AB1367 EFFECTIVENESS OF REHABILITATION STRATEGIES IN PRIMARY FIBROMYALGIA SYNDROME: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

BackgroundFibromyalgia is characterized by chronic inconsistent widespread pain and tenderness. It is also associated with other comorbid symptoms like sleep disturbances, fatigue, cognitive impairments (memory and mood disturbances), and/or irritable bowel syndrome.[1]Prevalence of fibromyalgia is 2.7% globally, being slightly higher in middle aged women (4-9%). 75 to 100 % patients with fibromyalgia face depression, anxiety and/or stress. The probability of occurrence of depression is almost 40% at any stage in the course of fibromyalgia.[2]Patients usually report physical symptoms of depression (e.g. appetite, sleep, and sexual dysfunction) rather than mood-related psychological symptoms (e.g. suicidal ideation, low self-esteem), however depression is affective expression of chronic pain and neuromarkers of both cannot be isolate.[3]Reviews done till date are either oriented toward specific form of exercise or towards specific outcome. We could not come across any review which included all form of exercise with measurement of multiple outcomes.ObjectivesThe aim of this review was to 1) summarize evidence on the effectiveness of rehabilitation strategies in Fibromyalgia syndrome (FMS) and 2) determine the most effective rehabilitation strategy for reducing pain and depression in people with FMS.MethodsPubMed, Ovid (Sp), and Cochrane search engines were used for identifying the studies done till 1 July 2022. Randomized control trials (RCTs) that have passive control group and active control group were included in this review for primary and secondary aim respectively. The primary outcome measures were Pain and depression. Secondary outcome was one from the sleep or fatigue or healthy related quality of life (HRQOL).ResultsA total of 25 RCTs were included. Separate random effect model meta-analysis is performed for randomised control trial with active and passive control group. Mean difference or Standard Mean difference with 95% confidence interval used to assess the effect size. Studies with passive control group showed moderate to large positive effects on pain (SMD -0.65, 95% CI -0.93 to -0.38; I2 = 72%) and HRQOL(MD -5.40, 95% CI -10.17 to -0.62; I2 = 74%) but non-significant for sleep, fatigue, and depression. Furthermore, on subgroup analysis studies with short term protocol showed significant effect on pain only, whereas studies with long term protocols showed positive effect on pain and HRQOL only but non-significant at the time of post-trial follow-up. Studies with active control group represent non- significant results except mixed exercises which showed positive effect (MD -4.78, 95% CI -7.98 to -1.57; I2 = 0%) for HRQOL.ConclusionAll rehabilitation strategies were effective for pain and HRQOL, and has marginal effect on depression, sleep, and fatigue but efficacy was not maintained at the time of post-trial follow-up. However, in this review we could not differentiate any rehabilitation strategies for the best among those used in the included studies.