Effect of a fibromyalgia rehabilitation programme in warm versus cold climate: a randomized controlled study.

Objective: To study the long-term effects on symptoms and physical function of a 4-week rehabilitation programme for patients with fibromyalgia, and to determine whether there are any differences if this programme is applied in a warm or cold climate.

Methods: A total of 132 patients with fibromyalgia were randomized to a rehabilitation programme in a warm or cold climate, or to a control group without intervention. Assessments were performed before and after intervention, and after 3 and 12 months. The main outcome measures were pain, measured by tender point count (TPC), and physical function, measured with the 6-min walk test (6MWT).

Results: There was no difference in any outcome variables at baseline. Persistent reduction in pain measured by TPC occurred only in the warm climatic setting. Mean difference (95% confidence interval (CI)) in TPC between warm and cold climate groups 1 year after the intervention was -1.7 (-2.9 to -0.5) and between the warm climate and the control group -2.2 (-3.3 to -1.0). Three months after the intervention the mean difference between the warm and cold climate groups in pain distribution (McGill mannequin) was -12 (-20 to -5) and between the warm climate and the control group -11 (-18 to -3). There were comparable improvements in physical function (6MWT) between the 2 intervention groups and the control group. The mean difference (95% CI) in 6MWT 1 year after the intervention between the warm climate and the control group was 33 (7-59) m. The corresponding value between the cold climate and the control group was 29 (3-55) m. Grip Strength (95% CI) was increased by 4.6 kg (2.3-6.4) in the warm climate and by 3.2 kg (0.9-5.5) in the cold climate compared with the control group 1 year after the intervention.

Conclusion: A rehabilitation programme for fibromyalgia may have a long-term effect on pain, as measured by TPC and pain distribution, when applied in a warm climatic setting, and may improve physical function regardless of the climatic setting.