# Clinical practice guidelines in fibromyalgia. Physiotherapists’ adherence in Denmark: a cross-sectional web-based survey study

## TL;DR

This study examines how Danish physiotherapists follow clinical guidelines for fibromyalgia, finding that most adhere to recommendations but with some exceptions.

## Contribution

The study provides new insights into physiotherapists' adherence to fibromyalgia guidelines in Denmark, highlighting areas needing improvement.

## Key findings

- 35% of physiotherapists were classified as fully adherent to guidelines.
- Tender points examination and massage therapy showed low adherence.
- 14 out of 24 statements exceeded the 70% agreement threshold with guidelines.

## Abstract

Fibromyalgia is a widespread chronic condition. Although Clinical Practice Guidelines for fibromyalgia currently exist, their application in diagnostic and therapeutic settings faces significant implementation challenges across healthcare systems. This has led to a persistent gap between knowledge and clinical practice, a phenomenon yet to be explored in the Danish context. A cross-sectional study was conducted to investigate the level of knowledge and adherence to Clinical Practice Guidelines for fibromyalgia among Danish physical therapists, throughout a questionnaire consisting in the selection of the elements that they would consider for the adequate assessment, treatment, and expected duration of the therapeutic approach, to classify professionals as adherent, partially adherent, or non-adherent based on their selection of assessment and treatment components, and to evaluate their responses to 24 statements on a 5-point Likert scale reflecting their alignment with recommendations from Clinical Practice Guidelines. A total of 149 physiotherapists (mean age 39.26 ± 11.50, and gender-balanced) participated, amongst which 35 (23.49%) were classified as ‘adherent’, and 46 subjects (30.87%) were labelled as ‘partially adherent’ to Clinical Practice Guidelines. Participants’ assessment and therapeutic tools selection was generally aligned with the Clinical Practice Guidelines’ extolled recommendations, except for tender points examination and massage therapy. A number of 14 out of the 24 statements exceeded the predefined 70% agreement threshold. The current study reflects an adequate level of knowledge and adherence amongst physiotherapists in Denmark. Further research and targeted implementation strategies are needed to reduce the evidence-to-practice gap.

The online version contains supplementary material available at 10.1007/s00296-026-06084-6.