Fibromyalgia Clinical Trial
Official title:
Effect of Anti-Depressants vs Physiotherapy in Management of Fibromyalgia Syndrome: What Predicts a Clinical Benefit?
To compare the efficacy of physiotherapy and anti-depressants in disability reduction in patients of Fibromyalgia syndrome.
Research Question:
Does the use of physiotherapy or pharmacotherapy help in improving quality of life in
patients of fibromyalgia as judged by fibromyalgia impact questionnaire at a 6 month follow
up period?
Study hypothesis:
Physiotherapy is no better than pharmacotherapy in improving the quality of life in patients
of fibromyalgia as judged by fibromyalgia impact questionnaire.
Study type- Interventional STUDY DESIGN: open label alternate patient treatment allocation
Ethical approval for the trial protocol has been obtained from the institute's ethics
committee of Mahatma Gandhi Institute of Medical Sciences, Sevagram.
Subjects and Methods The study will be conducted in Kasturba Hospital and Mahatma Gandhi
Institute of Medical Sciences, Sevagram, from 1 march 2006 - 1 dec 2007. Patients will be
selected to enter the study, in such a way that every patient presenting with chronic
muscular pain will be screened in the study and patients fulfilling inclusion criteria will
be recruited in the study.
Study population:
Total of 175 patients will be included in the study.
Methods:
The investigators will screen all patients who are referred to them for inclusion in the
study. Written informed consent will be obtained from all participants. The patients
included in the study will be administered a standardized questionnaire to record
socio-demographic characteristics, symptom characteristics and history of previous visits to
a health care provider. The socio-economic score (SES) will be determined using a validated
questionnaire.[6] Briefly, the questionnaire consists of following: (1) household profile,
(2) material possession profile, (3) educational profile, (4) occupational profile, (5)
economic profile (6) possessed land or house cost profile and (7) social profile.
Fibromyalgia impact questionnaire (FIQ) will be used to determine a baseline score. [7] For
the purpose of the study this questionnaire is translated to local language (Marathi), and
back-translated to English to ensure its accuracy. Minor modifications have been done in the
questionnaire to make it suitable for our setting (for example: the use of washer or dryer
for laundry was modified to washing the laundry by themselves). Assessment of psychiatric co
morbidity will be done using the Brief Psychiatric Rating Scale (BPRS), which is an 18 item
instrument, each item has a seven severity grades.[8] A score of 32 or more indicates
presence of psychopathology.[9]
Interventions:
A trained Physiotherapist will conduct a uniform structured physical training and aerobic
session for one group of patients. The patients will be advised to perform the exercises
daily twice for at least 10 minutes. There will be a step up pattern of exercise regimen
followed with relaxation, stretching and strengthening techniques. The methodology is
described in box 1. The second group of patients will receive antidepressant in the form
open label amitriptyline 25 mg once daily at bedtime. The dose of the drug may be increased
if required. All patients will be also offered pharmacologic treatment with 50 mg tramadol
in thrice daily doses and as required. The treatment recommendations are based on standard
recommendations on the management of fibromyalgia.[5]
Outcome assessment All patients will be followed up for six months at monthly intervals. At
each visit the study investigators will determine the course of the disease and compliance
with therapy. The FIQ score will be assessed at the end of 6 monthly visits. Reduction in
FIQ score from the baseline will be used as the principle outcome measure.
;
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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