Chris Henriksson

EULAR evidence-based recommendations for the management of fibromyalgia syndrome

Objective: To develop evidence-based recommendations for the management of fibromyalgia syndrome. Methods: A multidisciplinary task force was formed representing 11 European countries. The design of the study, including search strategy, participants, interventions, outcome measures, data collection and analytical method, was defined at the outset. A systematic review was undertaken with the keywords “fibromyalgia”, “treatment or management” and “trial”. Studies were excluded if they did not utilise the American College of Rheumatology classification criteria, were not clinical trials, or included patients with chronic fatigue syndrome or myalgic encephalomyelitis. Primary outcome measures were change in pain assessed by visual analogue scale and fibromyalgia impact questionnaire. The quality of the studies was categorised based on randomisation, blinding and allocation concealment. Only the highest quality studies were used to base recommendations on. When there was insufficient evidence from the literature, a Delphi process was used to provide basis for recommendation. Results: 146 studies were eligible for the review. 39 pharmacological intervention studies and 59 non-pharmacological were included in the final recommendation summary tables once those of a lower quality or with insufficient data were separated. The categories of treatment identified were antidepressants, analgesics, and “other pharmacological” and exercise, cognitive behavioural therapy, education, dietary interventions and “other non-pharmacological”. In many studies sample size was small and the quality of the study was insufficient for strong recommendations to be made. Conclusions: Nine recommendations for the management of fibromyalgia syndrome were developed using a systematic review and expert consensus.

Women with fibromyalgia: Work and rehabilitation

Purpose. To explore disability in women with fibromyalgia with a focus on their work situation. Method. Review of literature on work status of women with fibromyalgia. Results. Major differences exist between studies in reported disability and in the percentages of women working. Limitations caused by pain, fatigue, decreased muscle strength, and endurance influence work capacity. However, 34 – 77% of the women work. Individual adjustments in the work situation are reported. When the women find a level that matches their ability, they continue to work and find satisfaction in their work role. Many factors besides degree of impairment or disability influence whether clients with longstanding pain can remain in their work role or return to work after sickness leave. Conclusion. The total life situation, other commitments, type of work tasks, the ability to influence the work situation, and the physical and psychosocial work environment are important factors in determining whether a person can remain in a work role. More knowledge is needed about how to adjust work conditions for people with partial work ability to the benefit of society and the individual.

Chronic widespread musculoskeletal pain - a comparison of those who meet criteria for fibromyalgia and those who do not.

Fibromyalgia is currently classified as chronic widespread pain with widespread allodynia to pressure pain. There are few data describing pain characteristics, quality of life, consequences for daily living, and psychosocial status in patients who meet the classification criteria for fibromyalgia proposed by the American College of Rheumatology compared with patients with chronic widespread pain but not widespread allodynia.

The rehabilitation process for the geriatric stroke patient- an exploratory study of goal setting and interventions

PURPOSE The aim was to describe and analyse the rehabilitation process of the geriatric stroke patient from two perspectives; the treatment goals expressed by the staff and the patient and the treatment interventions chosen by the physiotherapist and occupational therapist. A secondary aim was to test whether the process, treatment goals and interventions could be classified according to the International Classification of Impairments, Disabilities and Handicaps (ICIDH). METHOD Qualitative interviews were performed with patients and personnel; diaries were used to register treatment interventions. The 30 interviews were categorized according to the goals expressed by physiotherapists, occupational therapists, physicians and patients. The diaries (n = 22) were analysed to describe how treatment interventions were connected in time, at what levels (impairment, disability and handicap) the interventions were directed, and finally, whether certain decisions were made in order to change the rehabilitation process. RESULTS The patients talked more about attaining their pre-stroke status than about their goals. The therapists set goals according to functional level, whereas the doctors expressed themselves in general terms. Three patterns of rehabilitation processes were found: one with clearly identified decision points, one with a set programme which was not changed through the process, and one where the goal was changed according to changes in medical status. CONCLUSIONS The patient does not participate in the goal-setting process, and the vaguely expressed goals are not measurable. The rehabilitation process and reason for discharge demonstrate different patterns. Treatment interventions, if related to the ICIDH, give a clear picture of the process, though certain interventions do not fit in the classification.

Responsiveness of the Swedish Version of the Canadian Occupational Performance Measure

In a client-centred approach, clients and therapists work together to define the occupational performance problem, the focus of and need for intervention and the preferred outcomes. Application of specific theories or techniques to involve clients in goal-setting may influence the therapist to use a client participation approach. The Canadian Occupational Performance Measure (COPM) presents a structure for formulating the treatment goals identified by the client in co-operation with the therapist. The aim of this study was to test the responsiveness of the Swedish version of the COPM. After translation into Swedish, the COPM was introduced to 21 occupational therapists who performed data collection. A sample of 108 clients within geriatric, neurologic and orthopaedic rehabilitation identified 418 problems at initial scoring and reassessment. Inclusion criteria for patients were the need for rehabilitation interventions and the ability to communicate well enough in an interview. The results indicate that t...

Impact of fibromyalgia on everyday life: a study of women in the USA and Sweden

The study investigated how 39 women with fibromyalgia (FM), living in two countries (USA or Sweden), report the consequences of fibromyalgia on everyday life activities. Data were collected using questionnaires, diaries and interviews. The result showed that the impact on everyday life was considerable. The majority of the women experienced pain and fatigue for more than 90% of their time awake. There were no significant differences between the national groups in time use, problems with everyday activities, or quality of life. Overall, the differences between individuals were greater than between the national groups. The majority of the employed patients in the Swedish group had reduced their working time, while the employed patients in the USA group worked mainly full-time. Patients who were able to reduce their working hours to fit their perceived capacity were less exhausted during their leisure, and reported higher satisfaction with daily activities.

Prevalence of widespread pain and associations with work status: a population study

BackgroundThis population study based on a representative sample from a Swedish county investigates the prevalence, duration, and determinants of widespread pain (WSP) in the population using two constructs and estimates how WSP affects work status. In addition, this study investigates the prevalence of widespread pain and its relationship to pain intensity, gender, age, income, work status, citizenship, civil status, urban residence, and health care seeking.MethodsA cross-sectional survey using a postal questionnaire was sent to a representative sample (n = 9952) of the target population (284,073 people, 18–74 years) in a county (Östergötland) in the southern Sweden. The questionnaire was mailed and followed by two postal reminders when necessary.ResultsThe participation rate was 76.7% (n = 7637); the non-participants were on the average younger, earned less money, and male. Women had higher prevalences of pain in 10 different predetermined anatomical regions. WSP was generally chronic (90–94%) and depending on definition of WSP the prevalence varied between 4.8–7.4% in the population. Women had significantly higher prevalence of WSP than men and the age effect appeared to be stronger in women than in men. WSP was a significant negative factor – together with age 50–64 years, low annual income, and non-Nordic citizen – for work status in the community and in the group with chronic pain. Chronic pain but not the spreading of pain was related to health care seeking in the population.ConclusionThis study confirms earlier studies that report high prevalences of widespread pain in the population and especially among females and with increasing age. Widespread pain is associated with prominent effects on work status.

Clinical utility of the Canadian Occupational Performance Measure: Swedish version

The Canadian Occupational Performance Measure (COPM) is an individualised outcome measure intended to detect change in a clients perception of occupational performance over time. The aim of this study was to test the clinical utility of the Swedish version of the COPM. Data was collected from 27 occupational therapists in six focus groups. Emerging themes included goal-setting, preparations, limitations, interactions with clients, and impact on practice. The results indicated that the COPM is helpful in the goal-setting process and in planning treatment interventions. Therapists need knowledge about the theoretical foundation of the instrument and a personal interview technique. Problems were found using the instrument with clients who had poor insight or in acute settings. The COPM facilitated feedback on improvement over time. In summary, the COPM ensures a client-centred approach, facilitates communication within the rehabilitation team, and encourages therapists in their professional role.

Chronic regional muscular pain in women with precise manipulation work : A study of pain characteristics, muscle function, and impact on daily activities

Pain characteristics, muscle function and impact on daily activities were studied in 39 women with chronic regional muscular pain (RMP). They were all blue-collar workers in work involving precise manipulations. The main location of the pain was in the neck-shoulder region. Nineteen age-matched women with fibromyalgia (FM) were studied in the same way as the RMP patients. Thirty-seven women with no pain and with the same age and weight as the RMP patients served as reference group with respect to muscle strength and endurance. A follow-up study was done with respect to pain distribution and other pain characteristics 20 months after the initial examination. The findings were of the same nature in the RMP and the FM groups. The intensity of pain, the lowering of pain threshold for pressure, and the degree of sleep disturbance were greater in the FM than in the RMP group. Isometric muscle strength and static muscular endurance were reduced in both FM and RMP compared to reference values. The reduction in strength and endurance was greater in FM than in RMP. Even if the impact on everyday activities were greater in FM than in RMP, the impact was substantial in RMP patients also, for example with regard to work capacity. There were no transitions from RMP to FM during the 20 months to follow-up. Three FM patients, however, did not meet the ACR criteria for FM at follow-up.

Time use and activity patterns in women with long-term pain

Earlier studies of people with fibromyalgia have shown that pain, tiredness, and sleep disruption seriously affect their daily performance and their ability to maintain life roles. A time-geographic diary method was used to study activities and time use in the daily lives of women with long-term pain. The results of the diaries were also used to evaluate activity changes over time. Sixteen women wrote diaries over seven days, and after three months for another four days. The diaries were analysed in a computer program. After considering the results of the first diary, the women formulated goals to be met in the following three months. The results showed that working women spent significantly less time on “Care for others”, “Care for oneself”, Rest, and “Procure and prepare food” compared with non-working women. Further, working women used time in a manner similar to that of the Swedish female population. The diary method gave a clear picture of the womens daily lives. Visualized in graphs and tables, it will serve as an educational tool in rehabilitation and can be used as a framework for discussing adjustment and coping strategies. Liedberg GM, Hesselstrand ME, Henriksson CM. Time use and activity patterns in women with long-term pain.