Predictors of multidisciplinary treatment outcome in fibromyalgia:a systematic review

Abstract

Purpose: To identify outcome predictors for multidisciplinary treatment in patients with chronic widespread pain (CWP) or fibromyalgia (FM). Methods: A systematic literature search in PubMed, PsycINFO, CINAHL, Cochrane Library, EMBASE and Pedro. Selection criteria included: age over 18; diagnosis CWP or FM; multidisciplinary treatment; longitudinal study design; original research report. Outcome domains: pain, physical functioning, emotional functioning, global treatment effect and ‘others’. Methodological quality of the selected articles was assessed and a qualitative data synthesis was performed to identify the level of evidence. Results: Fourteen studies (all with FM patients) fulfilled the selection criteria. Six were of high quality. Poorer outcome (pain, moderate evidence; physical functioning and quality of life, weak evidence) was predicted by depression. Similarly, poorer outcome was predicted by the disturbance and pain profile of the Minnesota Multiphasic Personality Inventory (MMPI), strong beliefs in fate and high disability (weak evidence). A better outcome was predicted by a worse baseline status, the dysfunctional and the adaptive copers profile of the Multidimensional Pain Inventory (MPI), and high levels of pain (weak evidence). Some predictors were related to specific multidisciplinary treatment (weak evidence). Inconclusive evidence was found for other demographic and clinical factors, cognitive and emotional factors, symptoms and physical functioning as predictors of outcome. Discussion: It was found that a higher level of depression was a predictor of poor outcome in FM (moderate evidence). In addition, it was found that the baseline status, specific patient profiles, belief in fate, disability, and pain were predictors of the outcome of multidisciplinary treatment. Our results highlight the lack of high quality studies for evaluating predictors of the outcome of multidisciplinary treatment in FM. Further research on predictors of multidisciplinary treatment outcome is needed.

Implications for Rehabilitation

• Predictors can be used either to adjust treatment to the needs of specific patients, or to allocate patients to suitable programs

• Depression seems to predict poor multidisciplinary treatment outcome in FM

• More well designed studies are needed to investigate predictors of treatment outcome

Keywords::

• Predictors
• multidisciplinary treatment
• outcome
• fibromyalgia
• chronic widespread pain

Acknowledgements

The authors would like to thank Dr. D.G. de Rooij for critical reading of the manuscript.

Declaration of Interest: The authors report no conflicts of interest. This study was carried out with no external funding. The authors alone are responsible for the content and writing of the paper.

Appendix A

Pubmed search

Search (“Fibromyalgia”[Mesh]) OR (Fibromyalgi*[tiab] OR Fibromyositis[tiab] OR fibromyotic[tiab]) OR ((“Chronic Disease”[Mesh] OR chronic[tiab]) AND (“pain”[MeSH Terms] OR “pain”[tiab]) AND (“wide spread”[tiab] OR widespread[tiab] OR aspecific[tiab] OR generalized[tiab] OR generalised[tiab] OR idiopathic[tiab] OR diffuse[tiab])) OR (“chronic pain”[tiab] OR “chronic wide spread pain”[tiab] OR “chronic widespread pain”[tiab] OR “chronic wide spread body pain”[tiab] OR “chronic widespread body pain” OR “chronic musculoskeletal pain”[tiab] OR “musculoskeletal pain syndrome”[tiab] OR “musculoskeletal pain syndromes”[tiab] OR “chronic pain syndrome”[tiab] OR “chronic pain syndromes”[tiab]) OR (fibrositis[tiab] OR fibrositides[tiab]) cohort studies[mesh] OR cohort[tiab] OR longitudinal[tiab] OR prospective[tiab] OR “follow up”[tiab] OR “follow-up”[tiab] OR followup[tiab] OR predict*[tiab] OR determinant*[tiab] OR fibromyalgia/therapy[mesh] AND ((Clinical Trial[ptyp] OR Meta-Analysis[ptyp] OR Randomized Controlled Trial[ptyp])) NOT (“drug therapy”[Subheading] NOT (“therapy”[Subheading:noexp] OR “diet therapy”[Subheading] OR “rehabilitation”[Subheading])) Limits: All Adult: 19+ years

Appendix B

Description of MMPI and MPI profiles

• MMPI: Minnesota Multiphasic Personality Inventory (26)

• Pain profile: Elevated scores T scores for hypochondriasis and hysteria, but not depression

• Psychological disturbance profile: Elevated T scores for hypochondriasis, hysteria and depression

• MPI: Multidimensional Pain Inventory (27)

• Adaptive copers profile: patients characterized by low levels of disability and psychological distress and, a high level of perceived life-control

• Dysfunctional profile: patients characterized by high levels of pain, disability, functional limitations, and psychological distress and low levels of activity and sense of control