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Few Canadian rheumatologists endorse recommended interventions for fibromyalgia
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Although most Canadian rheumatologists follow the country’s 2012 guideline recommendations for managing fibromyalgia, few believed they were effective, indicating an update may be necessary, according to findings published in the Journal of Clinical Rheumatology.
In addition, the researchers found that rheumatologists in Canada do not, in general, provide primary care for fibromyalgia.
“Fibromyalgia is a challenging condition for patients and their health care providers, and management is often highly variable,” Jason W. Busse, DC, PhD, of McMaster University, in Hamilton, Ontario, Canada, told Healio Rheumatology. “In recognition of this, professional associations have published clinical practice guidelines. However, the degree to which care is consistent with recommendations is uncertain — as is clinicians’ impressions of the effectiveness of guideline-recommended care.”
To determine the attitudes and management strategies of Canadian rheumatologists toward fibromyalgia, and how they relate to the 2012 Canadian Guidelines, the researchers drafted a 17-item cross-sectional survey with the aid of epidemiologists, other rheumatologists and previous studies. The survey measured respondents’ attitudes and concordance with the guideline recommendations.
Using contact information in the publicly available Canadian Rheumatology Association online member database, as well as the American College of Rheumatology membership directory, the researchers distributed the survey to the offices of 331 Canadian rheumatologists from July to October 2016. Of those, 140 returned the survey.
According to the researchers, 80% of respondents believed that fibromyalgia was a useful clinical diagnosis. However, just 54% said fibromyalgia was objectively defined, whereas 30% believe it is a psychosocial condition. Among the respondents, 37% said fibromyalgia could result in an inability to work.
In addition, 61% of respondents believed that tender points were useful in diagnosing fibromyalgia, and half agreed with potentially refusing consultations related to the disease — both contrary to the guideline recommendations. Just 42% agreed that therapies were effective in treating the disease, the researchers found.
However, more than 89% of rheumatologists who returned the survey agreed with the guideline’s recommendation that fibromyalgia should be managed with education, exercise therapy, antidepressants and nonnarcotic analgesics. Still, the confidence that such therapies were actually effective ranged from 9% to 47%.
According to the researchers, an analysis of the guideline uncovered several limitations.
“Our evaluation of the 2012 Canadian Guidelines suggests this document suffers from several limitations in terms of meeting standards for a trustworthy guideline,” Busse said.
He added that updates to the guideline are “urgently needed,” and must include recent evidence current best practices.
“Canadian rheumatologists find management of fibromyalgia to be challenging, despite good uptake of the 2012 Canadian guideline recommendations — apart from providing cognitive behavioral therapy,” he said. “Limited provision of cognitive behavioral therapy may reflect a resource issue, which should be considered by payers and policy makers. Rheumatologists cannot be expected to implement recommendations for treatments that are not available.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
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