Introduction: Fibromyalgia syndrome (FMS) is the most common form of chronic widespread pain, according to the International Classification of Disease-1. This work aimed to determine the level of knowledge, adherence to the Clinical Practice Guidelines (CPGs), confidence of Italian physiotherapists in managing FMS patients and difficulties in following the guidelines’ recommendations, and which variables explained most of the participants’ knowledge.

Methods: Survey’s final version consisted of 6 sections: introduction to the study; demographics; guidelines’ adherence; perceived knowledge of guidelines; participants’ difficulties; and knowledge of FMS. The questionnaire was administered via social media (e.g., Facebook, Instagram) and newsletter (i.e., Italian Association of Physiotherapists). The a-priori estimated sample size was 383 participants. This work was approved by the ethics committee of the University of Campobasso (protocol number 32/2023), and its protocol was prospectively registered in Open Science Framework.

Results: Total replies were 398. Forty-two percent of participants reported low or absent confidence in treating FMS patients, whereas 49% reported medium confidence and only 9% of responding physiotherapists reported a high or extremely high level of confidence. Similarly, 67% declared to have a poor or worse knowledge of CPGs. Among the 132 (33%) who reported a good or very good knowledge, four major themes describing their difficulties in implementing CPGs recommendations in their clinical practice arose: own factors, other professionals’ factors, patient’s factors, and external factors. Overall adherence to the CGPs recommendations was good. However, specific items showed too much reliance on posture, education techniques used in isolation, and focus on painful symptoms. The total score of the 20 True or False items revealed a good knowledge of FMS theory, with a median score of 17.0 points.

Conclusions: On average, Italian physiotherapists have a good knowledge of CPGs and of FMS. Despite this, only a small percentage report having high or extreme confidence in the management of these patients. Among the most commonly expressed difficulties there are the lack of training on education and communicative strategies, multidisciplinary relationships and factors related to the patient such as psychosocial aspects, compliance and clinical variability of each clinical case. This could indicate that knowledge of CPGS and FMS alone may not be sufficient and that clinicians need to develop, through specific training, transversal skills for the optimal management of these patients. Nonetheless, this survey was probably subjected to a selection bias, and items used to measure the knowledge of participants on FMS were not previously validated. For these reasons further research is necessary.

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2.        Macfarlane GJ, Kronisch C, Dean LE, et al. EULAR revised recommendations for the management of fibromyalgia. Ann Rheum Dis. 2017;76(2):318-328. doi:10.1136/ANNRHEUMDIS-2016-209724