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Ottawa Panel Evidence-Based Clinical Practice Guidelines for Aerobic Fitness Exercises in the Management of Fibromyalgia: Part 1

Ottawa Panel Members:
Ottawa Methods Group:
L Brosseau, PhD, Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Civic Campus, Ottawa, Ontario, Canada; Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; and University Research Chair, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa.
GA Wells, PhD, Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Civic Campus, and Department of Epidemiology and Community Medicine, University of Ottawa.
P Tugwell, MD, MSc, Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Civic Campus; Department of Epidemiology and Community Medicine, University of Ottawa; and Centre for Global Health, Institute of Population Health, Ottawa, Ontario, Canada.
M Egan, PhD, Program of Occupational Therapy, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa.
KG Wilson, PhD, Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Civic Campus, and The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada.
CJ Dubouloz, PhD, Program of Occupational Therapy, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa.
L Casimiro, MA, Director, Academic Health Council, University of Ottawa.
VA Robinson, MSc, Clinical Epidemiology Unit, Ottawa Hospital Research Institute, Ottawa Hospital, Civic Campus, and Centre for Global Health, Institute of Population Health, Ottawa, Ontario, Canada.
J McGowan, MLIS, Director, Medical Library, Centre for Global Health, Institute of Population Health.
External Experts:
A Busch, PhD, member of Canadian Physiotherapy Association and School of Physical Therapy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
S Poitras, PhD, School of Rehabilitation Sciences, University of Ottawa.
H Moldofsky, MD, Professor Emeritus, Toronto Psychiatric Research Foundation, Centre for Sleep and Chronobiology, Faculty of Medicine, University of Toronto.
M Harth, MD, Division of Rheumatology, St Joseph's Hospital, London, Ontario, Canada.
HM Finestone, MD, FRCPC, member of Canadian Association of Physical Medicine and Rehabilitation; SCO Health Service, Elisabeth Bruyere Health Centre, Ottawa, Ontario, Canada; and Faculty of Medicine, University of Toronto.
W Nielson, PhD, Arthritis Institute, St Joseph Health Care Centre, London, Ontario, Canada.
A Haines-Wangda, MSc, member of Canadian Physiotherapy Association and Ottawa Hospital, General Campus, Ottawa, Ontario, Canada.
M Russell-Doreleyers, MSc, member of Canadian Physiotherapy Association and The Arthritis Society Arthritis Rehabilitation & Education Program (AREP), Ottawa, Ontario, Canada.
K Lambert, The Arthritis Society Arthritis Rehabilitation & Education Program (AREP) and member of Canadian Occupational Therapy Association.
A consumer (KE) with fibromyalgia, referred by the Fibromyalgia and Chronic Fatigue Syndrome Canada, Ottawa, Ontario, Canada.
Assistant Manuscript Writers:
AD Marshall, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa.
L Veilleux, Program in Occupational Therapy, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa.

Lucie.Brosseau{at}uottawa.ca

Background and Purpose: The objective of this study was to create guidelines for the use of aerobic fitness exercises in the management of adult patients (>18 years of age) with fibromyalgia, as defined by the 1990 American College of Rheumatology criteria.

Methods: Following Cochrane Collaboration methods, the Ottawa Methods Group found and synthesized evidence from comparative controlled trials and formed the Ottawa Panel, with nominated experts from key stakeholder organizations. The Ottawa Panel then developed criteria for grading the recommendations based on experimental design (I for randomized controlled trials, II for nonrandomized studies) and strength of evidence (A, B, C+, C, D+, D, or D–). From the rigorous literature search, 13 randomized control trials and 3 controlled clinical trials were selected. Statistical analysis was based on Cochrane Collaboration methods. Continuous data were calculated with weighted mean differences between the intervention and control groups, and dichotomous data were analyzed with relative risks. Clinical improvement was calculated using absolute benefit and relative difference in change from baseline. Clinical significance was attained when an improvement of 15% relative to a control was found.

Results: Five positive recommendations of clinical benefit were produced.

Discussion and Conclusion: There were 24 positive recommendations: 10 grade A, 1 grade B, and 13 grade C+. The Ottawa Panel recommends aerobic fitness exercises for the management of fibromyalgia as a result of the emerging evidence (grades A, B, and C+, although most trials were rated low quality) shown in the literature.

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This article has been cited by other articles:

				L. Brosseau, G. A Wells, P. Tugwell, M. Egan, K. G Wilson, C.-J. Dubouloz, L. Casimiro, V. A Robinson, J. McGowan, A. Busch, et al. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Strengthening Exercises in the Management of Fibromyalgia: Part 2 Physical Therapy, July 1, 2008; 88(7): 873 - 886. [Abstract] [Full Text] [PDF]