Review Article

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

Table 3

Description of the rehabilitation programs.

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.