Only 28.33% of Spanish Physiotherapists Follow Fibromyalgia Guidelines

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Exactly half of the sample had previously read or applied ≥ 1 Clinical Practice Guideline in the field of fibromyalgia.

A new study revealed only 28.33% of physiotherapists in Spain follow Clinical Practice Guidelines on fibromyalgia, yet physiotherapists have an acceptable level of knowledge and adherence to the guidelines.1

“Our results also reveal the existence of an evidence-to-practice gap in the field, with potential room for improvement: further efforts on promoting and reinforcing the importance of evidence-based therapies are needed, from university teaching plans to clinical updates for daily practice,” wrote investigators, led by José Édgar Ferrández-Gómez, from the pathology and surgery department at University of Miguel Hernández de Elche in Spain.

In the past decades, new clinical practice guidelines have been published with recommendations for the management of fibromyalgia. American Pain Society published guidelines in 2004, and more recently, European Alliance of Associations for Rheumatology and the Italian Rheumatology Society published guidelines in 2017 and 2021, respectively.2,3

Due to the new guidelines, Ferrández-Gómez and colleagues aimed to evaluate the level of knowledge and adherence physiotherapists in Spain had regarding Clinical Practice Guidelines on fibromyalgia.1 They conducted a cross-sectional study with an ad-hoc online survey to assess parts on the assessment, treatment, and decision of the length of the therapeutic treatment for fibromyalgia.

Physiotherapists were classified as adherent (following the guidelines), partially adherent, and non-adherent. Additionally, professionals answered questions on the level of agreement with various statements on fibromyalgia to assess a potential consensus.

In total, 240 physiotherapists met the criteria (mean age: 37.21 years; 55.83% women). Among them, 28.33% (n = 68) were adherent, 21.67% (n = 52) were partially adherent, and 50% were non-adherent.

Professionals who adhered selected the statements: patient outcome, strengthening exercise, aerobic exercise, self-management, behavioral-cognitive therapy, recommendation for fibromyalgia association, mindfulness, hydrotherapy mediative therapies (qigong, yoga, tai chi), balneotherapy and/or thermal therapy, and acupuncture.

People who partially adhered picked ≥ 1 neutral statement within the assessment: neurological, gait and posture, management therapeutic strategy, stretching, postural reeducation, magnetotherapy, ultrasounds, electrotherapy, and trigger points. Furthermore, participants who non-adhered selected a “non-recommended” option for therapy, either a tender points assessment, laboratory tests, radiological images, massage, biofeedback, chiropractic, homeopathy, and leave job.

Exactly 50% of the sample had previous experiences with reading or applying ≥ 1 Clinical Practice Guideline in the field of fibromyalgia.

“This finding is in line with previous research having stated that roughly one physiotherapist out of two follows evidence-based recommendations in clinical practice,” investigators wrote. “Furthermore, among those professionals who adhere to [Clinical Practice Guidelines], the implementation of those strategies is not always adequately channeled, since recommendations from [Clinical Practice Guidelines] do not have an automatic translation to clinical practice.”

Investigators observed the academic level of studies (P = .001) and having previous training in fibromyalgia (P = .001) had statistically significant differences across adherence groups.

“Counterintuitively, the years of professional experience do not display a significant impact in this respect,” investigators noted.

The team explained this could be because research on fibromyalgia has expanded in the last decades, and professionals might not be updated on new knowledge of the conceptualization.

Physiotherapists reached consensus on 15 out of 24 statements. Professionals had a lack of consensus on the application of acupuncture and the use of pharmacological treatment. Many physiotherapists said they focus on patient education (92.50%), strength training (80.83%), aerobic exercise (75%), and self-management strategies (73.75%).

The team highlighted several limitations, including excluding participants if they did not treat ≥ 1 patient with fibromyalgia in the last 2 years, having a relatively small sample size, the classification of “non-adherent” could be viewed as “severe,” and not controlling for potential professional-based social desirability response bias.

“Our findings highlight the presence of an acceptable level of knowledge and adherence on clinical practice guidelines in the field of fibromyalgia among physiotherapists in Spain,” investigators concluded.


  1. Ferrández-Gómez JÉ, Gacto-Sánchez M, Nouni-García R, Gascón-Jaén J, Lozano-Quijada C, Baño-Alcaraz A. Physiotherapists' adherence to Clinical Practice Guidelines in fibromyalgia: a cross-sectional online survey. Rheumatol Int. Published online June 5, 2024. doi:10.1007/s00296-024-05630-4
  2. Macfarlane GJ, Kronisch C, Dean LE, Atzeni F, Häuser W, Fluß E, Choy E, Kosek E, Amris K, Branco J, Dincer F, Leino-Arjas P, Longley K, McCarthy GM, Makri S, Perrot S, Sarzi-Puttini P, Taylor A, Jones GT (2017) EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis 76:318–328.
  3. Ariani A, Bazzichi L, Sarzi-Puttini P, Salaffi F, Manara M, Prevete I, Bortoluzzi A, Carrara G, Scirè C, Ughi N, Parisi S (2021) The Italian Society for Rheumatology clinical practice guidelines for the diagnosis and management of fibromyalgia. Best practices based on current scientific evidence. Reumatismo 73:89–105.