Telerehabilitation Improves Quality of Life in Patients With Fibromyalgia

Results of a systematic review of randomized controlled trials (RCTs) demonstrated that telerehabilitation can improve the symptoms of quality of life (QoL), depression, pain intensity, and pain catastrophizing in patients with fibromyalgia, according to data published in Journal of Medical Internet Research.¹ However, investigators noted that the safety of telerehabilitation in inconclusive because of a lack of sufficient evidence for managing fibromyalgia. Therefore, future trials should be conducted to confirm the safety and efficacy of this method for this patient population.

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In addition to physical symptoms, fibromyalgia is also linked to sleep issues, cognitive dysfunctions, fatigue, and depression. These in turn lead to decreased QoL as well as an economic burden on the patient and their families.²

“With the rapid development of telecommunication technology, a number of RCTs on the application of telerehabilitation in patients with fibromyalgia have been published recently,” wrote Mao-Yuan Wang, PhD, Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, China, and colleagues. “However, few systematic reviews have summarized the characteristics, efficacy, and safety of telerehabilitation in fibromyalgia.”

The review and meta-analysis analyzed the efficacy and safety of telerehabilitation in patients with fibromyalgia using a search of databases including PubMed, Cochrane Library, Ovid MEDLINE, Embase, ScienceDirect, PEDro, and Web of Science from inception to November 2022. Eligibility studies included adult patients with a fibromyalgia diagnosis according to the American College of Rheumatology criteria, telerehabilitation intervention, and a control group that received non-telerehabilitation, such as face-to-face treatment, no intervention, usual care, or a waiting list.

The Cochrane Risk of Bias Tool was used to evaluate the methodological quality. Outcome measures included pain intensity, pain catastrophizing, QoL, the Fibromyalgia Impact Questionnaire (FIQ) scale, depression, and adverse events.

In total, 14 RCTs comprised of 1242 patients were included in the meta-analysis. The mean age of patients ranged from 39.7 to 55.5 years and the duration of symptoms ranged from 6.21 to 20.0 years.

Pooled results proved that telerehabilitation improved the FIQ score (weighted mean difference -8.32, 95% confidence interval [CI] -11.72 to -4.91; P <.001) and QoL (standardized mean difference [SMD] .32, 95% CI .18 to .47; P <.001) in patients with fibromyalgia when compared with controls. The intervention also improved depression levels (SMD -.42, 95% CI -.62 to -.22; P <.001), pain intensity (SMD -0.62, 95% CI -.76 to -.47; P <.001), and pain catastrophizing (weighted mean difference -5.81, 95% CI -9.40 to -2.23; P = .001) in this patient population.

Only 1 RCT reported a mild adverse event in patients receiving telerehabilitation, in which 34% of patients experienced mild pain. However, the regression analysis showed no significant relationship between telerehabilitation and adverse events.

Investigators noted several limitations of the analysis, such as only including studies that were published in English, which may have resulted in a language bias. Further, only 2 studies included a 6-month follow-up period. Therefore, the meta-analysis was only able to analyze the short-term effects of telerehabilitation intervention. Lastly, the RCTs included in the meta-analysis were heterogeneous regarding the medium and programs of telerehabilitation in the intervention cohort.

“Our study found that telerehabilitation is an effective treatment approach for patients with fibromyalgia,” investigators concluded. “Telerehabilitation can provide accessible and continuous rehabilitation medical services for patients with fibromyalgia who cannot attend traditional face-to-face services or are geographically remote, and it could enable patients to manage their disease at any time and place in a timely and appropriate manner.”

References

1. ^{Wu YQ, Long Y, Peng WJ, et al. The Efficacy and Safety of Telerehabilitation for Fibromyalgia: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res. 2023;25:e42090. Published 2023 Apr 25. doi:10.2196/42090}
2. ^{D'Onghia M, Ciaffi J, Ruscitti P, Cipriani P, Giacomelli R, Ablin JN, et al. The economic burden of fibromyalgia: a systematic literature review. Semin Arthritis Rheum 2022 Oct;56:152060.}