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Cited by 210Fibromyalgia and Chronic Fatigue Syndrome ResearchMusculoskeletal pain and rehabilitationMobile Health and mHealth Applications

Internet-enhanced management of fibromyalgia: A randomized controlled trial

Open access
Williams, David A., Kuper, David, Segar, Michelle, Mohan, Niveditha, Sheth, Manish, Clauw, Daniel J.·2010·Pain
DOI 10.1016/j.pain.2010.08.034PMC PMC2972378
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Abstract

Both pharmacological and non-pharmacological interventions have demonstrated efficacy in the management of fibromyalgia (FM). Non-pharmacological interventions however are far less likely to be used in clinical settings, in part due to limited access. This manuscript presents the findings of a randomized controlled trail of an Internet-based exercise and behavioral self-management program for FM designed for use in the context of a routine clinical care. 118 individuals with FM were randomly assigned to either (a) standard care or (b) standard care plus access to a Web-Enhanced Behavioral Self-Management program (WEB-SM) grounded in cognitive and behavioral pain management principles. Individuals were assessed at baseline and again at 6 months for primary endpoints: reduction of pain and an improvement in physical functioning. Secondary outcomes included fatigue, sleep, anxiety and depressive symptoms, and a patient global impression of improvement. Individuals assigned to the WEB-SM condition reported significantly greater improvement in pain, physical functioning, and overall global improvement. Exercise and relaxation techniques were the most commonly used skills throughout the 6 month period. A no-contact, Internet-based, self-management intervention demonstrated efficacy on key outcomes for FM. While not everyone is expected to benefit from this approach, this study demonstrated that non-pharmacological interventions can be efficiently integrated into routine clinical practice with positive outcomes.

AI snapshot

Written from the paper’s full text.

TL;DR

In a 6-month intent-to-treat randomized controlled trial, adding a no-contact Internet behavioral self-management program to standard care significantly improved pain and physical functioning in adults with fibromyalgia compared with standard care alone. Secondary sleep, fatigue, and mood outcomes did not differ, but patient global impression of change favored the web-enhanced group.

Key findings

  • Among 118 randomized participants (59 per arm), WEB-SM improved average pain versus standard care (F(1,115)=5.67, p<.01); 30% pain responders were 29% in WEB-SM vs 8% in standard care (p<.008), with NNT=5.
  • Physical functional status improved in WEB-SM versus standard care (F(1,115)=5.08, p<.03); 0.50 SD responders were 31% vs 6% (p<.002), with NNT=5.
  • Sleep, fatigue, depression, and anxiety did not show significant group differences. PGIC improvement was reported by 57% of WEB-SM participants vs 21% of standard care participants (n=35 vs n=33; p<.003).
  • Adherence: 89%–94% of WEB-SM participants used at least one module monthly, averaging 4 skills at a time; functional responders used exercise, pleasant activity, and problem solving more than non-responders (p<.03, p<.02, p<.03), while no clear skill pattern was tied to pain response.

Methods

  • Six-month RCT at Avera Research Institute in Sioux Falls, South Dakota, in a mostly rural five-state catchment; 118 adults meeting ACR fibromyalgia criteria were randomized 1:1 to standard care or standard care plus WEB-SM, a 13-module website with no additional coaching or professional contact.
  • Primary outcomes were SF-36 Physical Functioning and Brief Pain Inventory Severity; secondary outcomes included Multidimensional Fatigue Inventory, MOS Sleep Scale, CES-D, STPI anxiety, and PGIC.
  • Intent-to-treat analysis used baseline observation carried forward for missing endpoint values; baseline-adjusted ANCOVA tested group differences, with Fisher’s exact tests for responder, adherence, manipulation-check, and satisfaction comparisons. Sample was 95% female, mean age 50 years (SD=11.5), 97% Caucasian, 79% married, mean FM duration 9.4 years (SD=6.5), mean BMI 28.7 (SD=5.3); attrition was 10.2%.

Limitations

  • The authors state that the standard care control limits attribution of outcomes exclusively to module content rather than nonspecific factors such as increased Internet use or self-focus; they also note no passive web engagement tracking, no power for secondary outcomes, and that PGIC was added mid-trial and available for only about half the sample.
  • The authors state that a no-contact intervention may not be sufficiently intense or structured for all patients with fibromyalgia, and that fatigue, sleep, and mood were not impacted, possibly requiring more specialized content.
  • Evident from the text: the sample was predominantly female, Caucasian, married, and recruited through a rural telemedicine network, which may limit generalizability; outcomes were self-reported, and 10.2% attrition was handled with baseline observation carried forward.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.pain.2010.08.034

Cites

77 of 77 references verified0 citation errors · 0 not checkable

Statistics

5 tests recomputed · 0 with the reported and recomputed p on opposite sides of .05

Claims the paper makes

0 of 42 cited sources checked · 0 supported · 0 flagged

  • Findingreasoning

    No specific set of modules was uniquely tied to the pain responders.

    “however no specific set of modules were uniquely tied to the pain responders.”
    Quote in the paperSubstantial claim
  • Findingown data

    Using a responder criterion of 0.50 standard deviation improvement, the WEB-SM group had more individuals improving (31% vs 6%, p<.002).

    “Using a responder criterion of 0.50 standard deviation improvement, the WEB-SM group again demonstrated more individuals improving (WEB-SM: 31% vs. standard care: 6%; p<.002, Fisher’s exact test).”
    Quote in the paperSubstantial claim
  • Findingown data

    Improvement in overall well-being was observed more frequently in the web-based group than in the standard care control.

    “Improvement in overall well-being was also observed more frequently in the web-based group than in the standard care control.”
    Quote in the paperSubstantial claim
  • Findingown data

    Among those with PGIC data, 57% of WEB-SM recipients versus 21% of standard care recipients reported at least minimal improvement (p<.003).

    “Although available for only half of the sample (i.e., standard care, n=33, WEB-SM, n=35) there was a statistically significant difference in the numbers of individuals reporting at least minimal improvement (i.e., 57% of the WEB-SM recipients) but only 21% of standard care (p<.003, Fisher’s exact test).”
    Quote in the paperSubstantial claim
  • Findingown data

    The standard care control group demonstrated no appreciable effect on patients' pain or function.

    “In fact, the standard care control group demonstrated no appreciable effect on patient’s pain or function as can be seen in Table 3.”
    Quote in the paperSubstantial claim
  • May combine two claims. 14
  • Classified as probably not a substantial claim. 22

  • May combine two claims.

    Findingreasoning

    Fatigue, sleep and mood domains were not impacted by this Internet intervention.

    “Fatigue, sleep and mood domains (e.g., depressive and anxiety symptoms) were not impacted by this Internet intervention.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Unlike pain and functional deficits, which were common to all participants, not all participants possessed difficulties with each of the secondary outcome measures.

    “Relatedly, unlike pain and functional deficits which were common to all participants, not all participants possessed difficulties with each of the secondary outcome measures.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Group assignment was given to both the participant and selected study staff only after completion of the baseline assessments.

    “group assignment was given to both the participant and selected study staff only after completion of the baseline assessments.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    An intent-to-treat approach was used, and all 118 randomized individuals were included in the analyses.

    “An intent-to-treat approach was used in this study; therefore all 118 individuals who were randomized at baseline were included in the subsequent analyses.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    Participants were randomly assigned to treatment condition using a 1:1 ratio.

    “Participants were randomly assigned to a treatment condition using a 1:1 ratio.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The SF-36 is a widely used generic measure of self-reported functional status that can be compared across differing disease states.

    “The SF-36 is a widely used measure of self-reported functional status and was developed as a generic measure capable of being used and compared across differing disease states.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [65] Ware JE Snow K Kosinski M SF-36r Health Survey: Manual and Interpretation Guide Lincoln, RI QualityMetric, Inc 1993 2000

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Allocation concealment was utilized to prevent selection bias.

    “Allocation concealment was utilized to prevent selection bias”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The study had an attrition rate of 10.2%.

    “The attrition rate for the study was 10.2%.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    For many patients, optimal care may require the combination of pharmacological and non-pharmacological interventions such as cognitive-behavioral therapy and exercise.

    “For many patients, optimal care may require the combination of pharmacological and non-pharmacological interventions such as cognitive-behavioral therapy (CBT) and exercise [27].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [27] Goldenberg DL Burckhardt C Crofford L Management of fibromyalgia syndrome JAMA 2004 292 19 2388 2395 15547167 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Study personnel assigned to assist participants in the clinic setting were blinded to participants' treatment assignment.

    “Study personnel assigned to assist participants in the clinic setting were blinded to participants’ treatment assignment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Internet-adapted therapies have added benefits of convenience, privacy, and the ability to provide full-spectrum care to patients in remote areas.

    “with the added benefits of convenience, privacy, and providing clinicians with the ability to provide a full-spectrum of care to patients even in remote areas [29; 48].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [29] Griffiths KM Christensen H Internet-based mental health programs: a powerful tool in the rural medical kit Aust J Rural Health 2007 15 2 81 87 17441815 source

      Not checked in the free run.

    • cites [48] Ritterband LM Thorndike FP Cox DJ Kovatchev BP Gonder-Frederick LA A behavior change model for internet interventions Ann Behav Med 2009 38 1 18 27 19802647 PMC2878721 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Several cognitive-behavioral oriented Internet interventions have been studied for use with chronic pain.

    “Several cognitive-behavioral oriented Internet interventions have been studied for use with chronic pain (e.g., [14; 10; 46])”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [14] Buhrman M Faltenhag S Strom L Andersson G Controlled trial of Internet-based treatment with telephone support for chronic back pain Pain 2004 111 3 368 377 15363881 source

      Not checked in the free run.

    • cites [10] Brattberg G Internet-based rehabilitation for individuals with chronic pain and burnout: a randomized trial Int J Rehabil Res 2006 29 3 221 227 16900043 source

      Not checked in the free run.

    • cites [46] Palermo TM Wilson AC Peters M Lewandowski A Somhegyi H Randomized controlled trial of an Internet-delivered family cognitive-behavioral therapy intervention for children and adolescents with chronic pain Pain 2009 146 1–2 205 213 19695776 PMC2760656 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A face-to-face study demonstrated greater improvements in pain and functional status associated with interventions emphasizing behavioral over cognitive skills.

    “This finding is consistent with a face-to-face study demonstrating greater improvements in pain and functional status being associated with interventions emphasizing behavioral over cognitive skills [61].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [61] Thieme K Flor H Turk DC Psychological pain treatment in fibromyalgia syndrome: efficacy of operant behavioural and cognitive behavioural treatments Arthritis Res Ther 2006 8 4 R121 16859516 PMC1779398 source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    As a compromise, the study selected against passive monitoring in favor of homework monitoring, an older more traditional methodology for measuring adherence to behaviorally oriented treatments.

    “As a compromise we selected against the use of passive monitoring in favor of an older more traditional methodology for measuring adherence to behaviorally oriented treatments - homework monitoring [1].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Abraham C Michie S A taxonomy of behavior change techniques used in interventions Health Psychol 2008 27 3 379 387 18624603 source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    CBT is efficacious in insomnia and mental health conditions.

    “At first this might be surprising given the efficacy of CBT in insomnia and mental health conditions [22; 58].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [22] Edinger JD Wohlgemuth WK Krystal AD Rice JR Behavioral insomnia therapy for fibromyalgia patients: a randomized clinical trial ArchInternMed 2005 165 21 2527 2535 16314551 source

      Not checked in the free run.

    • cites [58] Stuhlmiller C Tolchard B Computer-assisted CBT for depression & anxiety: increasing accessibility to evidence-based mental health treatment J Psychosoc Nurs Ment Health Serv 2009 47 7 32 39 19678477 source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Patients benefit as they can access self-management information in private and at their own convenience over the long term, an important consideration for a chronic condition.

    “Patients also benefit as they can access self-management information in private and at their own convince over the long term–which is an important consideration when managing a condition that by definition is chronic [48].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [48] Ritterband LM Thorndike FP Cox DJ Kovatchev BP Gonder-Frederick LA A behavior change model for internet interventions Ann Behav Med 2009 38 1 18 27 19802647 PMC2878721 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The Brief Pain Inventory is a multidimensional pain measure validated for use in chronic, nonmalignant pain.

    “The BPI is a multidimensional pain measure validated for use in chronic, nonmalignant pain.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [59] Tan G Jensen MP Thornby JI Shanti BF Validation of the Brief Pain Inventory for chronic nonmalignant pain J Pain 2004 5 2 133 137 15042521 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    Such a program offers clinicians, particularly rural clinicians, high quality information for their patients without the requirement of finding a qualified local therapist.

    “Further, such a program offers clinicians (particularly rural clinicians) high quality information for their patients without the requirement of finding a qualified local therapist (which in some settings, is unattainable).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductreasoning

    The PGIC measure was added to the protocol mid-way through the trial, so data are available for roughly half of the subjects in each arm.

    “Both arms of the study initiated the use of this measure concurrently and thus these data are available for roughly half of the subjects in each arm of the study.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The study evaluated a purely web-based, no-contact intervention for use in the context of routine care.

    “Another strength of the current study was the objective of evaluating a purely web-based, no-contact intervention for use in the context of routine care.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The WEB-SM group differed from the standard care arm based on the content participants perceived themselves to have received, supporting the internal validity of the study.

    “In support of the internal validity of the study, the the WEB-SM group did in fact differ from the standard care arm based on the content participants perceived themselves to have received.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    This six-month randomized controlled intent-to-treat trial demonstrated that a no-contact educationally-based Internet self-management program significantly reduced pain and improved physical functioning in individuals with fibromyalgia compared to a standard care control group.

    “This six-month, randomized controlled intent-to-treat trial, demonstrated that a no-contact educationally-based Internet self-management program significantly reduced pain and improved physical functioning in individuals with FM compared to a standard care control group.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    These findings are consistent with previous studies demonstrating benefits of cognitive and behaviorally oriented approaches to managing fibromyalgia delivered in traditional face-to-face formats.

    “These findings are consistent with previous studies demonstrating the benefits of cognitive and behaviorally oriented approaches to managing FM delivered in traditional face-to-face formats [40; 68; 67; 61].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [40] Morley S Eccleston C Williams A Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache Pain 1999 80 1–2 1 13 10204712 source

      Not checked in the free run.

    • cites [68] Williams DA Cary MA Groner KH Chaplin W Glazer LJ Rodriguez AM Clauw DJ Improving physical functional status in patients with fibromyalgia: a brief cognitive behavioral intervention JRheumatol 2002 29 6 1280 1286 12064847

      Not checked in the free run.

    • cites [67] Williams DA Psychological and behavioural therapies in fibromyalgia and related syndromes BestPractResClinRheumatol 2003 17 4 649 665 12849717 source

      Not checked in the free run.

    • cites [61] Thieme K Flor H Turk DC Psychological pain treatment in fibromyalgia syndrome: efficacy of operant behavioural and cognitive behavioural treatments Arthritis Res Ther 2006 8 4 R121 16859516 PMC1779398 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    From the perspective of translational clinical research, using a standard care control condition represents a preferred methodology for a study of this nature.

    “From the perspective of translational clinical research, our use of a standard care control condition represents a preferred methodology for a study of this nature [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Danaher BG Seeley JR Methodological issues in research on web-based behavioral interventions Ann Behav Med 2009 38 1 28 39 19806416 PMC3846298 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A conservative approach to imputation, baseline observation carried forward, was used in intent-to-treat analyses for missing endpoint values due to early termination.

    “A conservative approach to imputation (i.e., baseline observation carried forward (BOCF)) was used in ITT analyses for missing endpoint values due to early termination.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisereasoning

    Each of the 13 modules contained in the website possessed theoretical grounding and empirical support from traditional face-to-face studies.

    “Thus each of the 13 modules contained in the website possessed theoretical grounding and possessed empirical support from traditional face-to-face studies justifying their inclusion in this program (see Table 1).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Table 1

      Not checked in the free run.

  • May combine two claims.

    Study design and conductown data

    The two groups did not differ from one another with respect to any sample characteristics or on baseline outcome measures, supporting the success of randomization.

    “The two groups did not differ from one another with respect to any of the sample characteristics or on baseline outcome measures (see Table 3) thus supporting the success of randomization.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Interpretationnone given

    A no-contact intervention may not be sufficiently intense or structured to address the needs, complex sets of symptoms, and preferences of all patients.

    “A no-contact intervention may not be sufficiently intense or structured to address the needs, complex sets of symptoms, and preferences of all patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The average use of 4 skills supports the accessibility, relevance, and durability of the information contained within the modules for this patient population.

    “supporting both the accessibility, relevance, and durability of the information contained within the modules for this patient population.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Metrics associated with duration of time spent on the website were not collected because this metric can be confounded by factors such as internet connection speed, the ability of participants to access a page and leave the room, and the fact that more viewing is not linearly tied with better outcomes.

    “Similarly metrics associated with duration of time spent on the website was not collected given that this metric can be confounded by factors such as internet connection speed, the ability of participants to access a page and leave the room, and the fact that more viewing is not linearly tied with better outcomes [20].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Danaher BG Seeley JR Methodological issues in research on web-based behavioral interventions Ann Behav Med 2009 38 1 28 39 19806416 PMC3846298 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Not everyone with fibromyalgia will benefit from this intervention.

    “As is the case with pharmacological agents, not everyone with FM will benefit from this intervention.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    The use of such a delivery platform has application in the context of primary care where clinical practice has not been able to take full advantage of evidence-based non-pharmacological interventions for fibromyalgia.

    “The use of such a delivery platform has application in the context of primary care where clinical practice has not been able to take full advantage of evidence-based non-pharmacological interventions for FM.”
    Quote in the paperNot a substantial claim
32 of 32

  • The paper relies on this without support.

    Integration of non-pharmacological interventions into routine clinical care for fibromyalgia has been slow.

    “yet the integration of non-pharmacological interventions into routine clinical care has been slow.”

  • The paper relies on this without support.

    Barriers to integrating non-pharmacological interventions into routine fibromyalgia care include lack of physician knowledge or time, limited access to qualified therapists, insufficient third-party coverage, and patient travel burden.

    “Potential barriers to integration include: lack of physician knowledge or time to implement non-pharmacological approaches, limited access to qualified therapists, insufficient third party coverage of non-pharmacological approaches, and patient burden associated with traveling to and from therapy.”

  • The paper relies on this without support.

    Most patients with fibromyalgia do not receive evidence-based non-pharmacological components of care.

    “Thus, most patients with FM do not receive these evidence-based components of care.”

  • The paper relies on this without support.

    To date, no web-based interventions have been studied addressing fibromyalgia.

    “but to date, no web-based interventions have been studied addressing the complicated issues associated with FM.”

  • The paper relies on this without support.

    CBT works best when developed to target a specific type of change.

    “However, while being theoretically grounded in common principles of behavioral and cognitive change, CBT works best when developed to target a specific type of change.”

  • The paper relies on this without support.

    The efficacy of the cognitive and behavioral skills was not in question.

    “As the efficacy of the cognitive and behavioral skills were not in question, and we were not challenging the potential superiority of face-to-face modalities when available, it was our intent to evaluate the WEB-SM program in the clinical context in which it would be most likely applied.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Statistics that don’t add up

Each reported p-value recomputed from its test statistic and degrees of freedom.

  • p-value fits an unstated one-tailed test: t(33)=2.26, p < .03

    Minor

    The paper reports p < .03 here; recomputing from the test statistic and its degrees of freedom gives p = .031 (two-tailed). The reported value is what a one-tailed test gives, but the paper does not say near this result that a one-tailed test was used.

    Reported p < .03 · recomputed p = .031

  • p-value fits an unstated one-tailed test: t(48)=2.19, p < .03

    Minor

    The paper reports p < .03 here; recomputing from the test statistic and its degrees of freedom gives p = .033 (two-tailed). The reported value is what a one-tailed test gives, but the paper does not say near this result that a one-tailed test was used.

    Reported p < .03 · recomputed p = .033

  • p-value fits an unstated one-tailed test: F(1,115)=5.67, p < .01

    Minor

    The paper reports p < .01 here; recomputing from the test statistic and its degrees of freedom gives p = .019. The reported value is what a one-tailed test gives, but the paper does not say near this result that a one-tailed test was used.

    Reported p < .01 · recomputed p = .019

  • p-value fits an unstated one-tailed test: t(45)=2.27, p < .02

    Minor

    The paper reports p < .02 here; recomputing from the test statistic and its degrees of freedom gives p = .028 (two-tailed). The reported value is what a one-tailed test gives, but the paper does not say near this result that a one-tailed test was used.

    Reported p < .02 · recomputed p = .028

4 of 4

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Doesn’t add upF(1, 115) = 5.67reported p < .01 · recomputed p = .019

    “F(1,115)=5.67, p < .01”

  • Doesn’t add upt(48) = 2.19reported p < .03 · recomputed p = .033

    “t(48)=2.19, p < .03”

  • Doesn’t add upt(45) = 2.27reported p < .02 · recomputed p = .028

    “t(45)=2.27, p < .02”

  • Doesn’t add upt(33) = 2.26reported p < .03 · recomputed p = .031

    “t(33)=2.26, p < .03”

  • ConsistentF(1, 115) = 5.08reported p < .03 · recomputed p = .026

    “F(1,115)=5.08, p < .03”

5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Pain-test p-value does not match its F statistic

    Minor

    For an F statistic of 5.67 with 1 and 115 degrees of freedom, the p-value is approximately 0.019, not less than 0.01.

1 of 1

Cites

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3 of the 80 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Williams, D. A., Kuper, D., Segar, M., Mohan, N., Sheth, M., & Clauw, D. J.
Affiliations
  • University of Pittsburgh (US)
  • Avera McKennan Hospital & University Health Center (US)
  • University of Michigan (US)
Corresponding author
Williams, David A.
ORCID
Venue
Pain
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2010-12
Volume
151
Issue
3
Pages
694-702
ISSN
0304-3959 (ISSN-L)
DOI
10.1016/j.pain.2010.08.034
PMC
PMC2972378
OpenAlex
W1971050325
Semantic Scholar
d8c2bb624d1937bec19e632bf6f0a6150418b789
Cited by
210
References
80
Citations by year
2026: 4 · 2025: 7 · 2024: 7 · 2023: 23 · 2022: 16 · 2021: 14 · 2020: 19 · 2019: 7 · 2018: 11 · 2017: 18 · 2016: 17 · 2015: 15 · 2014: 17 · 2013: 13 · 2012: 13
FWCI
7.65
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Pain (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • NIAMS/NIH (R01-AR050044)
  • DAMD (17-00-2-0018)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
fibromyalgia, online intervention, self-management program, physical activity, relaxation techniques, cognitive-behavioral pain management, non-pharmacological treatment, analgesia, physical function, fatigue, sleep, anxiety, depressive symptoms, routine clinical practice
MeSH terms
Behavior Therapy, Exercise Therapy, Fibromyalgia, Humans, Surveys and Questionnaires, Self Care, Severity of Illness Index, Treatment Outcome, Telemedicine, Internet

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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