Although the diagnosis and management of Lyme borreliosis are well established, some patients present with chronic symptoms that have been evolving for more than 6 months after a documented Lyme borreliosis that was correctly treated, or a suspected Lyme borreliosis. Of these patients consulting for suspected Lyme borreliosis with persistent symptoms, 20% are diagnosed as having functional somatic disorders, the diagnostic and therapeutic management of which is not consensual. Given the high prevalence of functional somatic disorders in the general population (6%), learned societies and the French National Authority for Health (HAS) recommend a global approach to care, involving specialists in the exploration of chronic fatigue, pain relief centers and fibromyalgia experts. At present, however, there is no such care pathway for these patients. Treatment is based on simple advice from the attending physician to promote physical activity.   We therefore propose, via the Saint-Etienne and Clermont-Ferrand University Hospital Centres (CHU), appointed: (1) a reference center for tick-borne vector-borne diseases by the French General Directorate for Health (July 2019), to assess the effectiveness of a care pathway involving (2) attending physicians,(3) the centers of competence for tick-borne vector-borne diseases designated by the Regional Health Agency (January 2020) with an infectiology department (concerns 5 out of 7 centers) and (4) the maisons sport-santé in the Auvergne-Rhône-Alpes region labeled by the Ministry of Sports (January 2020, attached to the St Etienne/Clermont reference center and the 5 centers of expertise) in response to the priority issues identified by the HAS, the recommendations of learned societies and the concerns of(5) patient associations. The aim of this care pathway is to offer an intervention combining adapted physical activity and therapeutic patient education, as recommended by learned societies on the basis of a good level of evidence (Level 1, Grade A) in fibromyalgia or chronic fatigue syndrome.

Project Leader : Dr. David Hupin

Researchers involved :  

Lab scientists involved:

Student involved :

Evolène FAYOLLE 

Fibromyalgia affects 2 to 5% of adults in the general population. Patients describe a combination of symptoms centred around fatigue not induced by exercise and not relieved by rest.  The diagnosis of fibromyalgia is self-perpetuating by the deconditioning, consequence of a reduced muscle mass due to inactivity and periods of prolonged rest.  Thus, it seems fundamental to develop other non-drug approaches: among them, adapted physical activity is recommended by most learned societies because of a good level of evidence (Level 1, Grade A). The question remains, however, whether simple advice to resume physical activity is sufficient (routine care with medical assessment at 3 months) or whether a physical activity supervised inside and outside the hospital is not more relevant. In order to set up an optimal patient path within the Group of hospitals of Loire territory, the working group composed of doctors from different specialities of the department considered it important to carry out a randomised study evaluating the effectiveness of a healthcare organisation combining:  an adapted and supervised physical activity intervention (1 month hospital initiation then 2 months in town) + therapeutic education sessions for the patient with motivational interviews ; Compared to usual clinical practice (adapted physical activity adapted in autonomy at home + therapeutic patient education sessions with motivational interviews).

Project Leader : Dr. David Hupin

Researchers involved :  

• Dr. Claire Colas

Lab scientists involved:

Student involved :

none