The DOI matches its Crossref record; 77 of the 80 references it cites were found in a registry or an index; none of the 42 sources its claims cite is checked for support yet.
Internet-enhanced management of fibromyalgia: A randomized controlled trial
Open accessAbstract
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.
Overview
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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.
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In the paper
“however no specific set of modules were uniquely tied to the pain responders.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
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In the paper
“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).”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 3. Results > 3.2 Primary Outcomes
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In the paper
“Improvement in overall well-being was also observed more frequently in the web-based group than in the standard care control.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 3. Results > 3.3 Secondary Outcomes
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In the paper
“In fact, the standard care control group demonstrated no appreciable effect on patient’s pain or function as can be seen in Table 3.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The WEB-SM group demonstrated statistically significant improvement in physical functional status compared to standard care only (F(1,115)=5.08, p<.03).”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 3. Results > 3.2 Primary Outcomes
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In the paper
“The number needed to treat (NNT) for the 30% responder rate was 5.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 3. Results > 3.2 Primary Outcomes
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“With treatment effect sizes being 0.64 for pain (i.e., Cohen’s d=.64 , calculated using change scores and pooled change score (SD))”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The WEB-SM group also reported a greater increase in self-management skill use (WEB-SM: 77% vs. standard care: 33%; p<.001, Fisher’s exact test)”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 3. Results > 3.5. Study manipulation check
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In response to the question, “Have you experienced an increase in self-management skills as a result of being in this study?”, 86% of the WEB-SM group answered affirmatively compared to only 42% of the standard care group (Fisher’s exact test, p<.001).”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 3. Results > 3.5. Study manipulation check
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- It may state two separate claims as one. 14
- Probably not a substantial claim. 22
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Fatigue, sleep and mood domains (e.g., depressive and anxiety symptoms) were not impacted by this Internet intervention.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Relatedly, unlike pain and functional deficits which were common to all participants, not all participants possessed difficulties with each of the secondary outcome measures.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“group assignment was given to both the participant and selected study staff only after completion of the baseline assessments.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 2. Methods > 2.4. Randomization procedure
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 2. Methods > 2.3. Study flow
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In the paper
“Participants were randomly assigned to a treatment condition using a 1:1 ratio.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 2. Methods > 2.4. Randomization procedure
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“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.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 2. Methods > 2.6. Primary outcome measures
What the sources say
- Not matchedcites [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.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Allocation concealment was utilized to prevent selection bias”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 2. Methods > 2.4. Randomization procedure
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The attrition rate for the study was 10.2%.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 2. Methods > 2.3. Study flow
Strength:plain· not yet calibratedn = 118Tests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“For many patients, optimal care may require the combination of pharmacological and non-pharmacological interventions such as cognitive-behavioral therapy (CBT) and exercise [27].”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 1. Introduction
What the sources say
- Not checked yetcites [27] Goldenberg DL Burckhardt C Crofford L Management of fibromyalgia syndrome JAMA 2004 292 19 2388 2395 15547167 source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Study personnel assigned to assist participants in the clinic setting were blinded to participants’ treatment assignment.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 2. Methods > 2.5. Schedule of assessments
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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].”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 1. Introduction
What the sources say
- Not checked yetcites [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 yetcites [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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Several cognitive-behavioral oriented Internet interventions have been studied for use with chronic pain (e.g., [14; 10; 46])”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 1. Introduction
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [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
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“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].”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
What the sources say
- Not checked yetcites [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
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
What the sources say
- Not checked yetcites [1] Abraham C Michie S A taxonomy of behavior change techniques used in interventions Health Psychol 2008 27 3 379 387 18624603 source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“At first this might be surprising given the efficacy of CBT in insomnia and mental health conditions [22; 58].”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
What the sources say
- Not checked yetcites [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 yetcites [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
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
In the paper
“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].”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
What the sources say
- Not checked yetcites [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
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“The BPI is a multidimensional pain measure validated for use in chronic, nonmalignant pain.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 2. Methods > 2.6. Primary outcome measures
What the sources say
- Not checked yetcites [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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
Tests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 2. Methods > 2.7. Secondary outcome measures
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 3. Results > 3.5. Study manipulation check
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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].”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
What the sources say
- Not checked yetcites [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 yetcites [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 yetcites [67] Williams DA Psychological and behavioural therapies in fibromyalgia and related syndromes BestPractResClinRheumatol 2003 17 4 649 665 12849717 source
- Not checked yetcites [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
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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].”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
What the sources say
- Not checked yetcites [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
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 2. Methods > 2.12. Statistical analysis plan
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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).”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 2. Methods > 2.11. Treatment regimens
What the sources say
- Not checked yetcites Table 1
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 3. Results > 3.1 Sample characteristics
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A no-contact intervention may not be sufficiently intense or structured to address the needs, complex sets of symptoms, and preferences of all patients.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“supporting both the accessibility, relevance, and durability of the information contained within the modules for this patient population.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“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].”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
What the sources say
- Not checked yetcites [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
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As is the case with pharmacological agents, not everyone with FM will benefit from this intervention.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Internet-Enhanced Management of Fibromyalgia: A Randomized Controlled Trial > 4. Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
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.”
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?
The cited source says what the claim attributes to it.
In the citing paper
“We excluded two studies because CBTs were delivered by Internet without any contact with a psychotherapist (Williams et al., 2010;Menga et al., 2014).”
From Efficacy, acceptability and safety of cognitive behavioural therapies in fibromyalgia syndrome – A systematic review and meta-analysis of randomized controlled trials (2018) · cites this paper as Williams et al., 2010
The cited source says what the claim attributes to it.
In the citing paper
“One of these studies was included in the first version of the review (Williams et al., 2010).”
From Efficacy, acceptability and safety of cognitive behavioural therapies in fibromyalgia syndrome – A systematic review and meta-analysis of randomized controlled trials (2018) · cites this paper as Williams et al., 2010
In the citing paper
“A randomized trial of an intervention consisting of a website with self-management information based on CBT and no therapist contact was found to reduce pain and increase physical functioning in individuals with fibromyalgia, compared with a control group receiving standard care alone, at a 6-month follow-up [17].”
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
MinorThe 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
“t(33)=2.26, p<.03”
p-value fits an unstated one-tailed test: t(48)=2.19, p < .03
MinorThe 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
“t(48)=2.19, p<.03”
p-value fits an unstated one-tailed test: F(1,115)=5.67, p < .01
MinorThe 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
“F(1,115)=5.67, p<.01”
p-value fits an unstated one-tailed test: t(45)=2.27, p < .02
MinorThe 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
“t(45)=2.27, p<.02”
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”
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
MinorFor 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.
“p<.01”
“F(1,115)=5.67”
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INTERNET COMO INSTRUMENTO DE PESQUISA, COLETA E INTERVENÇÃO EM FIBROMIALGIA: UMA REVISÃO SISTEMÁTICA
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Fibromyalgie : vers une cyber psychothérapie ?
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Williams, D. A. (2011) · Evidence-Based Nursing · doi:10.1136/ebnurs.2011.100293
Self-citationResponse to Professor Lewit's letter ‘Fibromyalgia and palpation’
Foell, J. (2011) · International Musculoskeletal Medicine · doi:10.1179/175361511x12965803070748
Børøsund, E. (2015) · NORA - Norwegian Open Research Archives
Therapeutic Indulgent of Fibromyalgia - a Systematic Review Revealing Research Crevices
Ranganathan, A. (2016) · Journal of Exercise Science and Physiotherapy · doi:10.18376//2016/v12i1/86808
Future Directions and Trends in Pain Medicine
Hurley, R. W., Benzon, H. T., & Turk, D. C. (2013) · Elsevier eBooks · doi:10.1016/b978-0-323-08340-9.00083-9
Perry, J. R. (2014) · QSpace (Queen's University Library)
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Exploring self-management of chronic low back pain in Saudi Arabia
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Nonpharmacologic pain management
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Telemedizin in der Schmerztherapie
Nau, C. (2020) · Springer eBooks · doi:10.1007/978-3-662-60611-7_8
Cognitive and Behaviorally Oriented Psychotherapies for Fibromyalgia
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Self-citationIntegrating The essence of online learning to facilitate research during COVID-19
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Metadata
- 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.
- Venue
- Pain
- Published
- 2010-12
- Volume
- 151
- Issue
- 3
- Pages
- 694-702
- ISSN
- 0304-3959 (ISSN-L)
- 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
- green
- www.ncbi.nlm.nih.gov
- 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 › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › 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
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