Isomeri 1993.

Study characteristics
Methods	Design: parallel Duration: 12 weeks Assessment: baseline and post‐intervention Country: Finland
Participants	Pain condition: fibromyalgia Population: people with fibromyalgia Minimum pain intensity: no Inclusion criteria Patients fulfilling the diagnostic criteria of Yunus 1983 for primary fibromyalgic syndrome Exclusion criteria Other diseases causing pain Total participants randomised: 51 Age in years (mean): 43.7 Gender: 39/51 were female Pain duration in years (mean): 7.9
Interventions	Physiotherapy and amitriptyline 25 mg n = 17 Combined intervention: physiotherapy + TCA Fixed dose of 25 mg Conventional physiotherapy consisting of light muscle stretching exercises only Physical fitness training n = 17 Cardiovascular fitness training Physical fitness training and amitriptyline 25 mg n = 17 Combined intervention: physical fitness training + TCA Physical fitness training of increasing strenuousness and amitriptyline 25 mg in the evenings Fixed dose
Outcomes	Withdrawal
Missing data methods	NR
Funding source	Non‐pharmaceutical: supported by grants from the Rheumatism Research Foundation
Conflicts of interest	NR
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Randomisation methods NR
Allocation concealment (selection bias)	Unclear risk	Allocation procedures NR
Blinding of participants and personnel (performance bias) All outcomes	High risk	Not able to be double‐blinded due to nature of interventions. Doesn't mention sham dosing or placebo for group not receiving amitriptyline
Blinding of outcome assessment (detection bias) All outcomes	High risk	Self‐reported outcomes from unblinded participants
Incomplete outcome data (attrition bias) All outcomes	High risk	Completer‐only analysis, no information given about withdrawal reasons Attrition Total: 6/51 (11.8%) Physiotherapy + amitriptyline 25 mg: 1/17 (5.9%) Physical fitness training: 2/17 (11.8%) Physical fitness training + amitriptyline 25 mg: 3/17 (17.7%)
Selective reporting (reporting bias)	Unclear risk	No protocol or trial registration found
Other bias	Low risk	No other sources of bias were identified.