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Franco KFM, Miyamoto GC, Franco YRDS, Salvador EMES, do Nascimento BCB, Menten LA, Cabral CMN. Is Pilates more effective and cost-effective than aerobic exercise in the treatment of patients with fibromyalgia syndrome? A randomized controlled trial with economic evaluation. Eur J Pain 2023; 27:54-71. [PMID: 36097826 DOI: 10.1002/ejp.2039] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 08/30/2022] [Accepted: 09/10/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study was to assess the effectiveness and cost-effectiveness of Pilates versus aerobic exercises in the treatment of patients with fibromyalgia syndrome from a societal perspective. METHODS This two-arm randomized controlled trial with blinded assessor and economic evaluation included 98 patients diagnosed with fibromyalgia syndrome using the American College of Rheumatology 2010 criteria, aged between 20 and 75 years, and pain intensity ≥3 points in the Pain Numerical Rating Scale. Patients were randomly allocated into the aerobic or Pilates group. Treatment was performed twice a week for 8 weeks. The primary outcome was the impact of fibromyalgia measured 8 weeks after randomization. Cost-effectiveness and cost-utility analyses were conducted for the impact of fibromyalgia and quality-adjusted life-years (QALYs), respectively, with a 12-month time horizon. RESULTS There was no difference between the groups for the impact of fibromyalgia (MD: 6.5 points; 95% CI: -1.8 to 14.9). The incremental cost-effectiveness ratio showed that 1-point increase in the impact of fibromyalgia was on average associated with a societal cost of £56 for the Pilates group compared to the aerobic group. The cost-utility analysis showed that the Pilates group had a 0.71 probability of being cost-effective at a willingness-to-pay of £30,000 per QALY gained. CONCLUSION There was no significant difference between groups for the impact of fibromyalgia. Pilates was not cost-effective compared to aerobic exercises for the impact of fibromyalgia. However, Pilates seemed to be the preferred option of treatment considering QALYs, although it depends on the willingness-to-pay threshold. SIGNIFICANCE Pilates showed to be a safe and effective alternative for the treatment of patients with fibromyalgia syndrome. Pilates presented similar results for the impact of fibromyalgia and superior results for pain relief compared to aerobic exercises, a highly recommended intervention for the treatment of fibromyalgia syndrome. Pilates was not cost-effective compared to aerobic exercises for the impact of fibromyalgia. However, Pilates seemed to be a cost-effective intervention for QALYs, depending on the decision-maker's willingness-to-pay threshold.
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Affiliation(s)
| | - Gisela Cristiane Miyamoto
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, Brazil.,Faculty of Science, Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, Netherlands
| | | | | | | | - Laura Alves Menten
- Physical Therapy Department, Universidade Cidade de São Paulo, Sao Paulo, Brazil
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Cabral CMN, Miyamoto GC, Franco KFM, Bosmans JE. Economic evaluations of educational, physical, and psychological treatments for fibromyalgia: a systematic review with meta-analysis. Pain 2021; 162:2331-2345. [PMID: 33605655 DOI: 10.1097/j.pain.0000000000002233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 02/02/2021] [Indexed: 11/27/2022]
Abstract
ABSTRACT Nonpharmacological interventions are recommended for the treatment of fibromyalgia, but there is a lack of knowledge about the cost-effectiveness of these interventions. The aim of this study was to systematically review economic evaluations of educational, physical, and psychological interventions for the treatment of fibromyalgia. The search was performed in PUBMED, EMBASE, CINAHL, Cochrane Library, Physiotherapy Evidence Database, PsycINFO, EconLit, National Health Service Economic Evaluation Database, and Health Technology Assessment. Economic evaluations of educational, physical, and psychological interventions for adult patients with fibromyalgia were included. Primary outcomes were healthcare and societal costs, and quality-adjusted life-years, and secondary outcomes were any disease-specific clinical outcome. Costs and effects were pooled in a meta-analysis, when possible. Eleven studies were included, of which 7 compared a psychological intervention with another intervention or usual care/control. Over a 6-month time horizon, healthcare and societal costs of the psychological intervention were significantly lower than usual care (mean difference: $-2087, 95% confidence interval [CI]: -3061 to -1112; mean difference: $-2411, 95% CI: -3582 to -1240, respectively), and healthcare costs were significantly lower for the psychological intervention compared with a pharmacological intervention (mean difference: $-1443, 95% CI: -2165 to -721). Over a 12-month time horizon, healthcare costs for the psychological intervention were significantly lower than for usual care (mean difference: $-538, 95% CI: -917 to -158). Incremental cost-effectiveness ratios for quality-adjusted life-years and impact of fibromyalgia showed that the psychological intervention was cost-effective compared with other interventions and control conditions. There is a need of more economic evaluations conducted alongside randomized controlled trials with interventions recommended for the treatment of fibromyalgia, such as physical exercise.
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Affiliation(s)
- Cristina Maria Nunes Cabral
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, the Netherlands
| | - Gisela Cristiane Miyamoto
- Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, SP, Brazil
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, the Netherlands
| | | | - Judith Ekkina Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, the Netherlands
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Sturman S, Killingback C. Is there a dose response relationship between soft tissue manual therapy and clinical outcomes in fibromyalgia? J Bodyw Mov Ther 2020; 24:141-153. [PMID: 32825980 DOI: 10.1016/j.jbmt.2020.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 02/03/2020] [Accepted: 02/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current clinical guidelines do not support the use of manual therapy (MT) interventions for Fibromyalgia (FM) patients, despite evidence of positive biochemical, mechanical and psychological effects, and the popularity of hands-on treatments amongst patients. An optimal dose for MT has not been established; this may explain the discrepancies found within the published literature. The aim of this systematic review was to determine whether there is a dose response relationship for MT leading to improvements in core domains of FM symptomology; Pain, Mood, Sleep, Global Measure of Impact (Functional Status & Quality of Life). METHODS We searched six databases from 1990 to January 2018; studies were evaluated using the PEDro scale. Within-group (ESd) and between-group (ESg) Effect Sizes were calculated. RESULTS We identified and screened 4012 articles, 12 articles were critically appraised. Overall, there is moderate evidence that MT has positive effects on the four clinical outcomes investigated. However, there was no consistent dose response relationship observed across all studies. CONCLUSIONS A dose of approximately 45 min MT, three to five times per week, for three to five weeks, totalling 11 h 15 min, should be considered a baseline generic protocol for treatment delivery and research trials. Further research is necessary to confirm domain specific, or patient specific optimal doses. Moderator variables such as treatment time, frequency, duration; and MT type also need to be explored to ensure optimal delivery of MT in future research and clinical care provision.
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Affiliation(s)
- Sarah Sturman
- Dorset Pain Management Service, Dorset Healthcare University NHS Foundation Trust, Poole, BH2 2NT, UK.
| | - Clare Killingback
- Faculty of Health Sciences, Department for Sport, Health and Exercise Science, University of Hull, Don 207, HU6 7RX, UK
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Pappolla MA, Manchikanti L, Andersen CR, Greig NH, Ahmed F, Fang X, Seffinger MA, Trescot AM. Is insulin resistance the cause of fibromyalgia? A preliminary report. PLoS One 2019; 14:e0216079. [PMID: 31059525 PMCID: PMC6502334 DOI: 10.1371/journal.pone.0216079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/11/2019] [Indexed: 12/21/2022] Open
Abstract
Fibromyalgia (FM) is one of the most frequent generalized pain disorders with poorly understood neurobiological mechanisms. This condition accounts for an enormous proportion of healthcare costs. Despite extensive research, the etiology of FM is unknown and thus, there is no disease modifying therapy available for this condition. We show that most (if not all) patients with FM belong to a distinct population that can be segregated from a control group by their glycated hemoglobin A1c (HbA1c) levels, a surrogate marker of insulin resistance (IR). This was demonstrated by analyzing the data after introducing an age stratification correction into a linear regression model. This strategy showed highly significant differences between FM patients and control subjects (p < 0.0001 and p = 0.0002, for two separate control populations, respectively). A subgroup of patients meeting criteria for pre-diabetes or diabetes (patients with HbA1c values of 5.7% or greater) who had undergone treatment with metformin showed dramatic improvements of their widespread myofascial pain, as shown by their scores using a pre and post-treatment numerical pain rating scale (NPRS) for evaluation. Although preliminary, these findings suggest a pathogenetic relationship between FM and IR, which may lead to a radical paradigm shift in the management of this disorder.
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Affiliation(s)
- Miguel A. Pappolla
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas, United States of America
- St. Michael’s Pain & Spine Clinics, Houston, Texas, United States of America
- * E-mail:
| | - Laxmaiah Manchikanti
- Department of Anesthesiology, LSU School of Medicine Health Sciences Center, New Orleans, Louisiana, United States of America
| | - Clark R. Andersen
- Office of Biostatistics, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Nigel H. Greig
- Drug Design and Development Section, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Fawad Ahmed
- St. Michael’s Pain & Spine Clinics, Houston, Texas, United States of America
| | - Xiang Fang
- Department of Neurology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Michael A. Seffinger
- Department of Neuromusculoskeletal Medicine, College of Osteopathic Medicine of the Pacific, Pomona, California, United States of America
| | - Andrea M. Trescot
- Pain and Headache Center, Eagle River, Alaska, United States of America
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Vriezekolk JE, Peters AJF, van den Ende CHM, Geenen R. Solicitous and invalidating responses are associated with health-care visits in fibromyalgia. Rheumatol Adv Pract 2019; 3:rkz008. [PMID: 31431996 PMCID: PMC6649929 DOI: 10.1093/rap/rkz008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/24/2019] [Indexed: 01/08/2023] Open
Abstract
Objectives Health-care use in FM is substantial. Besides the severity of the disease and psychological factors, previous research suggests that the social environment can influence patients’ health-care use. In this study, we describe health-care use in patients with FM and investigate the relationship of social responses of the partner and family with health-care use. Methods Cross-sectional data of 280 patients with FM were analysed. Sociodemographic variables, health-status variables, health-care use, partner’s solicitous and punishing responses, and invalidation (i.e. discounting and lack of understanding) by family were assessed. Heath-care use was defined as the number of visits to physicians and health professionals. Associations of independent variables with health-care use were examined using univariate and hierarchical regression analyses. Results In the preceding 6 months, 99% of the patients visited at least one physician and 66% visited at least one health professional. The mean (s.d.) total health-care visits and the number of different disciplines consulted were 18.5 (17.7) and 3.6 (1.7), respectively. Being female, paid employment, having a co-morbid condition, a higher severity of FM, more partner’s solicitous responses and more invalidating responses by family were univariately associated with visits to a physician. Having a co-morbid condition, severity of FM and invalidation by family were uniquely associated with visits to a physician. No other associations were found. Conclusion Therapeutic attention to patients’ close social environment might be a useful approach to improve health-related outcomes, including health-care use, in patients with FM.
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Affiliation(s)
| | | | | | - Rinie Geenen
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
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Skaer TL, Kwong WJ. Illness perceptions and burden of disease in fibromyalgia. Expert Rev Pharmacoecon Outcomes Res 2016; 17:9-15. [DOI: 10.1080/14737167.2017.1270207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Tracy L. Skaer
- College of Pharmacy, Washington State University, Spokane, WA, USA
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