Assessment and Treatment of Patients with Fibromyalgia Syndrome. Quantitative and Qualitative aspects.

Fibromyalgia syndrome (FMS) is characterised by diffuse, long-lasting, widespread pain and aching, accompanied by fatigue, stiffness and sleep disturbances. The symptoms may be aggravated by physiological and psychological overload. The aim of this thesis was to obtain further knowledge of the functional limitations and disabilities of patients with FMS and to evaluate the effects of physical exercise and patient education from a physiotherapeutic perspective.

The patients with FMS included in these studies were mainly recruited from primary health care. The physical performance capacity of the female FMS patients was compared with that of the age- and sex-matched healthy reference group, using performance-based measurements. The reliability of these measurements was evaluated. A number of patients were interviewed to obtain further knowledge of the way they experienced their symptoms and the interviews were analysed using a phenomenological method. Two randomised, controlled, prospective studies were conducted to evaluate the effects of treatment in FMS, using performance tests and self-administered questionnaires.

FMS patients displayed a reduction in physical performance capacity when compared with the healthy reference group. Six of seven measurements were found to possess acceptable reliability for use in FMS. Four different patterns of how FMS symptoms were experienced and managed were identified in the interviews: struggling, adapting, in despair and giving up. The 6-week programmes produced an improvement in self-efficacy in the treatment groups as they were compared with the control group. Individually adapted physical exercise in a temperate pool once a week for 6 months, combined with patient education, was found to improve symptoms, functional limitations, disabilities and psychological distress in the treatment group as compared with the control group.