PROGRAM RESULTS

| Inflammatory Arthritis | Fibromyalgia |

Inflammatory Arthritis

The following results are preliminary data from our evaluation of our Inflammatory Arthritis group (e.g., Rheumatoid Arthritis). This was a sample of 120 patients who completed a two-week program. The percentage change for each measure and the statistical significance of the pre to post-treatment change (based on paired t-tests) are given:

Variable	%Improvement	Statistical Significance
Grip Strength	9.8%	p < .05
Number of Tender Joints	11.3%	p < .01
Pain (Visual Analogue Scale)	21.6%	p < .0001
Coping (Visual Analogue Scale)	28.48%	p < .0001
Helplessness (Rheumatology Attitudes Index)	11.9%	p < .0001
Knowledge about disease (ACREU)	13.0%	p < .0001
Coping strategy use (Chronic Pain Coping Inventory)
Relaxation techniques	75.6%	p < .0001
Exercise	28.6%	p < .0001
Guarding/protecting	22.3%	p < .01
Depressed mood (CES Depression Scale)	29.6%	p < .01
Arthritis self-efficacy (ASES)	22.01%	p < .01

Fibromyalgia

Our Fibromyalgia Program was established in 1987 and was the first multidisciplinary treatment program for Fibromyalgia Syndrome in the world. This Program has operated without interruption since that time. Our findings were first published in the Journal of Rheumatology in 1992 [Nielson, W.R., Walker, C., & McCain, G.A. (1992). Cognitive-behavioural treatment of Fibromyalgia syndrome: Preliminary findings. Journal of Rheumatology, 19, 98 - 103] with a follow-up in 1995 [White, K.P. and Nielson, W.R. (1995) Cognitive-behavioural treatment of fibromyalgia syndrome: A follow-up assessment. Journal of Rheumatology, 22, 717 - 721].

The following are excerpts from our 1997 study published in Pain Research and Management (The Journal of the Canadian Pain Society) entitled "Outpatient cognitive- behavioural treatment of fibromyalgia: Impact on pain response and health status":

Authors
Warren Nielson PhD CPsych
Manfred Harth MD FRCPC
David Bell MD FRCPC

Method:

101 patients participated in the four week Rheumatology Day Care Program that included psychological, family educational, occupational therapy and physiotherapy interventions. Evaluation of patient status occured at admission, discharge, and at follow-up intervals of one, three, six and twelve months.

Results:

On the average, pain response and health status improved following the intensive cognitive-behavioural treatment. These effects persisted at the one year follow-up, albeit slightly weaker than at discharge. The largest effects observed were on the indexes reflecting emotional status and general well-being.

The complete abstract summarizing study results can be found here.

Detailed Observations:

Patient condition was evaluated on four major dimensions:

1. response to pain
2. health status
3. level of distorted thinking and pain-related worry
4. number of "tender points"

Observations are as follows under the above noted categories:

Pain Response
At discharge, strongest treatment effects were obtained for life control and emotional distress, with pain severity and life interference showing more moderate effects. At follow-up, life control and life interference showed the strongest effect.

Health Status
All variables under this measured dimension except physical impairment improved between admission and discharge. Strongest improvements were observed for the "feel good" and anxiety scales, with the most moderate changes occuring on the depression, stiffness and pain scales. At follow-up, scores from the physical impairment, feel good and anxiety scales were significantly improved over levels recorded at admission.

Emotional Thinking and Worry
Improvements were found in the emotional thinking and worry scales between admission and discharge, with the worry scale in particular improving further over the twelve month follow-up period.

Tender Point Count
No significant changes occurred in this area.

Note:
These results have been summarized from the original source article. More detail can be obtained through Dr. Warren Nielson, Program Director.

Our more recent research has focused on factors that predict how patients improve during our Program: Nielson, W.R. & Jensen, M.P. (2004). Relationship Between Changes in Coping and Treatment Outcome in Patients with Fibromyalgia Syndrome, Pain, 109, 233-241.

Jensen, M.P., Nielson, W.R., Turner, J.A., Romano, J.M. & Hill, M.L. (2004). Changes in Readiness to Self-Manage Pain are Associated with Improvement in Multidisciplinary Pain Treatment and Pain Coping. Pain, 111, 84-95.