ACR：综合治疗对患纤维肌痛综合征的低教育水平女性长期有效

混合线性模型分析揭示综合治疗的睡眠指数高，临床症状改善佳

纤维肌痛综合征（FM）的综合治疗是有效的。然而，综合治疗方法因不能维持疗效和没有关于特定人群的研究而受到质疑。针对这一情况，来自西班牙塔拉戈纳琼XXIII大学医院的ANTONI CASTEL等人进行了一项研究，该研究的目的是评价综合治疗对患FM的低教育水平女性的疗效，及在长期随访中综合治疗的疗效维持情况。研究结果在线发布在2013年3月的《关节炎护理及研究》（Arthritis Care & Research）杂志上。作者发现，综合治疗能有效减少低教育水平个体的主要FM症状。一些治疗效果能维持到综合治疗结束后的1年。
受试者的入选标准包括：女性、明确诊断FM（符合美国风湿病学会标准）、年龄在18岁到60岁之间，受教育年限在3至8年。研究对象被随机分配接受处理条件1或2，即传统治疗或综合治疗。结果评价包括：功能障碍、睡眠障碍、疼痛强度、灾难感和心理痛苦程度。采用实验和评估法进行分析，错误数据经基线观测结转方法去除。
该研究共招募155位受试者，2个实验组之间在预处理措施上未发现显著差异。总体统计比较揭示两个实验组在所有研究变量上都存在显著差异，P < 0.0001。在治疗结束后，混合线性模型分析证实综合治疗在所有研究变量上都存在优越性。在以后12个月的随访中，这种差异依然存在：睡眠障碍 (P < 0.0001)、灾难感( P < 0.0001)和心理痛苦(P < 0.01)等方面存在显著差异。
研究发现，综合治疗能有效减少低教育水平个体的主要FM症状。一些治疗效果能维持到综合治疗结束后的1年。

Efficacy of a multidisciplinary fibromyalgia treatment adapted for women with low educational levels: a randomized controlled trial.
OBJECTIVE
Multidisciplinary treatments of fibromyalgia (FM) have demonstrated efficacy. Nevertheless, they have been criticized for not maintaining their benefits and for not being studied for specific populations. Our objectives were to determine the efficacy of a multidisciplinary treatment for FM adapted for patients with low educational levels and to determine the maintenance of its therapeutic benefits during a long-term followup period.
METHODS
Inclusion criteria consisted of female sex, a diagnosis of FM (using American College of Rheumatology criteria), age between 18 and 60 years, and between 3 and 8 years of schooling. Patients were randomly assigned to 1 of the 2 treatment conditions: conventional pharmacologic treatment or multidisciplinary treatment. Outcome measures were functionality, sleep disturbances, pain intensity, catastrophizing, and psychological distress. Analysis was by intent-to-treat and missing data were replaced following the baseline observation carried forward method.
RESULTS
One hundred fifty-five participants were recruited. No statistically significant differences regarding pretreatment measures were found between the 2 experimental groups. Overall statistics comparison showed a significant difference between the 2 groups in all of the variables studied (P < 0.0001). Mixed linear model analysis demonstrated the superiority of the multidisciplinary treatment in all of the studied variables at posttreatment. The differences were maintained at 12-month followup in sleep disturbances (P < 0.0001), catastrophizing (P < 0.0001), and psychological distress (P < 0.01).
CONCLUSION
Multidisciplinary treatment adapted for individuals with low educational levels is effective in reducing key symptoms of FM. Some improvements were maintained 1 year after completing the multidisciplinary treatment.