, “Multidisciplinary approach to fibromyalgia. A pilot study,” Clinical Rheumatology, vol. 14, no. 2, pp. 165–170, 1995. View at: Publisher Site | Google Scholar
  57. A. Michalsen, C. Li, K. Kaiser et al., “In-patient treatment of fibromyalgia: a controlled nonrandomized comparison of conventional medicine versus integrative medicine including fasting therapy,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 908610, 7 pages, 2013. View at: Publisher Site | Google Scholar
  58. W. R. Nielson and M. P. Jensen, “Relationship between changes in coping and treatment outcome in patients with Fibromyalgia Syndrome,” Pain, vol. 109, no. 3, pp. 233–241, 2004. View at: Publisher Site | Google Scholar
  59. E. Persson, J. Lexell, M. Eklund, and M. Rivano-Fischer, “Positive effects of a musculoskeletal pain rehabilitation program regardless of pain duration or diagnosis,” PM and R, vol. 4, no. 5, pp. 355–366, 2012. View at: Publisher Site | Google Scholar
  60. S. Ripley, C. R. Ronzio, C. Cozad et al., “Evaluation of a multidisciplinary rehabilitation program for fibromyalgia: a pilot study,” Today's Therapeutic Trends, vol. 21, no. 2, pp. 159–184, 2003. View at: Google Scholar
  61. T. Romeyke, H. C. Scheuer, and H. Stummer, “Fibromyalgia with severe forms of progression in a multidisciplinary therapy setting with emphasis on hyperthermia therapy—a prospective controlled study,” Clinical Interventions in Aging, vol. 10, pp. 69–79, 2014. View at: Publisher Site | Google Scholar
  62. M. Salgueiro, X. Basogain, A. Collado et al., “An artificial neural network approach for predicting functional outcome in fibromyalgia syndrome after multidisciplinary pain program,” Pain Medicine, vol. 14, no. 10, pp. 1450–1460, 2013. View at: Publisher Site | Google Scholar
  63. I. Saral, D. Sindel, S. Esmaeilzadeh, H. O. Sertel-Berk, and A. Oral, “The effects of long- and short-term interdisciplinary treatment approaches in women with fibromyalgia: a randomized controlled trial,” Rheumatology International, vol. 36, no. 10, pp. 1379–1389, 2016. View at: Publisher Site | Google Scholar
  64. K. F. Stein and A. Miclescu, “Effectiveness of multidisciplinary rehabilitation treatment for patients with chronic pain in a primary health care unit,” Scandinavian Journal of Pain, vol. 4, no. 4, pp. 190–197, 2013. View at: Publisher Site | Google Scholar
  65. A. L. Suman, B. Biagli, G. Biasi et al., “One-year efficacy of a 3-week intensive multidisciplinary non-pharmacological treatment program fibromyalgia patients,” Clinical and Experimental Rheumatology, vol. 27, no. 1, pp. 7–14, 2009. View at: Google Scholar
  66. D. C. Turk, A. Okifuji, J. D. Sinclair, and T. W. Starz, “Interdisciplinary treatment for fibromyalgia syndrome: clinical and statistical significance,” Arthritis Care and Research, vol. 11, no. 3, pp. 186–195, 1998. View at: Publisher Site | Google Scholar
  67. S. Van Koulil, W. Van Lankveld, F. W. Kraaimaat et al., “Tailored cognitive-behavioural therapy and exercise training improves the physical fitness of patients with fibromyalgia,” Annals of the Rheumatic Diseases, vol. 70, no. 12, pp. 2131–2133, 2011. View at: Publisher Site | Google Scholar
  68. C. P. van Wilgen, H. Bloten, and B. Oeseburg, “Results of a multidisciplinary program for patients with fibromyalgia implemented in the primary care,” Disability and Rehabilitation, vol. 29, no. 15, pp. 1207–1213, 2007. View at: Publisher Site | Google Scholar
  69. H. K. Wennemer, J. Borg-Stein, L. Gomba et al., “Functionally oriented rehabilitation program for patients with fibromyalgia: preliminary results,” American Journal of Physical Medicine and Rehabilitation, vol. 85, no. 8, pp. 659–666, 2006. View at: Publisher Site | Google Scholar
  70. L. M. Worrel, L. E. Krahn, C. D. Sletten, and G. R. Pond, “Treating fibromyalgia with a brief interdisciplinary program: Initial outcomes and predictors of response,” Mayo Clinic Proceedings, vol. 76, no. 4, pp. 384–390, 2001. View at: Publisher Site | Google Scholar
  71. A. Pfeiffer, J. M. Thompson, A. Nelson et al., “Effects of a 1.5-day multidisciplinary outpatient treatment program for fibromyalgia: a pilot study,” American Journal of Physical Medicine and Rehabilitation, vol. 82, no. 3, pp. 186–191, 2003. View at: Publisher Site | Google Scholar
  72. T. H. Oh, M. H. Stueve, T. L. Hoskin et al., “Brief interdisciplinary treatment program for fibromyalgia: six to twelve months outcome,” American Journal of Physical Medicine and Rehabilitation, vol. 89, no. 2, pp. 115–124, 2010. View at: Publisher Site | Google Scholar
  73. A. Vincent, M. O. Whipple, T. H. Oh, J. A. Guderian, D. L. Barton, and C. A. Luedtke, “Early experience with a brief, multimodal, multidisciplinary treatment program for fibromyalgia,” Pain Management Nursing, vol. 14, no. 4, pp. 228–235, 2013. View at: Publisher Site | Google Scholar
  74. C. O. Townsend, J. L. Kerkvliet, B. K. Bruce et al., “A longitudinal study of the efficacy of a comprehensive pain rehabilitation program with opioid withdrawal: comparison of treatment outcomes based on opioid use status at admission,” Pain, vol. 140, no. 1, pp. 177–189, 2008. View at: Publisher Site | Google Scholar
  75. R. M. Gordon, J. R. Corcoran, P. Bartley-Daniele, D. Sklenar, P. R. Sutton, and F. Cartwright, “A transdisciplinary team approach to pain management in inpatient health care settings,” Pain Management Nursing, vol. 15, no. 1, pp. 426–435, 2014. View at: Publisher Site | Google Scholar
  76. S. Stanos and T. T. Houle, “Multidisciplinary and interdisciplinary management of chronic pain,” Physical Medicine and Rehabilitation Clinics of North America, vol. 17, no. 2, pp. 435–450, 2006. View at: Publisher Site | Google Scholar
  77. K. Karjalainen, A. Malmivaara, M. van Tulder et al., “Multidisciplinary rehabilitation for fibromyalgia and musculoskeletal pain in working age adults,” Cochrane Database of Systematic Reviews, no. 2, Article ID CD001984, 2000. View at: Google Scholar
  78. A.-M. Momsen, J. O. Rasmussen, C. V. Nielsen, M. D. Iversen, and H. Lund, “Multidisciplinary team care in rehabilitation: an overview of reviews,” Journal of Rehabilitation Medicine, vol. 44, no. 11, pp. 901–912, 2012. View at: Publisher Site | Google Scholar

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