Efficacy of Multicomponent Treatment in Fibromyalgia Syndrome: A Meta-Analysis of Randomized Controlled Clinical Trials
Efficacy of Multicomponent Treatment in Fibromyalgia Syndrome: A Meta-Analysis of Randomized Controlled Clinical Trials
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DOI：
10.1002/art.24276
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发表时间：
2009-02-15
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影响因子：
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通讯作者：
Schiltenwolf, Marcus
中科院分区：
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作者：
Haeuser, Winfried;Bernardy, Kathrin;Schiltenwolf, Marcus
Objective.目的系统评价纤维肌痛综合征（FMS）多组分治疗的疗效。我们筛选了Medline、PsychINFO、Scopus和科克伦图书馆（截至2007年12月），以及原始研究、综述和循证指南的参考部分。对FMS的多组分治疗（至少一种教育或其他心理疗法和至少一种运动疗法）的随机对照试验（RCT）进行分析。我们在荟萃分析中纳入了9项（共14项）RCT，共1，119例受试者（中位治疗时间24小时）。使用标准化平均差异（SMD）或加权平均差异（WMD）总结效果。有强有力的证据表明，多组分治疗可以减轻疼痛（SMD -0.37; 95%置信区间[95% CI]-0.62，-0.13），疲劳（WMD-0. 85; 95% CI-1. 50，-0. 20），抑郁症状（SMD -0.67; 95% CI-1.08，-0.26）和健康相关生活质量（HRQOL）的局限性（SMD-0. 59; 95% CI-0. 90，-0. 27），并改善治疗后的自我效能疼痛（SMD 0. 54; 95% CI 0. 26，0. 82）和身体健康（SMD 0. 30; 95% CI 0. 02，0. 57）。没有证据表明其对疼痛、疲劳、睡眠障碍、抑郁症状、HRQOL或自我效能疼痛的长期疗效。有强有力的证据表明，对身体健康的积极影响（SMD 0.30; 95% CI 0.09，0.51）可以长期维持（中位随访7个月）。有强有力的证据表明，多组分治疗对FMS的主要症状具有有益的短期效果。需要制定战略，长期保持多组分治疗的益处。
Objective. To systematically review the efficacy of multicomponent treatment of fibromyalgia syndrome (FMS).Methods. We screened Medline, PsychINFO, Scopus, and the Cochrane Library (through December 2007), as well as reference sections of original studies, reviews, and evidence-based guidelines. Randomized controlled trials (RCTs) on the multicomponent treatment (at least 1 educational or other psychological therapy with at least 1 exercise therapy) of FMS were analyzed.Results. We included 9 (of 14) RCTs with 1,119 subjects (median treatment time 24 hours) in the meta-analysis. Effects were summarized using standardized mean differences (SMDs) or weighted mean differences (WMDs). There was strong evidence that multicomponent treatment reduces pain (SMD -0.37; 95% confidence interval [95% CI] -0.62, -0.13), fatigue (WMD -0.85; 95% CI -1.50, -0.20), depressive symptoms (SMD -0.67; 95% CI -1.08, -0.26), and limitations to health-related quality of life (HRQOL) (SMD -0.59; 95% CI -0.90, -0.27) and improves self-efficacy pain (SMD 0.54; 95% CI 0.26, 0.82) and physical fitness (SMD 0.30; 95% CI 0.02, 0.57) at posttreatment. There was no evidence of its efficacy on pain, fatigue, sleep disturbances, depressive symptoms, HRQOL, or self-efficacy pain in the long term. There was strong evidence that positive effects on physical fitness (SMD 0.30; 95% CI 0.09, 0.51) can be maintained in the long term (median followup 7 months).Conclusions. There is strong evidence that multicomponent treatment has beneficial short-term effects on the key symptoms of FMS. Strategies to maintain the benefits of multicomponent treatment in the long term need to be developed.