Long-term follow up of a physical therapy programme for patients with fibromyalgia syndrome

Relationship between body awareness level and musculoskeletal pain complaints, physical activity level and emotional status in healthy people

INTRODUCTıON/AIM: Defining the physical, psycho-social effects of body awareness may help to explain the functional effects. It was aimed to examine the relationship between the body awareness level and musculoskeletal pain complaints, physical activity level, and emotional state in healthy people.

MATERIALS AND METHODS

A total of 289 healthy individuals between the ages of 18 and 25 were included in the study. Body awareness level was using Body Awareness Questionnaire (BAQ), musculoskeletal pain complaint using The Nordic Musculoskeletal Questionnaire (NMQ), physical activity levels using International Physical Activity Questionnaire (IPAQ-short form) and emotional status using Beck Depression Inventory (BDI) were assessed.

RESULTS

The mean age of the participants was 19.50 ± 1.55 years. The mean pain intensity was 2.48 ± 1.99. The BAQ score average was 91.87 ± 15.55. Thirty percent of the participants had a mild level and 14.9% had a moderate level of depression risk. While there was a weak positive relationship between the Disease Startup sub-dimension of BAQ and the moderate-level IPAQ score (r = 0.135, p = 0.022). Also there was a weak negative relationship between Disease Startup sub-dimension and the level of depression risk. A weak positive relationship was found between the changes in the body process and attention to subjects sub-dimension and the level of depression risk (r = 0.127, p = 0.030). There was a positive correlation between level of depression risk and pain intensity (r = 0.237, p = 0.000). Body awareness levels of individuals who had back pain in the last 1 month were higher than those who did not experience pain (p = 0.029).

CONCLUSION

The results of the study showed that physical activity positively affected body awareness level. The body awareness level was directly related to the pain associated with the musculoskeletal system and emotional state. There is a need more studies examining the relationship between body awareness and pain, physical activity and emotional status with subdimensions of the BAQ.

Pool-based exercise for amelioration of pain in adults with fibromyalgia syndrome: A systematic review and meta-analysis

OBJECTIVE

To evaluate the effects of pool-based exercises on pain symptomatology among adults with fibromyalgia syndrome.

METHODS

A systematic review and meta-analysis were carried out using PRISMA guidelines. Database search was conducted by two independent reviewers. For meta-analysis, the visual analogue scale (VAS) score for pain was used as the primary outcome and the Fibromyalgia Impact Questionnaire (FIQ) score was utilized as the secondary outcome.

RESULTS

A total of 42 out of 292 potentially eligible studies were selected for being read in full by reviewers, 14 of which were included in meta-analysis, being 10 of them used in sensitivity analysis of either the primary or secondary outcome. Data pooled from 10 randomized controlled trials (n = 508) revealed that patients who underwent pool-based exercises exhibited a significantly lower mean in VAS score as compared to controls (SMD = -0.27, 95% CI: -0.45 to -0.09). Regarding FIQ scores, data from 10 randomized controlled trials were pooled (n = 578) and a lower mean score was also shown in the group that underwent a pool-based exercise program (SMD = -0.29, 95% CI: -0.49 to -0.09). Limitations of this study include the small sample size and moderate dropout rates in currently available clinical trials.

CONCLUSION

Pool-based exercise may provide some additional benefit for pain relief in adults with fibromyalgia as compared to either land-based or no physical exercise.

IMPLICATIONS OF KEY FINDINGS

Collectively, these findings suggest that pool-based exercise deserves further attention as a potential adjuvant therapeutic option for adults with fibromyalgia. PROSPERO registration number: CRD42019136755.

Knowledge, Awareness, and Perceptions of the Diagnosis and Management of Fibromyalgia Among Physical Therapists in Saudi Arabia: A Cross-Sectional Survey

Aim

To explore awareness of the diagnostic criteria and management of fibromyalgia (FM) among physical therapists practicing in Saudi Arabia.

Methods

A cross-sectional survey was distributed electronically among musculoskeletal physical therapists. It was designed based on the research literature relevant to FM and reviewed by two rheumatologists for accuracy and comprehension. The survey included two sections: participants' demographic information and questions related to FM. The data were described using absolute and relative frequencies.

Results

A total of 234 physical therapists accepted the invitation to participate in the study, and 52 were excluded for not satisfying the inclusion criteria or not completing the survey. Responses were received from March to May 2020; only 118 (65%) respondents completed the FM section. The average age of the participants was 31.2 (SD=6.9) years, and 36% were females. Eighty percent reported seeing fewer than five patients with FM in the past year; 51% acquired FM-related knowledge through self-learning; half reported having little to no confidence in their FM assessments and management; and less than 20% were familiar with common diagnostic criteria and management guidelines for FM.

Conclusion

Participating physical therapists showed little awareness of or confidence in the assessment and management of patients with FM; moreover, their awareness was not supported by their adherence to recent FM guidelines. Despite the common practice of referring patients with FM for physical therapy, there are many misconceptions about FM. This study highlights the need for educational programs to provide up-to-date evidence in undergraduate and postgraduate education.

Multicomponent interdisciplinary group intervention for self-management of fibromyalgia: a mixed-methods randomized controlled trial

BACKGROUND

This study evaluated the efficacy of the PASSAGE Program, a structured multicomponent interdisciplinary group intervention for the self-management of FMS.

METHODS

A mixed-methods randomized controlled trial (intervention (INT) vs. waitlist (WL)) was conducted with patients suffering from FMS. Data were collected at baseline (T0), at the end of the intervention (T1), and 3 months later (T2). The primary outcome was change in pain intensity (0-10). Secondary outcomes were fibromyalgia severity, pain interference, sleep quality, pain coping strategies, depression, health-related quality of life, patient global impression of change (PGIC), and perceived pain relief. Qualitative group interviews with a subset of patients were also conducted. Complete data from T0 to T2 were available for 43 patients.

RESULTS

The intervention had a statistically significant impact on the three PGIC measures. At the end of the PASSAGE Program, the percentages of patients who perceived overall improvement in their pain levels, functioning and quality of life were significantly higher in the INT Group (73%, 55%, 77% respectively) than in the WL Group (8%, 12%, 20%). The same differences were observed 3 months post-intervention (Intervention group: 62%, 43%, 38% vs Waitlist Group: 13%, 13%, 9%). The proportion of patients who reported ≥ 50% pain relief was also significantly higher in the INT Group at the end of the intervention (36% vs 12%) and 3 months post-intervention (33% vs 4%). Results of the qualitative analysis were in line with the quantitative findings regarding the efficacy of the intervention. The improvement, however, was not reflected in the primary outcome and other secondary outcome measures.

CONCLUSION

The PASSAGE Program was effective in helping FMS patients gain a sense of control over their symptoms. We suggest including PGIC in future clinical trials on FMS as they appear to capture important aspects of the patients' experience.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number Register ISRCTN14526380.

Beyond pain in fibromyalgia: insights into the symptom of fatigue

Fatigue is a disabling, multifaceted symptom that is highly prevalent and stubbornly persistent. Although fatigue is a frequent complaint among patients with fibromyalgia, it has not received the same attention as pain. Reasons for this include lack of standardized nomenclature to communicate about fatigue, lack of evidence-based guidelines for fatigue assessment, and a deficiency in effective treatment strategies. Fatigue does not occur in isolation; rather, it is present concurrently in varying severity with other fibromyalgia symptoms such as chronic widespread pain, unrefreshing sleep, anxiety, depression, cognitive difficulties, and so on. Survey-based and preliminary mechanistic studies indicate that multiple symptoms feed into fatigue and it may be associated with a variety of physiological mechanisms. Therefore, fatigue assessment in clinical and research settings must consider this multi-dimensionality. While no clinical trial to date has specifically targeted fatigue, randomized controlled trials, systematic reviews, and meta-analyses indicate that treatment modalities studied in the context of other fibromyalgia symptoms could also improve fatigue. The Outcome Measures in Rheumatology (OMERACT) Fibromyalgia Working Group and the Patient Reported Outcomes Measurement Information System (PROMIS) have been instrumental in propelling the study of fatigue in fibromyalgia to the forefront. The ongoing efforts by PROMIS to develop a brief fibromyalgia-specific fatigue measure for use in clinical and research settings will help define fatigue, allow for better assessment, and advance our understanding of fatigue.

Sense of coherence and pain experience in older age

BACKGROUND

We investigate to what extent pain in older individuals is predicted by on the one hand chronic morbidity as a resistance deficit, and on the other hand psychological resistance resources and the sense of coherence. For the first time, we tested the salutogenic hypothesis that the sense of coherence mediates the relationship between resources/deficits and pain.

METHODS

In our questionnaire study, we assessed selected psychological resistance resources (self-esteem, generalized self-efficacy, optimism, and social support), the number of self-reported medical diagnoses of chronic illness, the sense of coherence, and pain (SF-36 Bodily Pain subscale) in a sample of 387 older persons (at the mean age of 73.8 years).

RESULTS

Using hierarchical regression, we found that morbidity and sense of coherence were the only significant predictors of pain, with morbidity showing the strongest effect. Using path analysis, the sense of coherence was a mediator of the relationship between resistance resources/deficits and pain.

CONCLUSIONS

With respect to our analytical model, in which pain experience was the criterion variable, morbidity and the sense of coherence are important predictors of pain. Moreover, we found evidence for the salutogenic idea that the sense of coherence represents a mediator variable as it pools resistance/deficits influences on pain. We recommend a prospective design to explore these assumed causal chains in future research.

Benefit of Qigong exercise in patients with fibromyalgia: a pilot study

OBJECTIVE

Fibromyalgia (FM) patients present with widespread chronic pain and other symptoms. Some studies in the literature have reported inconsistent results after a Qigong exercise intervention in patients with FM. The purpose of this study was to test the feasibility of a home-based Qigong exercise in patients with FM.

METHODS

A total of 14 subjects were randomly assigned into one of two groups. The experimental group went through a six-week Qigong exercise program involving meditation, deep breathing, and synchronized rhythmic body movements. The control group took part in a sham Qigong exercise program using the same body movements also for six weeks. Clinical assessments at baseline and end of intervention used the Short-Form McGill Pain Questionnaire, Multidimensional Fatigue Inventory, Pittsburgh Sleep Quality Index, and Fibromyalgia Impact Questionnaire.

RESULTS

Group mean scores of four measurements were significantly (p < .0125) reduced in the intervention group, but not in the control group. The percentage changes in the four measurements were 44.2%, 24.8%, 37.3%, and 44.3% in the intervention group, and 10.1%, 6.3%, 9.9%, and 11.8% in the control group.

CONCLUSION

Qigong exercise may potentially be an effective self-management approach in controlling FM symptoms. In this pilot study, regular daily Qigong exercise, accumulated number of exercise sessions, and the specific form of Qigong exercise may all be important factors for the significant improvement in the study subjects. Future research is required to determine whether the same benefit can be obtained in a larger sample.

Ottawa Panel evidence-based clinical practice guidelines for strengthening exercises in the management of fibromyalgia: part 2

BACKGROUND AND PURPOSE

The objective of this study was to create guidelines for the use of strengthening exercises in the management of adult patients (>18 years of age) with fibromyalgia (FM), as defined by the 1990 American College of Rheumatology criteria.

METHODS

Following Cochrane Collaboration methods, the Ottawa Methods Group found and synthesized evidence from comparative controlled trials and formed the Ottawa Panel, with nominated experts from key stakeholder organizations. The Ottawa Panel then developed criteria for grading the recommendations based on experimental design (I for randomized controlled trials, II for nonrandomized studies) and strength of evidence (A, B, C+, C, D+, D, or D-). From the rigorous literature search, 5 randomized controlled trials were selected. Statistical analysis was based on Cochrane Collaboration methods. Continuous data were calculated with weighted mean differences between the intervention and control groups, and dichotomous data were analyzed with relative risks. Clinical improvement was calculated using absolute benefit and relative difference in change from baseline. Clinical significance was attained when an improvement of 15% relative to a control was found.

RESULTS

There were 5 positive recommendations: 2 grade A and 3 grade C+. All 5 were of clinical benefit.

DISCUSSION AND CONCLUSION

The Ottawa Panel recommends strengthening exercises for the management of fibromyalgia as a result of the emerging evidence (grades A, B, and C+, although most trials were rated low quality) shown in the literature.