ABSTRACT
BACKGROUND: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. METHODS: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A literature search for systematic reviews of randomized, controlled trials on physiotherapy, occupational therapy and physical therapy from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. RESULTS AND CONCLUSION: Low to moderate intensity endurance and strength training are strongly recommended. Chiropractic, laser therapy, magnetic field therapy, massage and transcranial magnetic stimulation are not recommended.
Subject(s)
Fibromyalgia/therapy , Occupational Therapy , Physical Therapy Modalities , Practice Guidelines as Topic , Combined Modality Therapy , Exercise , Fibromyalgia/diagnosis , Humans , Patient Care Team , Societies, MedicalABSTRACT
BACKGROUND: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. METHODS: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A search of the literature for systematic reviews of randomized controlled trials of complementary and alternative therapies from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was formed by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences and applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. RESULTS AND CONCLUSION: Meditative movement therapies (e.g. qi gong, tai chi and yoga) are strongly recommended. Acupuncture and weight reduction in cases of obesity can be considered.
Subject(s)
Complementary Therapies/methods , Fibromyalgia/therapy , Practice Guidelines as Topic , Consensus Development Conferences as Topic , Evidence-Based Medicine , Fibromyalgia/diagnosis , Germany , Humans , Randomized Controlled Trials as Topic , Societies, MedicalABSTRACT
BACKGROUND: The regular update of the guidelines on fibromyalgia syndrome, AWMF number 145/004, was scheduled for April 2017. METHODS: The guidelines were developed by 13 scientific societies and 2 patient self-help organizations coordinated by the German Pain Society. Working groups (n =8) with a total of 42 members were formed balanced with respect to gender, medical expertise, position in the medical or scientific hierarchy and potential conflicts of interest. A search of the literature for systematic reviews on randomized, controlled trials on patient education and shared decision-making from December 2010 to May 2016 was performed in the Cochrane library, MEDLINE, PsycINFO and Scopus databases. Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine version 2009. The strength of recommendations was achieved by multiple step formalized procedures to reach a consensus. Efficacy, risks, patient preferences, clinical and practical applicability of available therapies were weighed up against each other. The guidelines were reviewed and approved by the board of directors of the societies engaged in the development of the guidelines. RESULTS AND CONCLUSION: The diagnosis of fibromyalgia syndrome should be explicitly communicated to the affected individual. Shared decision-making with the patient on the therapeutic options based on individual preferences of the patient, comorbidities and the success of previous treatment is recommended. A step-wise treatment approach depending on the severity of fibromyalgia syndrome and the response to therapeutic measures is recommended.
Subject(s)
Fibromyalgia/diagnosis , Fibromyalgia/therapy , Interdisciplinary Communication , Intersectoral Collaboration , Patient Education as Topic/methods , Practice Guidelines as Topic , Decision Making , Fibromyalgia/classification , Germany , Humans , Societies, MedicalABSTRACT
OBJECTIVES: The aim of this exploratory double-blinded, randomized, cross-over, in situ study was to compare the effects of various model parameters ('intervention', 'brushing', 'position') on enamel caries lesions in a dose-response model. METHODS: In each of four experimental legs of four weeks 16 participants wore intraoral mandibular appliances with four 'plaque-retaining' and four 'easily cleanable' positioned pre-demineralized bovine enamel specimens in the vestibular flanges mimicking proximal and buccal surfaces, respectively (n=512). The four randomly allocated interventions (either application only or brushing) included the following dentifrices: AlF3 1360ppmF(-)+chlorhexidine 0.05% (Lacalut aktiv, LA1360), NaF 1,450ppmF(-)(Blend-a-Med ProExpert), NaF 500ppm F(-) and 0ppm F(-) as negative control (NC) (both experimental, based on Blend-a-Med ProExpert). RESULTS: Differences in integrated mineral loss (ΔΔZ) and lesion depth (ΔLD) were calculated between values before and after the in situ period using transversal microradiography. Significant differences for ΔΔZ [adjusted mean (95% CI))] were found between NC, NaF500 and LA1360for both 'plaque-retaining' [-1830 (-2371;1289); -986 (-1530;442); -2 (-548;544)vol%×µm] as well as 'easily cleanable' specimens [-399 (-682; -116); -391 (-672; -110); -16 (-302;270)vol%×µm]. Values for NaF1450 revealed a similar dose-response as LA1360.Values for LA1360 and NaF1450 did not differ significantly (p>0.05; ANCOVA). CONCLUSION/CLINICAL SIGNIFICANCE: The design of the present in situ study was able to reveal a fluoride dose-response to hamper further demineralization of enamel specimens for 'easily cleanable' and 'plaque-retaining' sites being brushed or not. Particularly 'plaque-retaining' sites seem to be recommendable for measuring potential anticaries efficacy in situ.
