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Taub R, Agmon-Levin N, Frumer L, Samuel-Magal I, Glick I, Horesh D. Mindfulness-based stress reduction (MBSR) for fibromyalgia patients: The role of pain cognitions as mechanisms of change. Complement Ther Clin Pract 2024; 56:101860. [PMID: 38692113 DOI: 10.1016/j.ctcp.2024.101860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/24/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Fibromyalgia (FM) is a pain condition characterized by physical and psychological difficulties. This randomized controlled trial aimed to evaluate the effects of a mindfulness-based stress reduction (MBSR) on FM patients and identify the role of two pain cognitions: psychological inflexibility in pain (PIPS) and pain catastrophizing (PCS), as mechanisms of change. METHODS 95 FM patients (Mean ± SD: 49.18 ± 13.26 years) were randomly assigned to MBSR group therapy (n = 49) or a waitlist (WL) control group (n = 46). An adapted MBSR protocol for FM was employed. A series of measures were taken, covering FM symptoms, depression, perceived stress (PSS), PIPS and PCS. Three measurements were conducted: pre-intervention, post-intervention and 6-months follow up. RESULTS Compared to WL controls, the MBSR group showed greater improvements in FM symptoms (F(1,78) = 2.81, p < 0.05), PSS (F(1,78) = 4.38, p < 0.05) and Depression (F(1,78) = 21.12, p < 0.001), with mostly medium effect sizes. Improvements in PSS (F(2,68) = 7.75, p < 0.05) and depression (F(2,68) = 15.68, p < 0.05) remained stable over six months. The effect of MBSR on FM and PSS was mediated by one's reported change in PIPS. The effect of MBSR on depression was mediated by one's reported change in PCS. CONCLUSIONS These results reveal the significant therapeutic potential of MBSR for FM patients, due to the emphasis on non-judging and acceptance of negative inner states. Furthermore, this research identified two important pain-related cognitions as mechanisms of change, suggesting that MBSR contributes to cognitive change, which enables the reduction of physical and psychological distress. TRIAL REGISTRATION NUMBER NCT04304664.
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Affiliation(s)
- Renen Taub
- Department of Psychology, Bar-Ilan University, Ramat Gan, 5290002, Israel.
| | - Nancy Agmon-Levin
- Clinical Immunology, Angioedema and Allergy, Center for Autoimmune Diseases, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, 52621, Israel.
| | - Lee Frumer
- Department of Psychology, Bar-Ilan University, Ramat Gan, 5290002, Israel.
| | - Inbal Samuel-Magal
- Technion Israel Institute of Technology, Students Counseling Center, Haifa, 3200003, Israel.
| | - Ittai Glick
- Shachaf Clinic for Stress Reduction, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, 52621, Israel.
| | - Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan, 5290002, Israel; Department of Psychiatry, New York University School of Medicine, 1 Park Ave., New York, NY, 10016, USA.
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Ardila Suárez EF, Escalada-Hernández P. Proposal of nursing diagnosis "adult disuse syndrome": A conceptual derivation and integrative review. Int J Nurs Knowl 2024; 35:205-212. [PMID: 37469211 DOI: 10.1111/2047-3095.12440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE To develop a nursing diagnosis proposal derived from the concept of "disuse syndrome" based on an integrative review. METHODS The conceptual derivation technique, proposed by Walker and Avant, was used in the following phases: an integrative review of the literature was carried out, applying the parameters of Whitermore and Knalf, where 43 articles were selected that covered the existence of the concept in the nursing discipline and other health sciences, the concepts were subsequently analyzed, and the new concept was redefined following the middle-range theory of causality and validation of nursing diagnoses proposed by Oliveira-Lopes et al. FINDINGS The proposal of the new nursing diagnosis was developed, including the following elements: diagnostic label adult disuse syndrome, the corresponding definition, 25 defining characteristics, eight related factors, eight risk populations, and 14 associated problems. CONCLUSIONS The concept of the proposed new diagnosis describes adult disuse syndrome as a phenomenon that transcends the physiological component and should be viewed from a multidimensional view, expressing a clinical judgment related to a series of nursing diagnoses that appear together. IMPLICATIONS FOR NURSING PRACTICE The results of this study will help nursing professionals to identify the phenomenon of adult disuse syndrome in any setting and in turn guide optimal care interventions that decrease the consequences of adult disuse syndrome.
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Mediation Effect of Pain on the Relationship between Kinesiophobia and Postural Control: Comparison and Correlations in Individuals with Fibromyalgia Syndrome and Asymptomatic Individuals-A Cross-Sectional Study. Life (Basel) 2023; 13:life13010175. [PMID: 36676124 PMCID: PMC9861203 DOI: 10.3390/life13010175] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Background: Individuals with fibromyalgia syndrome (FM) usually present with a fear of movement (kinesiophobia), which causes their symptoms to be maintained and exacerbated. Kinesiophobia can significantly impact postural control; ascertaining their association is crucial in evaluating and managing individuals with FM. This study aims to (1) compare postural control between individuals with FM and asymptomatic individuals, (2) estimate the relationship between kinesiophobia and postural control in individuals with FM, and (3) evaluate whether pain intensity mediates the association between kinesiophobia and postural control in individuals with FM. Methods: This study enrolled 92 individuals (mean age: 51.52 ± 7.7 years) diagnosed with FM and 106 asymptomatic individuals (mean age: 50.47 ± 6.6 years). The examiners estimated the fear of movement and the intensity of pain utilizing the Tampa scale of kinesiophobia (TSK) scores and the visual analogue scale (VAS), respectively. The postural control variables included anteroposterior (A-P) sway in mm, medio-lateral (M-L) sway in mm, and ellipse area in mm2. Results: The individuals with FM had impaired postural control compared to the asymptomatic individuals (p < 0.001). Kinesiophobia exhibited mild-to-moderate correlations with the postural control variables (nondominant side: A-P sway: r = 0.48, M-L sway: r = 0.49, ellipse area: r = 0.43. Dominant side: A-P sway: r = 0.41, M-L sway: r = 0.33, ellipse area: r = 0.44). The pain intensity significantly mediated the relationship between kinesiophobia and postural control (p < 0.001). Conclusion: Kinesiophobia showed a significant positive relationship with postural control. The individuals with FM with higher TSK scores had decreased postural control. Pain intensity mediated the relationship between kinesiophobia and postural control. These factors must be considered when evaluating and formulating treatment strategies for people with FM.
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Velasco L, López-Gómez I, Gutiérrez L, Écija C, Catalá P, Peñacoba C. Exploring the Preference for Fatigue-avoidance Goals as a Mediator Between Pain Catastrophizing, Functional Impairment, and Walking Behavior in Women With Fibromyalgia. Clin J Pain 2021; 38:182-188. [PMID: 34928869 DOI: 10.1097/ajp.0000000000001010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Along with the symptoms of pain and fatigue, pain catastrophizing and avoidance behaviors are highly prevalent and associated with functional impairment in fibromyalgia (FM) patients. Although pain and fatigue affect patients' quality of life, research has been exclusively focused on how pain affects physical activity and exercise. The aim of this study was to analyze the role of pain catastrophizing and preference for fatigue-avoidance goals in walking behavior and functional impairment in women with FM. MATERIALS AND METHODS In this cross-sectional study the sample was composed of 76 participants aged 18 years and older (mean age=55.05, SD=7.70). The study evaluated pain catastrophizing, preference for fatigue-avoidance goals, functional impairment, and walking behavior along with sociodemographic variables and clinical data. RESULTS Pain catastrophizing was associated with preference for fatigue-avoidance goals and this preference was associated with greater functional impairment and less distance walked. Path analysis supported the mediating role of preference for fatigue-avoidance goals in the relationship between pain catastrophizing and walking behavior and between pain catastrophizing and functional impairment. Furthermore, pain catastrophizing predicted greater preference for fatigue-avoidance goals which predicted more problems in functioning and less distance walked. DISCUSSION The present study may help clarify the connection between the factors that stop individuals with FM from implementing beneficial behaviors such as walking, and thus, allowing for the design of psychological interventions that seek to maintain physical functioning despite experiencing fatigue.
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Affiliation(s)
- Lilian Velasco
- Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid, Spain
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López-Roig S, Peñacoba C, Martínez-Zaragoza F, Abad E, Catalá P, Suso-Ribera C, Pastor-Mira MÁ. The Activity Patterns Scale: An Analysis of its Construct Validity in Women With Fibromyalgia. Clin J Pain 2021; 37:887-897. [PMID: 34483231 DOI: 10.1097/ajp.0000000000000980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Avoidance, persistence, and pacing are activity patterns that have different adaptive effects in chronic pain patients. Some inconsistent findings have been explained from a contextual perspective that underlines the purpose of the activity. In this way, avoidance, persistence, and pacing are multidimensional constructs, nuanced by their goals. This multidimensionality has been supported with a new instrument, the Activity Patterns Scale, in heterogeneous chronic pain samples. Owing to the clinical implications of this conceptualization, the complexity of the activity patterns and their relationships with health outcomes in fibromyalgia (FM), our aim was to explore the construct validity of this scale in this pain problem, testing its internal structure and the relationships with other constructs. MATERIALS AND METHODS The sample included 702 women with diagnosis of FM from tertiary (53.3%) and community settings (46.7%). Confirmatory factor analysis was conducted to test different factor structures of the activity patterns and Pearson correlation to explore the relationships with health outcomes and psychosocial variables. RESULTS A 6-factor structure showed acceptable fit indices (standardized root mean square residual=0.062; root mean-square error of approximation=0.066; comparative fit index=0.908). The highest significant relationships for health outcomes was between activity avoidance and FM impact (r=0.36) and excessive persistence and negative affect (r=0.41). DISCUSSION Avoidance and persistence activity patterns are shown as multidimensional constructs but not pacing. The ongoing pain in these women may make it difficult to regulate their activity taking into account other goals not contingent on pain fluctuations.
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Affiliation(s)
- Sofía López-Roig
- Department of Behavioral Sciences and Health, Miguel Hernández University, Elche
| | | | | | - Esther Abad
- Fibromyalgia Unit, Hospital of San Vicente del Raspeig, Alicante
| | - Patricia Catalá
- Department of Psychology, Rey Juan Carlos University, Madrid
| | - Carlos Suso-Ribera
- Department of Basic and Clinical Psychology and Psychobiology, Jaume I, University, Castellon, Spain
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Sheila B, Octavio LR, Patricia C, Dolores B, Lilian V, Cecilia P. Perfectionism and Pain Intensity in Women with Fibromyalgia: Its Influence on Activity Avoidance from The Contextual Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8442. [PMID: 33202698 PMCID: PMC7698249 DOI: 10.3390/ijerph17228442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 12/25/2022]
Abstract
Given the scarcity of studies regarding perfectionism from a contextual perspective, this study aims to analyze its role in the relationship between pain and activity avoidance and its differential effect among patients with different fibromyalgia severity. A cross-sectional study with 228 women with fibromyalgia classified into two disease severity groups (low/moderate vs. high) was carried out. Moderation analyses were conducted; perfectionism was used as moderator, pain (in high and low pain situations) as independent variable, and activity avoidance as the outcome. Among the high disease severity group, analyses showed direct contributions of perfectionism (p < 0.001) but not of pain (p > 0.05); moderation effects were found in high pain situations (p = 0.002) (for low levels of perfectionism, a positive association was found between pain intensity and avoidance). Among the low severity group, direct effects of perfectionism (p < 0.05) and pain intensity (p = 0.04) were found (although the latter only for high pain situations); moderation effects were found in high pain situations (p = 0.018) (for high levels of perfectionism a positive and significant association was found between pain intensity and avoidance). Perfectionism has been found to be a key variable in the differential relationship between pain intensity (in high pain situations) and activity avoidance in groups with high and low disease severity.
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Affiliation(s)
- Blanco Sheila
- Department of Psychology, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (B.S.); (L.-R.O.); (C.P.); (V.L.)
| | - Luque-Reca Octavio
- Department of Psychology, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (B.S.); (L.-R.O.); (C.P.); (V.L.)
| | - Catala Patricia
- Department of Psychology, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (B.S.); (L.-R.O.); (C.P.); (V.L.)
| | - Bedmar Dolores
- Pain Unit, Hospital Universitario de Fuenlabrada, 28944 Fuenlabrada, Madrid, Spain;
| | - Velasco Lilian
- Department of Psychology, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (B.S.); (L.-R.O.); (C.P.); (V.L.)
| | - Peñacoba Cecilia
- Department of Psychology, Universidad Rey Juan Carlos, 28933 Madrid, Spain; (B.S.); (L.-R.O.); (C.P.); (V.L.)
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KoÇyİĞİt BF, Akaltun MS. Kinesiophobia Levels in Fibromyalgia Syndrome and the Relationship Between Pain, Disease Activity, Depression. Arch Rheumatol 2020; 35:214-219. [PMID: 32851370 DOI: 10.46497/archrheumatol.2020.7432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 07/01/2019] [Indexed: 11/03/2022] Open
Abstract
Objectives This study aims to compare kinesiophobia levels between patients with fibromyalgia syndrome (FMS) and healthy volunteers and to investigate the factors associated with kinesiophobia in FMS. Patients and methods This case-control study included 88 female patients with FMS (mean age 41.61 years; range 21 to 61 years) and 67 female healthy volunteers (mean age 41.34 years; range 19 to 59 years). The participants' age, body mass index (BMI), and educational status were recorded. Patients were evaluated using a visual analog scale for pain, the Fibromyalgia Impact Questionnaire (FIQ) for disease activity, the Hamilton Depression Scale (HAM-D) for depression level, and the Tampa Scale for Kinesiophobia (TSK) for kinesiophobia. Additionally, the patients' serum 25-hydroxyvitamin D levels were measured. Results No significant differences were found between the patient and control groups in terms of age, BMI, and educational status (p>0.05). The mean TSK scores were 42.0±7.6 in the patient group and 37.2±8.8 in the control group. TSK score was significantly higher in the patient group (p<0.001). BMI levels, FIQ scores, and vitamin D concentrations were significantly associated with TSK scores according to the linear regression analysis (p<0.05). However, age, symptom duration, and HAM-D scores were not found to be associated with TSK scores (p>0.05). Conclusion Kinesiophobia scores were significantly higher in patients with FMS. Physicians should focus on kinesiophobia when evaluating patients with FMS and inform patients about the importance and treatment strategies of kinesiophobia.
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Affiliation(s)
- Burhan Fatih KoÇyİĞİt
- Department of Physical Medicine and Rehabilitation, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Mazlum Serdar Akaltun
- Department of Physical Medicine and Rehabilitation, Kahramanmaraş Necip Fazıl State Hospital, Kahramanmaraş, Turkey
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Beems MEC, Toonders SAJ, van Westrienen PE, Veenhof C, Pisters MF. Identifying subgroups based on self-management skills in primary care patients with moderate medically unexplained physical symptoms. J Psychosom Res 2019; 125:109785. [PMID: 31421323 DOI: 10.1016/j.jpsychores.2019.109785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 07/15/2019] [Accepted: 07/20/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Medically Unexplained Physical Symptoms (MUPS) are a major burden on both patients and society and frequently develop into chronic MUPS. Self-management interventions may prevent moderate MUPS from becoming chronic. Tailoring interventions to the patient population is strongly recommended. This can be facilitated by identifying subgroups based on self-management skills. This study aimed to identify these subgroups and their clinical profiles in primary care patients with moderate MUPS. METHODS A cross-sectional study was performed on baseline measurements from a randomized clinical trial (PARASOL-study). To identify subgroups based on self-management skills, a hierarchical cluster analysis was conducted for adults with moderate MUPS from primary health care centers. Self-management skills were measured with the Health education impact Questionnaire. Cluster variables were seven constructs of this questionnaire. Additionally, specific patient profiles were determined by comparing the identified clusters on the clinical variables pain, fatigue and physical functioning. RESULTS Four subgroups were identified: High-Self-Management Skills (SMS) (n = 29), Medium-SMS (n = 55), Low-SMS (n = 49) and Active & Low Distress-SMS (n = 20). The latter showed a distinctly different pattern on cluster variables, while the other subgroups differed significantly on means of the cluster variables (p < .001). On clinical variables, significant differences between subgroups were mainly found on fatigue and physical functioning. CONCLUSION This study found four specific subgroups based on self-management skills in moderate MUPS-patients. One subgroup demonstrated a distinctly different pattern on self-management skills. In other subgroups, more similar patterns on self-management skills were found that negatively correlated with pain and fatigue and positively correlated with physical functioning.
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Affiliation(s)
- M E C Beems
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, the Netherlands; Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands; Fysio Center Den Haag, The Hague, the Netherlands.
| | - S A J Toonders
- Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands; Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands.
| | - P E van Westrienen
- Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands; Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands.
| | - C Veenhof
- Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands; Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands; Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, Utrecht University of Applied Sciences, Utrecht, the Netherlands.
| | - M F Pisters
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, the Netherlands; Center for Physical Therapy Research and Innovation in Primary Care, Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands; Physical Therapy Research, Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Health Innovation and Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands.
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Pastor-Mira MA, López-Roig S, Martínez-Zaragoza F, León E, Abad E, Lledó A, Peñacoba C. Goal Preferences, Affect, Activity Patterns and Health Outcomes in Women With Fibromyalgia. Front Psychol 2019; 10:1912. [PMID: 31496975 PMCID: PMC6712496 DOI: 10.3389/fpsyg.2019.01912] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 08/05/2019] [Indexed: 02/05/2023] Open
Abstract
Some motivational models understand health behavior as a result of the interaction between goal preferences and mood. However, this perspective has not been explored in fibromyalgia. Furthermore, in chronic pain, it has only been explored with regard to negative affect. Thus, our aims were: (1) to develop a Spanish version of the Goal Pursuit Questionnaire (GPQ); (2) to explore the relationships between goal preferences and health outcomes, testing the moderator role of affect and the mediating role of chronic pain activity patterns. We conducted two cross-sectional studies. In Study 1, after a double translation/back-translation process, we interviewed 94 women attending the Fibromyalgia Unit of the Community of Valencia in order to identify the cultural feasibility and the content validity of the GPQ. Study 2 comprised 260 women. We explored the GPQ structure and performed path analyses to test conditional mediation relationships. Eight activities from the original GPQ were changed while maintaining the conceptual equivalence. Exploratory factor analysis showed two factors: 'Pain-avoidance goal' and 'Mood-management goal' (37 and 13% of explained variance, respectively). These factors refer to patients' preference for hedonic goals (pain avoidance or mood-management) over achievement goals. Robust RMSEA fit index of the final models ranged from 0.039 for pain to 0.000 for disability and fibromyalgia impact. Pain avoidance goals and negative affect influenced pain mediated by task-contingent persistence. They also affected disability mediated by task and excessive persistence. Pain avoidance goals and positive affect influenced fibromyalgia impact mediated by activity avoidance. We also found a direct effect of negative and positive affect on health outcomes. Preference for pain avoidance goals was always related to pain, disability and fibromyalgia impact through activity patterns. Affect did not moderate these relationships and showed direct and indirect paths on health outcomes, mainly by increasing persistence and showing positive affect as an asset and not a risk factor. Intervention targets should include flexible reinforcement of achievement goals relative to pain avoidance goals and positive affect in order to promote task-persistence adaptive activity patterns and decreased activity avoidance.
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Affiliation(s)
| | - Sofía López-Roig
- Department of Behavioral Sciences and Health, Miguel Hernández University, Elche, Spain
| | | | - Eva León
- Department of Behavioral Sciences and Health, Miguel Hernández University, Elche, Spain
| | - Ester Abad
- Fibromyalgia Unit, San Vicente del Raspeig Hospital, San Vicente del Raspeig, Spain
| | - Ana Lledó
- Department of Behavioral Sciences and Health, Miguel Hernández University, Elche, Spain
| | - Cecilia Peñacoba
- Health Sciences Faculty, Rey Juan Carlos University, Madrid, Spain
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The Impact of a Group-Based Multidisciplinary Rehabilitation Program on the Quality of Life in Patients With Fibromyalgia. ACTA ACUST UNITED AC 2019; 26:313-319. [DOI: 10.1097/rhu.0000000000001120] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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den Boeft M, Huisman D, van der Wouden JC, Numans ME, van der Horst HE, Lucassen PL, Olde Hartman TC. Recognition of patients with medically unexplained physical symptoms by family physicians: results of a focus group study. BMC FAMILY PRACTICE 2016; 17:55. [PMID: 27175489 PMCID: PMC4866284 DOI: 10.1186/s12875-016-0451-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/09/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with medically unexplained physical symptoms (MUPS) form a heterogeneous group and frequently attend their family physician (FP). Little is known about how FPs recognize MUPS in their patients. We conducted a focus group study to explore how FPs recognize MUPS and whether they recognize specific subgroups of patients with MUPS. Targeting such subgroups might improve treatment outcomes. METHODS Six focus groups were conducted with in total 29 Dutch FPs. Two researchers independently analysed the data applying the principles of constant comparative analysis in order to detect characteristics to recognize MUPS and to synthesize subgroups. RESULTS FPs take into account various characteristics when recognizing MUPS in their patients. More objective characteristics were multiple MUPS, frequent and long consultations and many referrals. Subjective characteristics were negative feelings towards patients and the feeling that the FP cannot make sense of the patient's story. Experience of the FP, affinity with MUPS, consultation skills, knowledge of the patient's context and the doctor-patient relationship seemed to influence how and to what extent these characteristics play a role. Based on the perceptions of the FPs we were able to distinguish five subgroups of patients according to FPs: 1) the anxious MUPS patient, 2) the unhappy MUPS patient, 3) the passive MUPS patient, 4) the distressed MUPS patient, and 5) the puzzled MUPS patient. These subgroups were not mutually exclusive, but were based on how explicit and predominant certain characteristics were perceived by FPs. CONCLUSIONS FPs believe that they can properly identify MUPS in their patients during consultations and five distinct subgroups of patients could be distinguished. If these subgroups can be confirmed in further research, personalized treatment strategies can be developed and tested for their effectiveness.
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Affiliation(s)
- Madelon den Boeft
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, room D5.40. 1081 BT, Amsterdam, The Netherlands.
| | - Danielle Huisman
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, room D5.40. 1081 BT, Amsterdam, The Netherlands
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, room D5.40. 1081 BT, Amsterdam, The Netherlands
| | - Mattijs E Numans
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, room D5.40. 1081 BT, Amsterdam, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Henriette E van der Horst
- Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, room D5.40. 1081 BT, Amsterdam, The Netherlands
| | - Peter L Lucassen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Tim C Olde Hartman
- Department of Primary and Community Care, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Evers AWM, Gieler U, Hasenbring MI, van Middendorp H. Incorporating biopsychosocial characteristics into personalized healthcare: a clinical approach. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 83:148-57. [PMID: 24732828 DOI: 10.1159/000358309] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 01/02/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
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Brauer M, Lakeman M, van Lunsen R, Laan E. Predictors of Task‐Persistent and Fear‐Avoiding Behaviors in Women with Sexual Pain Disorders. J Sex Med 2014; 11:3051-63. [DOI: 10.1111/jsm.12697] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bernik M, Sampaio TPA, Gandarela L. Fibromyalgia comorbid with anxiety disorders and depression: combined medical and psychological treatment. Curr Pain Headache Rep 2014; 17:358. [PMID: 23904203 DOI: 10.1007/s11916-013-0358-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Fibromyalgia is associated with high level of pain and suffering. Lack of diagnosis leads to onerous indirect economic costs. Recent data indicate that fibromyalgia; anxiety disorders, and depression tend to occur as comorbid conditions. They also share some common neurochemical dysfunctions and central nervous system alterations such as hypofunctional serotonergic system and altered reactivity of the hypothalamic-pituitary-adrenal axis. Conversely, functional neuroimaging findings point to different patterns of altered pain processing mechanisms between fibromyalgia and depression. There is no cure for fibromyalgia, and treatment response effect size is usually small to moderate. Treatment should be based on drugs that also target the comorbid psychiatric condition. Combined pharmacotherapy and cognitive-behavior therapy should ideally be offered to all patients. Lifestyle changes, such as physical exercise should be encouraged. The message to patients should be that all forms of pain are true medical conditions and deserve proper care.
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Affiliation(s)
- Marcio Bernik
- Anxiety Disorders Program, Institute of Psychiatry FMUSP, R. Dr. Ovidio Pires de Campos, 785, Caixa Postal 3671, CEP 01060-970, Sao Paulo, SP, Brazil.
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MOTOYA RYO, ODA KEIKO, ITO EIJI, ICHIKAWA MASAHIRO, SATO TAKU, WATANABE TADASHI, SAKUMA JUN, SAITO KIYOSHI, NIWA SHINICHI, YABE HIROOKI. EFFECTIVENESS OF COGNITIVE BEHAVIORAL THERAPY BASED ON THE PAIN SUSTAINMENT/EXACERBATION MODEL IN PATIENTS WITH TENSION-TYPE HEADACHE: A PILOT STUDY. Fukushima J Med Sci 2014; 60:133-40. [DOI: 10.5387/fms.2014-15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- RYO MOTOYA
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine
- Center for Medical Education and Career Development, Fukushima Medical University
| | - KEIKO ODA
- Department of Neurosurgery, Fukushima Medical University School of Medicine
| | - EIJI ITO
- Department of Neurosurgery, Fukushima Medical University School of Medicine
| | - MASAHIRO ICHIKAWA
- Department of Neurosurgery, Fukushima Medical University School of Medicine
| | - TAKU SATO
- Department of Neurosurgery, Fukushima Medical University School of Medicine
| | - TADASHI WATANABE
- Department of Neurosurgery, Fukushima Medical University School of Medicine
| | - JUN SAKUMA
- Department of Neurosurgery, Fukushima Medical University School of Medicine
| | - KIYOSHI SAITO
- Department of Neurosurgery, Fukushima Medical University School of Medicine
| | - SHIN-ICHI NIWA
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine
- Fukushima Prefecture
| | - HIROOKI YABE
- Department of Neuropsychiatry, Fukushima Medical University School of Medicine
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Ceulemans K, Karsdorp PA, Vlaeyen JWS. Mood, stop-rules and task persistence: no mood-as-input effects in the context of pain. J Behav Ther Exp Psychiatry 2013; 44:463-8. [PMID: 23850589 DOI: 10.1016/j.jbtep.2013.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 06/07/2013] [Accepted: 06/10/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Task persistence despite experiencing pain might be a risk factor for development and maintenance of chronic pain. The Mood-as-Input (MAI) model predicts that the impact of mood on individuals' motivation to persist in a task depends on the interpretation of current mood within a certain motivational context. The aim of the current study was to replicate the original MAI study (Martin, Ward, Achee, & Wyer, 1993), but in a context where the task is painful. METHODS A 2 Mood (negative versus positive) × 2 Stop-Rule (achievement versus hedonic) between-subjects factorial design was used in which 120 healthy participants (97 women, mean age = 21.78 years, SD = 3.07) performed an impression-formation task while being exposed to mechanically induced pressure pain. RESULTS The MAI interaction hypothesis was not confirmed. Instead, participants showed more task persistence when they used hedonic stop-rules as a ground to decide on task (dis)continuation than when they used an achievement-oriented stop-rule. Additionally, participants reporting less pain-related fear also spent more time on the painful impression-formation task. The current findings suggest that the MAI perspective might not apply to task persistence behavior in a pain context. LIMITATIONS These findings may not generalize to task performance in patients with chronic pain.
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Affiliation(s)
- Ken Ceulemans
- Department of Clinical Psychological Science, Research Group Behavioral Medicine, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
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17
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Ceulemans K, Karsdorp PA, Vlaeyen JWS. Effects of responsibility and mood on painful task persistence. J Behav Ther Exp Psychiatry 2013. [PMID: 23207966 DOI: 10.1016/j.jbtep.2012.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Not just avoidance behaviour, but also painful task persistence might be a risk factor for development and maintenance of pain complaints. In seeking to understand these dysfunctional patterns of task performance, it has been suggested that mood influences the individuals' motivation to persist in a task depending on the interpretation of current mood within a certain motivational context. The aim of the present study was to test the effects of a social responsibility context and mood on persistence on a painful finger pressing task. METHODS A 2 Mood (positive vs. negative) × 2 Responsibility (high vs. neutral) between-subjects factorial design was used in which 79 healthy participants (53 women; mean age = 22.99 years, SD = 4.77) performed the finger pressing task. RESULTS The results show that mood and sense of responsibility independently influence task persistence: participants in a negative as opposed to positive mood spent more time on the task; the same was true for participants who reported a stronger sense of responsibility. In addition, an increase in pain during the task was associated with longer task persistence. No effect of pain-related fear on task persistence was found. CONCLUSION This experimental study was the first to demonstrate an effect of sense of responsibility on persistence in a painful physical task.
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Affiliation(s)
- Ken Ceulemans
- Department of Clinical Psychological Science, Research Group Behavioural Medicine, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
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Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice. Clin Rheumatol 2013; 32:1121-9. [DOI: 10.1007/s10067-013-2277-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
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19
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¿Por qué las personas con fibromialgia persisten en la actividad a pesar del dolor creciente?: estudio Delphi sobre el contenido del Cuestionario Clínic de Persistencia en la Actividad en Fibromialgia. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2013; 6:33-44. [DOI: 10.1016/j.rpsm.2012.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 03/06/2012] [Accepted: 03/08/2012] [Indexed: 11/20/2022]
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Hasenbring MI, Hallner D, Klasen B, Streitlein-Böhme I, Willburger R, Rusche H. Pain-related avoidance versus endurance in primary care patients with subacute back pain: Psychological characteristics and outcome at a 6-month follow-up. Pain 2012; 153:211-217. [DOI: 10.1016/j.pain.2011.10.019] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 08/31/2011] [Accepted: 10/11/2011] [Indexed: 10/15/2022]
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van Koulil S, Kraaimaat FW, van Lankveld W, van Helmond T, Vedder A, van Hoorn H, Donders ART, Thieme K, Cats H, van Riel PLCM, Evers AWM. Cognitive-behavioral mechanisms in a pain-avoidance and a pain-persistence treatment for high-risk fibromyalgia patients. Arthritis Care Res (Hoboken) 2011; 63:800-7. [PMID: 21312345 DOI: 10.1002/acr.20445] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The heterogeneity of cognitive-behavioral patterns in patients with fibromyalgia (FM) has been proposed to underlie the variability in treatment outcomes. It has previously been shown that pain-avoidance and pain-persistence treatments tailored to the patient's pattern are effective in improving physical and psychological functioning and overall impact in high-risk patients with heightened psychological distress. In the present study, the cognitive-behavioral effects of these treatments were evaluated to provide insight into the main proposed mechanisms, specifically pain-avoidance behaviors and activity pacing in the pain-avoidance and pain-persistence treatments, respectively. METHODS High-risk FM patients were classified into 2 groups, pain avoidance and pain persistence, and randomized in groups to the relevant treatment or waiting-list control condition. The pain-avoidance and pain-persistence treatments both comprised 16 twice-weekly sessions of cognitive-behavioral therapy and exercise training. Cognitive--behavioral factors assessed at pre- and posttreatment and 6 months of followup were evaluated using linear mixed models. RESULTS A significant treatment effect was found for pain-avoidance behavior in the pain-avoidance treatment and for activity pacing in the pain-persistence treatment, showing improvements in the treatment condition relative to the controls. Furthermore, the effect on functioning was mediated by changes in pain-avoidance behavior in the pain-avoidance treatment and by changes in activity pacing in the pain-persistence treatment. Both treatments also showed significant improvements in other relevant cognitive-behavioral factors. CONCLUSION Both the pain-avoidance and pain-persistence treatments are effective in improving cognitive-behavioral factors in high-risk FM patients. Pain-avoidance behavior and activity pacing might be important mediating mechanisms for beneficial outcomes in pain-avoidance and pain-persistence treatments, respectively.
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Affiliation(s)
- S van Koulil
- Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Evers AWM, Zautra A, Thieme K. Stress and resilience in rheumatic diseases: a review and glimpse into the future. Nat Rev Rheumatol 2011; 7:409-15. [PMID: 21691322 DOI: 10.1038/nrrheum.2011.80] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Stress resilience factors, and interventions to ease stress and enhance resilience, are gaining increasing attention for the treatment of rheumatic conditions. This Review presents a digest of empirical work on the factors that determine the risk of adapting poorly to a rheumatic condition, and on the resilience factors that counteract such risks. We consider the types of stress-management and resilience treatments that are most effective in promoting the physical and psychological functioning of patients at risk of long-term adjustment problems. Prospective research shows that cognitive-behavioral and social risk and resilience factors predict the long-term physical and psychological functioning of patients with rheumatic conditions. Furthermore, validated screening instruments are becoming increasingly useful in clinical practice to identify and select patients at risk. Stress-management and resilience interventions offer promising ways to improve the long-term functioning of patients. These treatment methods might be especially useful when they are tailored to the specific risk and resilience factors of patients, and when they incorporate innovative approaches to the delivery of services, including internet applications such as eHealth, to increase efficiency and availability of treatments, and to optimize patient empowerment in rheumatic conditions.
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Affiliation(s)
- Andrea W M Evers
- Department of Medical Psychology (840), Radboud University Nijmegen Medical Center, PO Box 9101, 6500 HB, Nijmegen, the Netherlands.
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van Koulil S, van Lankveld W, Kraaimaat FW, van Helmond T, Vedder A, van Hoorn H, Donders R, de Jong AJL, Haverman JF, Korff KJ, van Riel PLCM, Cats HA, Evers AWM. Tailored cognitive-behavioral therapy and exercise training for high-risk patients with fibromyalgia. Arthritis Care Res (Hoboken) 2010; 62:1377-85. [PMID: 20521308 DOI: 10.1002/acr.20268] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The treatment of patients with fibromyalgia (FM), a high-prevalence chronic pain condition with a high impact on both patients and society, poses a great challenge to clinicians due to a lack of effective treatments. In view of the large individual variability in outcome, selecting patients at risk of long-term dysfunction and offering tailored treatment may be promising for beneficial treatment effects. METHODS High-risk patients were selected and classified into 2 groups (pain-persistence and pain-avoidance groups) and subsequently randomized in groups to either a treatment condition (TC) or a waiting list control condition (WLC). Treatment consisted of 16 sessions of cognitive-behavioral therapy (CBT) and exercise training in groups, tailored to the patient's specific cognitive-behavioral pattern, delivered within 10 weeks. Physical and psychological functioning and impact of FM were assessed at baseline, posttreatment, and 6-month followup. Treatment effects were evaluated using a linear mixed model. RESULTS The treatment effects were significant for all primary outcomes, showing significant differences in physical (pain, fatigue, and functional disability) and psychological (negative mood and anxiety) functioning, and impact of FM for the TC in comparison with the WLC. Effect sizes in the TC were overall large, and reliable change indices indicated a clinically relevant improvement among the TC. CONCLUSION The presented results demonstrate for the first time that tailored CBT and exercise training for high-risk patients with FM is effective in improving short- and long-term physical and psychological functioning, indicating that tailoring treatment is likely to promote beneficial outcomes in FM and reduce the burden for patients and society.
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van Koulil S, Kraaimaat FW, van Lankveld W, van Riel PLCM, Evers AWM. A patient's perspective on multidisciplinary treatment gain for fibromyalgia: An indicator for pre-post treatment effects? ACTA ACUST UNITED AC 2009; 61:1626-32. [DOI: 10.1002/art.24792] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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