Effectiveness of psychological therapies in the rehabilitation of individuals with Fibromyalgia: Responder analysis

Rehabilitative therapies combining education and exercise with psychological components have been shown to be efficacious in the treatment of patients with fibromyalgia (FM). The current study was designed to identify the factors associated with treatment success for FM patients participating in rehabilitative treatment. Patients were designated as responders vs. non-responders based on changes (pre to post) in their Fibromyalgia Impact Questionnaire Physical Scale (FIQ-P Change). An extreme groups method was used - Responders were defined as participants with FIQ-P Change z-scores > .5, and Non-Responders as participants with FIQ-P Change z-scores < -.5. A hierarchical logistic regression was conducted with: (1) demographics (i.e., age, symptom duration), (2) change in pain (Multidimensional Pain Inventory- Pain Severity scale, (3) change in physical measures (i.e., range of motion, muscle strength), and (4) change in self-efficacy (Modified Arthritis Self-efficacy Scale) and depressed mood (Center for Epidemiological Studies Depression scale). A difference in Chi-square test was utilized to determine whether the addition of this set of variables significantly added to the model. The final reduced model included education, changes in self-efficacy, and changes in depressed mood. This model accounted for approximately 42.6% of the variance χ2 ([3] = 65.80, p < .001). On the basis of these 3 variables, classification was correct for 76.8% of non-responders, and 80.9% of responders, for an overall classification rate of 78.9%. These results suggest that education and improvement of self-efficacy and mood mediate response to treatment. The results confirm the important role of patients' mood and beliefs in treatment effectiveness for rehabilitative approaches. Treatments for FM should focus on improving patients' self-efficacy and depressed mood as well as directly on symptom management and physical functioning.

This research was support from a grant from the National Institutes of Health (AR 44724)