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Rivas Neira S, Pasqual Marques A, Fernández Cervantes R, Seoane Pillado MT, Vivas Costa J. Efficacy of aquatic vs land-based therapy for pain management in women with fibromyalgia: a randomised controlled trial. Physiotherapy 2024; 123:91-101. [PMID: 38447497 DOI: 10.1016/j.physio.2024.02.005] [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: 11/11/2022] [Revised: 12/28/2023] [Accepted: 02/14/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE To determine the efficacy of two physiotherapeutic interventions - aquatic therapy (AT) and land-based therapy (LBT) - for reducing pain in women with fibromyalgia. DESIGN Single-blind, randomised controlled, equivalence trial. SETTING Fibromyalgia, Chronic Fatigue Syndrome and Multiple Chemical Sensitivity Association in A Coruña, Spain. PARTICIPANTS Forty women with fibromyalgia were assigned at random in a 1:1 manner to two groups: AT (n = 20) and LBT (n = 20). INTERVENTIONS Two therapeutic exercise programmes, with 60-min sessions, were undertaken three times per week for 12 weeks. Sessions were carried out in groups by a trained physiotherapist. OUTCOME The primary outcome was pain intensity (visual analogue scale). The secondary outcomes were pressure pain threshold (algometer), quality of life (Revised Fibromyalgia Impact Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), fatigue (Multidimensional Fatigue Inventory) and physical ability (6-Minute Walk Test). Patients were evaluated at baseline, 12 weeks (post-treatment) and 18 weeks (follow-up). The statistical analysis was per-protocol. P < 0.05 was considered to indicate significance. Effect size was calculated. RESULTS The mean age was 50 [standard deviation (SD) 9] years, with median body mass index of 27 [interquartile range (IQR) 25-30] kg/m2 and median symptom duration of 11 (IQR 6-15) years. No differences were observed between the groups post-treatment, but differences in favour of AT were found in pain intensity [2.7 (IQR 1.5-4.9) vs 5.5 (IQR 3.3-7.6); p= 0.023; large effect, Cohen's d= 0.8; 95% confidence interval (CI) 0.1-1.5] and sleep quality [12.0 (IQR 7.3-15.3) vs 15.0 (IQR 13.0-17.0); p= 0.030; large effect, Cohen's d= 0.8; 95% CI 0.1-1.5] at follow-up. CONCLUSIONS The results suggest that AT is better than LBT for reducing pain intensity and improving sleep quality after 6 weeks of follow-up. AT may be a good treatment option for women with fibromyalgia. CLINICAL TRIALS REGISTRATION NUMBER ClinicalTrials.gov NCT02695875 CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- S Rivas Neira
- Department of Physiotherapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy, Universidade da Coruña, A Coruña, Spain.
| | - A Pasqual Marques
- Department of Physiotherapy, Speech-Language Pathology and Audiology, and Occupational Therapy, Faculty of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - R Fernández Cervantes
- Department of Physiotherapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy, Universidade da Coruña, A Coruña, Spain
| | - M T Seoane Pillado
- Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Spain
| | - J Vivas Costa
- Department of Physiotherapy, Medicine and Biomedical Sciences, Faculty of Physiotherapy, Universidade da Coruña, A Coruña, Spain
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Bravo C, Rubí-Carnacea F, Colomo I, Sánchez-de-la-Torre M, Fernández-Lago H, Climent-Sanz C. Aquatic therapy improves self-reported sleep quality in fibromyalgia patients: a systematic review and meta-analysis. Sleep Breath 2024; 28:565-583. [PMID: 37847348 PMCID: PMC11136798 DOI: 10.1007/s11325-023-02933-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 09/26/2023] [Accepted: 09/29/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND This systematic review and meta-analysis aimed to evaluate the effectiveness of aquatic therapy on pain, sleep quality, psychological symptoms, quality of life, and health status in people diagnosed with fibromyalgia. METHODS We searched PubMed, CINAHL, The Cochrane Library, PEDro and Scopus databases. Articles were eligible if they were randomised controlled trials (RCTs) analysing the effects of aquatic therapy in adult people diagnosed with fibromyalgia, and published by October of 2022 in English or Spanish. The Cochrane Risk of Bias tool was employed to conduct the methodological quality assessment of the encompassed studies, and the overall quality of evidence for each comparison was determined using the GRADE approach. RESULTS Of 375 articles found, 22 met the inclusion criteria. Forest plot analysis of Pittsburgh sleep quality index at short- and mid-term follow-up showed a trend in favour of aquatic therapy, although not statistically significant, with weighted mean difference (WMD) = -1.71 (95% CI: -4.17 to -0.75, p = 0.17). Heterogeneity was substantial (χ2 = 8.74, df = 5 (p < 0.000001; I2 = 95%). Relating the pain outcome by fibromyalgia impact questionnaire (FIQ) short term showed a trend in favour of the aquatic therapy group with WMD = -5.04 (95% CI: - 9.26 to - 0.82, p = = 0.02) with heterogeneity χ2 = 11.07, df = 4 (p = 0.03; I2 = 64%). Great heterogeneity was found between trials in medium term. CONCLUSION This systematic review and meta-analysis demonstrated the effectiveness of aquatic therapy as an adjunct treatment to usual care in people suffering from fibromyalgia. Aquatic therapeutic exercise improves the symptomats of sleep quality, pain, and quality of life of adults with fibromyalgia. Further research on long-term outcomes may contribute to the currently available evidence.
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Affiliation(s)
- Cristina Bravo
- Department of Nursing and Physiotherapy, University of Lleida, Montserrat Roig St. n2 P.C, 25198, Lleida, Spain
- Health Care Research Group, GRECS, Biomedical Research Institute of Lleida, Lleida, Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura, GESEC, University of Lleida, Lleida, Spain
- Group of Salut&Genesis, Lleida Institute for Biomedical Research Dr. Pifarré Foundation, 25198, Lleida, Spain
| | - Francesc Rubí-Carnacea
- Department of Nursing and Physiotherapy, University of Lleida, Montserrat Roig St. n2 P.C, 25198, Lleida, Spain
- Health Care Research Group, GRECS, Biomedical Research Institute of Lleida, Lleida, Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura, GESEC, University of Lleida, Lleida, Spain
| | - Iolanda Colomo
- Department of Nursing and Physiotherapy, University of Lleida, Montserrat Roig St. n2 P.C, 25198, Lleida, Spain
| | - Manuel Sánchez-de-la-Torre
- Department of Nursing and Physiotherapy, University of Lleida, Montserrat Roig St. n2 P.C, 25198, Lleida, Spain
- Group of Precision Medicine in Chronic Diseases, Hospital Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Helena Fernández-Lago
- Department of Nursing and Physiotherapy, University of Lleida, Montserrat Roig St. n2 P.C, 25198, Lleida, Spain.
- Health Care Research Group, GRECS, Biomedical Research Institute of Lleida, Lleida, Spain.
- Grup d'Estudis Societat, Salut, Educació i Cultura, GESEC, University of Lleida, Lleida, Spain.
| | - Carolina Climent-Sanz
- Department of Nursing and Physiotherapy, University of Lleida, Montserrat Roig St. n2 P.C, 25198, Lleida, Spain
- Health Care Research Group, GRECS, Biomedical Research Institute of Lleida, Lleida, Spain
- Grup d'Estudis Societat, Salut, Educació i Cultura, GESEC, University of Lleida, Lleida, Spain
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de Souza LC, Vilarino GT, Andrade A. Effects of home-based exercise on the health of patients with fibromyalgia syndrome: a systematic review of randomized clinical trials. Disabil Rehabil 2024:1-12. [PMID: 38588585 DOI: 10.1080/09638288.2024.2337105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/24/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Analyze the effects of interventions with home-based physical exercise on the health of patients with fibromyalgia and the characteristics of the protocols used. METHODS This systematic review was registered at PROSPERO and followed the PRISMA recommendations. Searches were performed in six electronic databases. Eligibility criteria for the selection of studies were compiled using the acronym PICOS. Data were extracted and checked in a Microsoft Excel® spreadsheet and the risk of bias was assessed using the Rob 2 tool. RESULTS The search resulted in seven studies included for analysis. Among them, the most common modality was aerobic exercise. The analyzed outcomes were: pain, quality of life, depression, anxiety, disease severity, physical function, pain catastrophizing, self-efficacy, psychological well-being, sleep quality and somatosensory and temporal discrimination. The effects of home-based exercise are limited, and improvements in pain and quality of life was found. For the other outcomes, the results were inconclusive. Most studies presented some concerns about the risk of bias. CONCLUSION It is necessary to expand the evidence on home-based exercises for fibromyalgia, as this is the first systematic review on the subject. Subsequent research should focus on methodological rigor and protocol detail, allowing findings to be replicated.
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Affiliation(s)
- Loiane Cristina de Souza
- Department of Physical Education, Health and Sports Science Center, Santa Catarina State University, Florianópolis, Brazil
| | - Guilherme Torres Vilarino
- Department of Physical Education, Health and Sports Science Center, Santa Catarina State University, Florianópolis, Brazil
| | - Alexandro Andrade
- Department of Physical Education, Health and Sports Science Center, Santa Catarina State University, Florianópolis, Brazil
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Ma J, Zhang T, Li X, Chen X, Zhao Q. Effects of aquatic physical therapy on clinical symptoms, physical function, and quality of life in patients with fibromyalgia: A systematic review and meta-analysis. Physiother Theory Pract 2024; 40:205-223. [PMID: 36062580 DOI: 10.1080/09593985.2022.2119906] [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: 11/30/2021] [Accepted: 08/23/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The main feature of fibromyalgia syndrome is extensive musculoskeletal pain and tenderness. It not only has a significant impact on patients but also brings a huge burden to families and society. Exercise is considered to be the most important part of the fibromyalgia treatment, and aquatic physical therapy can be considered one of the most recommended interventions. Therefore, the effects of aquatic physical therapy on fibromyalgia patients were discussed in this article. OBJECTIVE The purpose of this study was to evaluate the effects of aquatic physical therapy on clinical symptoms, physical function, and quality of life in patients with fibromyalgia. METHODS Eight databases were retrieved. "Fibromyalgia," "Aquatic Therapy," "Aquatic Exercise," and "Hydrotherapy" was used for retrieval. Randomized controlled trials of the effects of aquatic physical therapy on patients with fibromyalgia were included. The Cochrane risk of bias tool to assess research quality. Meta-analysis was performed by Revman version 5.3. RESULTS Finally, 14 articles (762 patients) were included in the analysis. Compared with other exercises or no exercise, aquatic physical therapy has more significant effects. There were significant differences in visual analogue scale (MD: - 0.98, 95%CI: - 1.36 to - 0.60, Z = 5.03, P < .00001), six minute walk test (MD: 38.12, 95%CI: 13.65 to 62.59, Z = 3.05, P = .002), fibromyalgia impact questionnaire total scores(MD: - 7.35, 95%CI: - 13.05 to - 1.65, Z = 2.53, P = .01), vitality of short form 36 (MD: 9.53, 95%CI: 0.62 to 18.43, Z = 2.10, P = .04) and general health of short form 36 (MD: 10.39, 95%CI: 1.42 to 19.36, Z = 2.27, P = .02). CONCLUSIONS Aquatic physical therapy may have some benefits on the clinical symptoms, physical function, and quality of life of patients with fibromyalgia.
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Affiliation(s)
- Ji Ma
- Orthopaedic Spinal Ward, Shanxi Provincial People's Hospital, Taiyuan, P.R. China
| | - Teng Zhang
- School of Nursing, Shanxi Medical University, Taiyuan, P.R. China
| | - Xin Li
- School of Nursing, Shanxi Medical University, Taiyuan, P.R. China
| | - Xiaoyu Chen
- School of Nursing, Shanxi University of Traditional Chinese Medicine, Jinzhong, P.R. China
| | - Qian Zhao
- Department of Nursing, Shanxi Provincial People's Hospital, Taiyuan, P.R.China
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Saleh E, Yabroudi MA, Al-Wardat M, Nawasreh ZH, Almhdawi K, Etoom M. The effectiveness of home-based therapeutic exercises on adults with fibromyalgia: a systematic review and meta-analysis. Int J Rehabil Res 2023; 46:359-368. [PMID: 37909314 DOI: 10.1097/mrr.0000000000000606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
The objective of this systematic review and meta-analysis is to evaluate the effectiveness of home-based exercises (HBE) in alleviating pain, fatigue, depression, and anxiety and enhancing the quality of life (QOL) among adults with fibromyalgia. A comprehensive search was conducted across four databases PubMed, Cochrane, CINAHL (EBSCO), and PEDro to identify eligible randomized controlled trials (RCTs). Standardized mean differences (SMDs) at a 95% confidence interval (CI) were computed. Ten RCTs met the inclusion criteria, involving 601 participants, with a good-to-fair quality according to the PEDro scale. Of the 10 included studies, 3 compared HBE to no exercise, while 7 compared HBE to center-based exercises (CBE). HBE showed significant pain reduction (SMD = 0.775, P = 0.003) and improved QOL as measured by the fibromyalgia impact questionnaire (FIQ) (SMD = 0.621, P = 0.001) compared with no exercise, but there were no significant differences in depression and QOL as measured by SF-36 compared with CBE. In contrast, CBE demonstrated greater pain reduction (SMD = -1.325, P < 0.001) and improved FIQ scores (SMD = -0.843, P = 0.017) compared with HBE. In conclusion, HBE exhibit effectiveness in alleviating pain, and depression and enhancing QOL among fibromyalgia patients in comparison to no exercise. However, CBE are more effective in reducing pain and enhancing QOL than HBE, although HBE can be valuable for maintaining activity levels in fibromyalgia patients between treatment cycles.
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Affiliation(s)
- Esra' Saleh
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Neelapala YVR, Mercuri D, Macedo L, Hanna S, Kobsar D, Carlesso L. Mechanisms hypothesized for pain-relieving effects of exercise in fibromyalgia: a scoping review. Ther Adv Musculoskelet Dis 2023; 15:1759720X231182894. [PMID: 37484924 PMCID: PMC10356998 DOI: 10.1177/1759720x231182894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/31/2023] [Indexed: 07/25/2023] Open
Abstract
Background Exercise is one of the most recommended management strategies by treatment guidelines for fibromyalgia (FM); however, the mechanism through which exercise improves pain in FM is still unknown. Objective We aimed to summarize the hypothesized theoretical mechanisms for the pain-relieving effects of exercise in people with FM. Eligibility Criteria Randomized controlled trials (RCTs) in English reporting mechanisms for pain-relieving effects of exercise in the 'Introduction' and 'Discussion' sections and significant within- group or between-group effects of exercise interventions were included. Sources of Evidence We searched the databases Ovid MEDLINE(R), EMBASE, CINAHL, COCHRANE, Sports Discuss, and AMED with the keywords: exercise and fibromyalgia until December 2021. Charting Methods Two authors independently performed title/abstract, full-text review, and data abstraction using a data abstraction form. The hypothesized mechanisms from individual studies were grouped into three categories. Results The literature search resulted in 2147 studies, out of which 220 studies were considered for full-text review. A total of 50 RCTs proposing 29 unique mechanisms for the pain-relieving effects of exercise were included. These mechanisms were divided into three categories: physical, neuro-physiological, and psychological. The neuro-physiological category was further subdivided into exercise-induced hypoalgesia (EIH), pain sensitization, the autonomic system, the immune system, the endocrine system, and miscellaneous categories. The most frequently hypothesized mechanisms were EIH (n = 15), autonomic modulation (n = 7), improved sleep (n = 6), muscle oxygenation (n = 6), self-efficacy (n = 5), mental health (n = 4), and benefits of the aquatic environment (n = 12). While all exercise interventions involved FM patients, most of the supporting evidence for these mechanisms was cited from previous studies conducted on healthy samples. No studies performed analyses to demonstrate causal associations between the mechanisms and outcomes. Conclusion Multiple mechanisms were hypothesized for the positive influence of exercise in people with FM. Future studies using causal analyses, such as mediation analysis, are recommended to validate these mechanisms.
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Affiliation(s)
| | - Domenico Mercuri
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Luciana Macedo
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Steven Hanna
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Dylan Kobsar
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
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Manojlović D, Kopše EI. The effectiveness of aerobic exercise for pain management in patients with fibromyalgia. Eur J Transl Myol 2023; 33:11423. [PMID: 37449965 PMCID: PMC10583145 DOI: 10.4081/ejtm.2023.11423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023] Open
Abstract
The effectiveness of exercise therapy is being increasingly studied in patients with fibromyalgia. The aim of our systematic review was to determine the effectiveness of different types of aerobic exercise programs for pain management in patients with fibromyalgia. The literature search was performed by two independent researchers in the PubMed, CINAHL and PEDro databases using various combinations of the following keywords: fibromyalgia, pain and aerobic exercise. Studies were eligible if they included adults diagnosed with fibromyalgia and examined the effectiveness of at least one aerobic exercise program on pain management. A total of 14 randomized controlled trials were screened in full-text, nine of which were included in the systematic review. Overall, our results indicate that aerobic exercise is effective for pain management in patients with fibromyalgia. The results of the aerobic exercise programs were more effective for pain management than stretching exercises, but did not differ significantly from those of pilates, muscle strengthening exercises, relaxation techniques and stress management treatment. Additional high-quality studies are warranted to determine accurate clinical guidelines in terms of aerobic exercise programs for pain management in patients with fibromyalgia.
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Zhang KD, Wang LY, Zhang ZH, Zhang DX, Lin XW, Meng T, Qi F. Effect of Exercise Interventions on Health-Related Quality of Life in Patients with Fibromyalgia Syndrome: A Systematic Review and Network Meta-Analysis. J Pain Res 2022; 15:3639-3656. [PMID: 36444171 PMCID: PMC9700437 DOI: 10.2147/jpr.s384215] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/12/2022] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE Several guidelines highlight the beneficial impact of exercise on the management of symptoms and health-related quality of life (HRQOL) in patients with fibromyalgia syndrome (FMS). However, few analyses have compared different types of exercise. We, therefore, intent to compare the effects of different exercise types on improving the overall HRQOL and typical symptoms in patients with FMS. METHODS Medline, Embase, the Cochrane Register of Clinical Trials, and NIH ClinicalTrials.gov were searched from inception to April 21, 2022. Randomized clinical trials (RCTs) were included to assess the impact of exercise intervention on health parameters in adult FMS patients. Data were extracted independently and a frequentist network meta-analyses (NMA) was performed to rank the effects of interventions according to P-scores. The NMA evidence certainty was assessed using the method recommended by Grading of Recommendations Assessment, Development, and Evaluation Working Group. RESULTS A total of 57 RCTs were identified, including 3319 participants, involving 9 interventions (7 types of exercise, 2 controls). Of all treatments compared with usual care in efficacy outcomes, Mind-body exercise was associated with the best HRQOL (SMD, -12.12; 95% CI, -15.79 to -8.45). On the other characteristic symptom dimensions, based on moderate quality evidence, sensorimotor training was associated with minimal pain scores compared with usual care (SMD, -1.81; 95% CI, -2.81 to -0.82), whole body vibration therapy was most promising for improving sleep quality (SMD, -6.95; 95% CI, -10.03 to -3.87), pool-based aerobic exercise was most likely to ease anxiety (SMD, -4.83; 95% CI, -7.47 to -2.19), and whole body vibration was most likely to improve depression (SMD, -10.44; 95% CI, -22.00 to 1.12). CONCLUSION Mind-body exercise seems to be the most effective exercise to improve the overall HRQOL of patients with FMS. But at the same time, clinicians still need to develop individualized exercise plans for patients according to their symptoms and accessibility.
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Affiliation(s)
- Kang-Da Zhang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
| | - Lin-Yu Wang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
| | - Zhi-Hua Zhang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
| | - Dan-Xu Zhang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
| | - Xiao-Wen Lin
- Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Tao Meng
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
| | - Feng Qi
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, People’s Republic of China
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Comparison of the Superiority of Quadriceps Strengthening Isometric and Isotonic Exercises with Respect to Pain, Quality of Life, and Functional Capacity of Patients with Chondromalacia Patellae. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1075389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose: This study aims to investigate the superiority of different exercise modalities, including isotonic and isometric strengthening for quadriceps, over each other and their effect on pain, quality of life and functional capacity in patients diagnosed with chondromalacia patellae (CMP).
Methods: This study was designed as a prospective study in 30 patients(15 patients in isometric, 15 patients in isotonic group) and 15 healthy volunteers aged 20–50 years who were diagnosed with CMP based on physical examination and magnetic resonance imaging and had pain complaints. Pain level was evaluated with Visual Analogue Scala (VAS), functional capacity with Lysholm scale, and quality of life with Short Form-36(SF-36). Q-angle, and thigh circumference were evaluated before and after exercise in all patients.
Results: In patients with CMP, there were significant differences in Q-angle, pain, functional capacity, and some subcomponents of the SF-36 quality of life after performing isometric or isotonic exercises compared with the control group (p0,05). In the evaluation of the isotonic and isometric exercise groups, there were no significant difference in the assessment of Q-angle, thigh circumference, pain, functional capacity, and quality of life of patients with CMP (p>0,05).
Conclusion: Isometric and isotonic quadriceps strengthening exercises are not superior to each other in terms of pain, functional capacity, and quality of life in CMP treatment.
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Alvarez MC, Albuquerque MLL, Neiva HP, Cid L, Rodrigues F, Teixeira DS, Matos R, Antunes R, Morales-Sánchez V, Monteiro D. Exploring the Relationship between Fibromyalgia-Related Fatigue, Physical Activity, and Quality of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084870. [PMID: 35457737 PMCID: PMC9032824 DOI: 10.3390/ijerph19084870] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 12/28/2022]
Abstract
The symptoms of fibromyalgia are varied, including general muscle pain and pain at specific points (also called tender points), excessive fatigue, anxiety, depression, and some psychological problems that can have a negative impact on quality of life. Physical activity is a widely used option by health professionals to alleviate the effects of this syndrome. However, there is no clear information on the possible mediating role of physical activity in the relationship between fibromyalgia-related fatigue and quality of life. Therefore, this study aims to evaluate the relationship between fibromyalgia-related fatigue and quality of life, and to investigate the mediating role of physical activity in patients with this syndrome. Methods: In a cross-sectional study, 237 Portuguese women aged 28 to 75 years (M = 49.12; SD ± 8.87) and 117 Brazilian women aged 20 to 69 years (M = 46.72; SD ± 8.38) were recruited to participate in this study. These patients completed three valid and reliable questionnaires related to the assessment of fibromyalgia-related fatigue (MDF-Fibro-17), physical activity (IPAQ), and quality of life (SF-36). Results: Both samples had scores above the midpoint for all dimensions of fibromyalgia-related fatigue and scores below the midpoint for quality of life. Physical activity had no mediating effect in either sample, as the total indirect effect was not significant. Conclusions: Physical activity does not mediate the relationship between fatigue and quality of life. However, the results also show that the fatigue dimensions associated with fibromyalgia had a negative and significant association with physical and mental health indicators in both samples. Thus, patients with FM with higher scores on fatigue-related symptoms might suffer more from physical and mental health, both of which are related to quality of life.
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Affiliation(s)
- Marcos C. Alvarez
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; (M.C.A.); (M.L.L.A.); (H.P.N.)
| | - Maria Luiza L. Albuquerque
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; (M.C.A.); (M.L.L.A.); (H.P.N.)
| | - Henrique P. Neiva
- Department of Sport Sciences, University of Beira Interior, 6201-001 Covilhã, Portugal; (M.C.A.); (M.L.L.A.); (H.P.N.)
- Research Center in Sport, Health and Human Development (CIDESD), Trás os Montes and Alto Douro University, 5000-558 Vila Real, Portugal;
| | - Luis Cid
- Research Center in Sport, Health and Human Development (CIDESD), Trás os Montes and Alto Douro University, 5000-558 Vila Real, Portugal;
- Sport Sciences School of Rio Maior, Polytechnic of Santarém (ESDRM-IPSantarém), 2040-413 Rio Maior, Portugal
- Life Quality Research Centre (CIEQV), 2400-901 Leiria, Portugal; (F.R.); (R.M.); (R.A.)
| | - Filipe Rodrigues
- Life Quality Research Centre (CIEQV), 2400-901 Leiria, Portugal; (F.R.); (R.M.); (R.A.)
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Diogo S. Teixeira
- Faculty of Physical Education and Sport, Lusófona University (ULHT/FEFD), 1749-024 Lisbon, Portugal;
- Research Center in Sport, Physical Education, and Exercise and Health (CIDEFES), 1749-024 Lisbon, Portugal
| | - Rui Matos
- Life Quality Research Centre (CIEQV), 2400-901 Leiria, Portugal; (F.R.); (R.M.); (R.A.)
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal
| | - Raúl Antunes
- Life Quality Research Centre (CIEQV), 2400-901 Leiria, Portugal; (F.R.); (R.M.); (R.A.)
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Center for Innovative Care and Health Technology (ciTechCare), 2415-396 Leiria, Portugal
| | - Verónica Morales-Sánchez
- Department of Social Psychology, Social Work, Social Anthropology and East Asian Studies, Faculty of Psychology, Malaga University, 29003 Malaga, Spain;
| | - Diogo Monteiro
- Research Center in Sport, Health and Human Development (CIDESD), Trás os Montes and Alto Douro University, 5000-558 Vila Real, Portugal;
- Life Quality Research Centre (CIEQV), 2400-901 Leiria, Portugal; (F.R.); (R.M.); (R.A.)
- ESECS—Polytechnic of Leiria, 2411-901 Leiria, Portugal
- Correspondence:
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11
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Khruakhorn S, Chiwarakranon S. Effects of hydrotherapy and land-based exercise on mobility and quality of life in patients with knee osteoarthritis: a randomized control trial. J Phys Ther Sci 2021; 33:375-383. [PMID: 33935364 PMCID: PMC8079887 DOI: 10.1589/jpts.33.375] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/30/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To determine the effects of hydrotherapy and land-based exercises on functional mobility and quality of life among patients with knee osteoarthritis. [Participants and Methods] We conducted a randomized controlled trial with knee osteoarthritis patients randomly allocated into land-based (n=17) and hydrotherapy groups (n=17). The Time-Up and Go (TUG), Five Times Sit-to-Stand (5STS), Stair Climbing Test (SCT), and Quality of Life by questionnaires including the Modified Western Ontario and McMaster Universities Osteoarthritis Index questionnaire Thai version (Thai WOMAC) were assessed at baseline and 6 weeks. The World Health Organization Quality of Life BREF Thai version (WHOQOL-BREF-THAI) questionnaire were assessed at baseline and six weeks and 6 months. [Results] There was no significant difference in outcomes between the groups after 6-weeks and 6-months of follow-up. After 6 weeks, Thai WOMAC score improved in both groups. Only 5STS was improved in the land-based group, while the hydrotherapy group showed significant TUG, 5STS, and SCT improvement. Furthermore, only hydrotherapy showed significant improvement in WHOQOL-BREF-THAI scores in the mental, social, quality of health, and total domains after six months. [Conclusion] Both exercises equally improved functional mobility and quality of life. Hydrotherapy and land-based exercise could improve functional mobility and quality of life in patients with knee osteoarthritis.
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Affiliation(s)
- Santhanee Khruakhorn
- Department of Physical Therapy, Faculty of Allied Health
Sciences, Thammasat University Rangsit Campus: 99 Moo.18 Phahonyothin Road, Khlong Nueng,
Khlong Luang, Pathum Thani 12120, Thailand
| | - Sanon Chiwarakranon
- Department of Physical Therapy, Faculty of Allied Health
Sciences, Thammasat University Rangsit Campus: 99 Moo.18 Phahonyothin Road, Khlong Nueng,
Khlong Luang, Pathum Thani 12120, Thailand
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12
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Galvão-Moreira LV, de Castro LO, Moura ECR, de Oliveira CMB, Nogueira Neto J, Gomes LMRDS, Leal PDC. Pool-based exercise for amelioration of pain in adults with fibromyalgia syndrome: A systematic review and meta-analysis. Mod Rheumatol 2021; 31:904-911. [PMID: 32990113 DOI: 10.1080/14397595.2020.1829339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
| | | | | | | | - João Nogueira Neto
- Department of Medicine I, Federal University of Maranhão, São Luís, Brazil
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13
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Ferro Moura Franco K, Lenoir D, Dos Santos Franco YR, Jandre Reis FJ, Nunes Cabral CM, Meeus M. Prescription of exercises for the treatment of chronic pain along the continuum of nociplastic pain: A systematic review with meta-analysis. Eur J Pain 2020; 25:51-70. [PMID: 32976664 DOI: 10.1002/ejp.1666] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 09/16/2020] [Accepted: 09/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE To compare different exercise prescriptions for patients with chronic pain along the continuum of nociplastic pain: fibromyalgia, chronic whiplash-associated disorders (CWAD), and chronic idiopathic neck pain (CINP). DATABASES AND DATA TREATMENT Randomized controlled trials comparing different exercise parameters were included. The search was performed in the databases Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL and PEDro. Data on the parameters for the physical exercise programs for pain management were extracted for analysis. RESULTS Fifty studies with 3,562 participants were included. For fibromyalgia, both aerobic strengthening exercises were similar and better than stretching exercises alone. Exercises could be performed in 50- to 60-min supervised sessions, 2 to 3 times a week, for 13 weeks or more. For CWAD, body awareness exercises were similar to combined exercises, and there was no difference in adding sling exercises to a strengthening exercise program. The exercises could be performed in 90-min supervised sessions, twice a week, for 10 to 16 weeks. For CINP, motor control exercises and nonspecific muscle strengthening had a similar effect. Exercises could be performed in 30- to 60-min supervised sessions, 2 to 3 times a week, for 7 to 12 weeks. CONCLUSIONS The choice of parameters regarding exercises should emphasize global exercises in nociplastic pain conditions (such as fibromyalgia and CWAD) and specific exercises in non-nociplastic pain conditions (such as CINP) and be based on patient's preference and therapist's skills. PROSPERO REGISTRATION NUMBER CRD42019123271. SIGNIFICANCE The pain mechanism must be considered to optimize exercise prescription in patients with different chronic pain profiles. The main message of this article is that low to moderate intensity global exercises performed for a long period of treatment should be performed in patients with nociplastic pain predominance. Additionally, focused and intense exercises for a short period of treatment can be prescribed for patients with nociceptive pain predominance.
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Affiliation(s)
- Katherinne Ferro Moura Franco
- Master's and Doctoral Program in Physical Therapy, Universidade Cidade de São Paulo, São Paulo, Brazil.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dorine Lenoir
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Pain in Motion International Research Group, Brussels, Belgium
| | | | - Felipe José Jandre Reis
- Pain in Motion International Research Group, Brussels, Belgium.,Physical Therapy Department, Instituto Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Mira Meeus
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Pain in Motion International Research Group, Brussels, Belgium.,Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, MOVANT Research Group, University of Antwerp, Antwerp, Belgium
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14
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Kramer S, Deuschle L, Kohls N, Offenbächer M, Winkelmann A. The Importance of Daily Activity for Reducing Fibromyalgia Symptoms: A Retrospective "Real World" Data Comparison of two Multimodal Treatment Programs. Arch Rheumatol 2020; 35:575-583. [PMID: 33758814 PMCID: PMC7945713 DOI: 10.46497/archrheumatol.2021.7739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/04/2019] [Indexed: 12/02/2022] Open
Abstract
Objectives
This study aims to evaluate the effectiveness of two multidisciplinary fibromyalgia programs with different intensities. Materials and methods
In this retrospective real-world comparison of patient data, pre- and post-program datasets of Short Form 36 (SF36) and Fibromyalgia Impact Questionnaire (FIQ) were obtained from a total of 210 female patients in two fibromyalgia multidisciplinary day hospital programs including one intensive program with daily treatments summing up to 20 treatment days during four weeks (P20, n=70) versus a less intensive program with 12 treatment days during four weeks (P12, n=140). Results
Multiple subscales of SF36 and FIQ were improved in the pre-post comparison in both groups. In the comparison between the two groups, a statistically significantly higher improvement was found in the P20 group compared to the P12 group for the FIQ subscales of stiffness (p=0.001) and the number of days during which the patient felt “good” (p=0.007). Conclusion An intensive program of daily treatments and activity seems to be more effective in reducing fibromyalgia-associated stiffness and improving the number of days during which patients feel good than a less intensive program.
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Affiliation(s)
- Sybille Kramer
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University of Munich, Munich, Germany
| | - Lana Deuschle
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University of Munich, Munich, Germany
| | - Niko Kohls
- Division of Integrative Health Promotion, University of Applied Sciences and Art, Coburg, Germany
| | - Martin Offenbächer
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University of Munich, Munich, Germany
| | - Andreas Winkelmann
- Department of Orthopaedics, Physical Medicine and Rehabilitation, University of Munich, Munich, Germany
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15
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Çetinkaya FN, Koçak FA, Kurt EE, Güçlü K, Tuncay F, Şaş S, Erdem HR. The Effects of Balneotherapy on Oxidant/Antioxidant Status in Patients With Fibromyalgia: An Observational Study. Arch Rheumatol 2020; 35:506-514. [PMID: 33758807 PMCID: PMC7945715 DOI: 10.46497/archrheumatol.2020.7857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/22/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives
This study aims to evaluate whether there was a difference between oxidative stress index (OSI), total antioxidant status (TAS), and total oxidant status (TOS) values between patients with fibromyalgia syndrome (FMS) and healthy controls, and to show the effect of balneotherapy on clinical conditions such as pain, depression, and quality of life in patients with FMS and oxidative stress. Patients and methods
Thirty-five females (mean age 39.9±5.8 years; range, 18 to 50 years) with fibromyalgia and 35 healthy females (mean age 37.9±6.6 years; range, 18 to 50 years) were included in the study. The TAS, TOS, and OSI of patients with FMS and healthy controls were measured. Disease severity was evaluated using the Fibromyalgia Impact Questionnaire, pain levels were evaluated using a visual analog scale (VAS), mood was evaluated using the Beck Depression Inventory (BDI), and quality of life was evaluated using the Short Form 36 (SF-36). Patients with FMS were given 15 sessions of balneotherapy. After treatment, the laboratory and clinical parameters of the patients were reevaluated. Results
Although the TAS levels of patients with FMS were not significantly different from those of the control group (p=0.114), the TOS and OSI levels were higher than those of the control group (p<0.001). The VAS, BDI, and SF-36 parameter scores of patients with FMS were significantly higher than those of the control group (p<0.001). A statistically significant decrease (p<0.001) in TOS and OSI levels of patients with FMS was detected after balneotherapy; however, the TAS levels of patients with FMS did not change significantly (p=0.538). All clinical parameters showed significant improvement with balneotherapy (p<0.001). Conclusion An oxidative disorder was detected in patients with FMS compared with the control group. Balneotherapy showed antioxidant activity and decreased oxidative stress while also improving clinical parameters and quality of life.
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Affiliation(s)
- Feyza Nur Çetinkaya
- Department of Physical Medicine and Rehabilitation, Kırşehir Ahi Evran University Faculty of Medicine, Kırşehir, Turkey
| | - Fatmanur Aybala Koçak
- Department of Physical Medicine and Rehabilitation, Kırşehir Ahi Evran University Faculty of Medicine, Kırşehir, Turkey
| | - Emine Eda Kurt
- Department of Physical Medicine and Rehabilitation, Kırşehir Ahi Evran University Faculty of Medicine, Kırşehir, Turkey
| | - Kenan Güçlü
- Department of Medical Biochemistry, Kırşehir Ahi Evran University Training and Research Hospital, Kırşehir, Turkey
| | - Figen Tuncay
- Department of Physical Medicine and Rehabilitation, Kırşehir Ahi Evran University Faculty of Medicine, Kırşehir, Turkey
| | - Senem Şaş
- Department of Physical Medicine and Rehabilitation, Kırşehir Ahi Evran University Training and Research Hospital, Kırşehir, Turkey
| | - Hatice Rana Erdem
- Department of Physical Medicine and Rehabilitation, Kırşehir Ahi Evran University Faculty of Medicine, Kırşehir, Turkey
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Gómez-Hernández M, Gallego-Izquierdo T, Martínez-Merinero P, Pecos-Martín D, Ferragut-Garcías A, Hita-Contreras F, Martínez-Amat A, Montañez-Aguilera FJ, Achalandabaso Ochoa A. Benefits of adding stretching to a moderate-intensity aerobic exercise programme in women with fibromyalgia: a randomized controlled trial. Clin Rehabil 2019; 34:242-251. [PMID: 31847574 DOI: 10.1177/0269215519893107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effects of adding stretching to a moderate-intensity aerobic exercise programme in women with fibromyalgia. DESIGN Randomized controlled trial. SUBJECTS Sixty-four female patients who were diagnosed with fibromyalgia syndrome based on the American College of Rheumatology criteria were recruited (mean age: 54.27 ± 6.94 years). INTERVENTIONS The control group (n = 32) underwent supervised moderate-intensity cycling (50%-70% of the age-predicted maximum heart rate) three times per week for 12 weeks. The experimental group (n = 32) underwent the same exercise programme plus a stretching programme once per week for 12 weeks. MAIN MEASURES The main measures of this study were sleep quality assessed by the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale, the impact of fibromyalgia on quality of life assessed by the Fibromyalgia Impact Questionnaire, and pain perception assessed by the visual analogue scale at baseline, after 4 weeks, and after 12 weeks. RESULTS The experimental group experienced significant improvements at 4-week measure compared with control group: Pittsburgh Sleep Quality Index (P < 0.001); Epworth Sleepiness Scale (P = 0.002); Fibromyalgia Impact Questionnaire (0.93 ± 7.39, P < 0.001); and visual analogue scale (0.52 ± 0.05, P < 0.001). Also at 12-week measure, experimental group experienced significant improvements compared with control group: Pittsburgh Sleep Quality Index (P < 0.001), Epworth Sleepiness Scale (P < 0.001); Fibromyalgia Impact Questionnaire (1.15 ± 9.11, P < 0.001); and visual analogue scale (0.81 ± 0.62, P < 0.001). CONCLUSION Adding stretching to a moderate-intensity aerobic exercise programme increased sleep quality, decreased the impact of fibromyalgia on the quality of life, and reduced pain compared with just a moderate-intensity aerobic exercise programme in our sample of women with fibromyalgia.
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Affiliation(s)
- Miguel Gómez-Hernández
- Department of Nursing and Physiotherapy, Universidad de Alcalá, Alcalá de Henares, Spain
| | | | - Patricia Martínez-Merinero
- Physiotherapy Department, Faculty of Health, Exercise and Sport, European University of Madrid, Madrid, Spain
| | - Daniel Pecos-Martín
- Department of Nursing and Physiotherapy, Universidad de Alcalá, Alcalá de Henares, Spain
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Aquatic exercise and Far Infrared (FIR) modulates pain and blood cytokines in fibromyalgia patients: A double-blind, randomized, placebo-controlled pilot study. J Neuroimmunol 2019; 337:577077. [DOI: 10.1016/j.jneuroim.2019.577077] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/27/2019] [Accepted: 09/27/2019] [Indexed: 01/19/2023]
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18
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Zamunér AR, Andrade CP, Arca EA, Avila MA. Impact of water therapy on pain management in patients with fibromyalgia: current perspectives. J Pain Res 2019; 12:1971-2007. [PMID: 31308729 PMCID: PMC6613198 DOI: 10.2147/jpr.s161494] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 05/20/2019] [Indexed: 11/23/2022] Open
Abstract
Exercise-related interventions have been recommended as one of the main components in the management of fibromyalgia syndrome (FMS). Water therapy, which combines water's physical properties and exercise benefits, has proven effective in improving the clinical symptoms of FMS, especially pain, considered the hallmark of this syndrome. However, to our knowledge, the mechanisms underlying water therapy effects on pain are still scarcely explored in the literature. Therefore, this narrative review aimed to present the current perspectives on water therapy and the physiological basis for the mechanisms supporting its use for pain management in patients with FMS. Furthermore, the effects of water therapy on the musculoskeletal, neuromuscular, cardiovascular, respiratory, and neuroendocrine systems and inflammation are also addressed. Taking into account the aspects reviewed herein, water therapy is recommended as a nonpharmacologic therapeutic approach in the management of FMS patients, improving pain, fatigue, and quality of life. Future studies should focus on clarifying whether mechanisms and long-lasting effects are superior to other types of nonpharmacological interventions, as well as the economic and societal impacts that this intervention may present.
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Affiliation(s)
| | | | - Eduardo Aguilar Arca
- Departamento de Fisioterapia, Universidade do Sagrado Coração, Bauru, São Paulo, Brasil
| | - Mariana Arias Avila
- Departamento de Fisioterapia e Programa de Pós-Graduação em Fisioterapia, Universidade Federal de São Carlos, São Carlos, São Paulo, Brasil
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19
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Bidonde J, Busch AJ, Schachter CL, Webber SC, Musselman KE, Overend TJ, Góes SM, Dal Bello‐Haas V, Boden C. Mixed exercise training for adults with fibromyalgia. Cochrane Database Syst Rev 2019; 5:CD013340. [PMID: 31124142 PMCID: PMC6931522 DOI: 10.1002/14651858.cd013340] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Exercise training is commonly recommended for individuals with fibromyalgia. This review is one of a series of reviews about exercise training for fibromyalgia that will replace the review titled "Exercise for treating fibromyalgia syndrome", which was first published in 2002. OBJECTIVES To evaluate the benefits and harms of mixed exercise training protocols that include two or more types of exercise (aerobic, resistance, flexibility) for adults with fibromyalgia against control (treatment as usual, wait list control), non exercise (e.g. biofeedback), or other exercise (e.g. mixed versus flexibility) interventions.Specific comparisons involving mixed exercise versus other exercises (e.g. resistance, aquatic, aerobic, flexibility, and whole body vibration exercises) were not assessed. SEARCH METHODS We searched the Cochrane Library, MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Thesis and Dissertations Abstracts, the Allied and Complementary Medicine Database (AMED), the Physiotherapy Evidence Databese (PEDro), Current Controlled Trials (to 2013), WHO ICTRP, and ClinicalTrials.gov up to December 2017, unrestricted by language, to identify all potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) in adults with a diagnosis of fibromyalgia that compared mixed exercise interventions with other or no exercise interventions. Major outcomes were health-related quality of life (HRQL), pain, stiffness, fatigue, physical function, withdrawals, and adverse events. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, extracted data, and assessed risk of bias and the quality of evidence for major outcomes using the GRADE approach. MAIN RESULTS We included 29 RCTs (2088 participants; 98% female; average age 51 years) that compared mixed exercise interventions (including at least two of the following: aerobic or cardiorespiratory, resistance or muscle strengthening exercise, and flexibility exercise) versus control (e.g. wait list), non-exercise (e.g. biofeedback), and other exercise interventions. Design flaws across studies led to selection, performance, detection, and selective reporting biases. We prioritised the findings of mixed exercise compared to control and present them fully here.Twenty-one trials (1253 participants) provided moderate-quality evidence for all major outcomes but stiffness (low quality). With the exception of withdrawals and adverse events, major outcome measures were self-reported and expressed on a 0 to 100 scale (lower values are best, negative mean differences (MDs) indicate improvement; we used a clinically important difference between groups of 15% relative difference). Results for mixed exercise versus control show that mean HRQL was 56 and 49 in the control and exercise groups, respectively (13 studies; 610 participants) with absolute improvement of 7% (3% better to 11% better) and relative improvement of 12% (6% better to 18% better). Mean pain was 58.6 and 53 in the control and exercise groups, respectively (15 studies; 832 participants) with absolute improvement of 5% (1% better to 9% better) and relative improvement of 9% (3% better to 15% better). Mean fatigue was 72 and 59 points in the control and exercise groups, respectively (1 study; 493 participants) with absolute improvement of 13% (8% better to 18% better) and relative improvement of 18% (11% better to 24% better). Mean stiffness was 68 and 61 in the control and exercise groups, respectively (5 studies; 261 participants) with absolute improvement of 7% (1% better to 12% better) and relative improvement of 9% (1% better to 17% better). Mean physical function was 49 and 38 in the control and exercise groups, respectively (9 studies; 477 participants) with absolute improvement of 11% (7% better to 15% better) and relative improvement of 22% (14% better to 30% better). Pooled analysis resulted in a moderate-quality risk ratio for all-cause withdrawals with similar rates across groups (11 per 100 and 12 per 100 in the control and intervention groups, respectively) (19 studies; 1065 participants; risk ratio (RR) 1.02, 95% confidence interval (CI) 0.69 to 1.51) with an absolute change of 1% (3% fewer to 5% more) and a relative change of 11% (28% fewer to 47% more). Across all 21 studies, no injuries or other adverse events were reported; however some participants experienced increased fibromyalgia symptoms (pain, soreness, or tiredness) during or after exercise. However due to low event rates, we are uncertain of the precise risks with exercise. Mixed exercise may improve HRQL and physical function and may decrease pain and fatigue; all-cause withdrawal was similar across groups, and mixed exercises may slightly reduce stiffness. For fatigue, physical function, HRQL, and stiffness, we cannot rule in or out a clinically relevant change, as the confidence intervals include both clinically important and unimportant effects.We found very low-quality evidence on long-term effects. In eight trials, HRQL, fatigue, and physical function improvement persisted at 6 to 52 or more weeks post intervention but improvements in stiffness and pain did not persist. Withdrawals and adverse events were not measured.It is uncertain whether mixed versus other non-exercise or other exercise interventions improve HRQL and physical function or decrease symptoms because the quality of evidence was very low. The interventions were heterogeneous, and results were often based on small single studies. Adverse events with these interventions were not measured, and thus uncertainty surrounds the risk of adverse events. AUTHORS' CONCLUSIONS Compared to control, moderate-quality evidence indicates that mixed exercise probably improves HRQL, physical function, and fatigue, but this improvement may be small and clinically unimportant for some participants; physical function shows improvement in all participants. Withdrawal was similar across groups. Low-quality evidence suggests that mixed exercise may slightly improve stiffness. Very low-quality evidence indicates that we are 'uncertain' whether the long-term effects of mixed exercise are maintained for all outcomes; all-cause withdrawals and adverse events were not measured. Compared to other exercise or non-exercise interventions, we are uncertain about the effects of mixed exercise because we found only very low-quality evidence obtained from small, very heterogeneous trials. Although mixed exercise appears to be well tolerated (similar withdrawal rates across groups), evidence on adverse events is scarce, so we are uncertain about its safety. We downgraded the evidence from these trials due to imprecision (small trials), selection bias (e.g. allocation), blinding of participants and care providers or outcome assessors, and selective reporting.
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Affiliation(s)
- Julia Bidonde
- Norwegian Institute of Public HealthPO Box 4404 NydalenOsloNorway0403
| | - Angela J Busch
- University of SaskatchewanSchool of Rehabilitation Science104 Clinic PlaceSaskatoonCanadaS7N 2Z4
| | - Candice L Schachter
- University of SaskatchewanSchool of Rehabilitation Science104 Clinic PlaceSaskatoonCanadaS7N 2Z4
| | - Sandra C Webber
- University of ManitobaCollege of Rehabilitation Sciences, Faculty of Health SciencesR106‐771 McDermot AvenueWinnipegCanadaR3E 0T6
| | | | - Tom J Overend
- University of Western OntarioSchool of Physical TherapyElborn College, Room 1588,School of Physical Therapy, University of Western OntarioLondonCanadaN6G 1H1
| | - Suelen M Góes
- University of SaskatchewanSchool of Rehabilitation Science104 Clinic PlaceSaskatoonCanadaS7N 2Z4
| | - Vanina Dal Bello‐Haas
- McMaster UniversitySchool of Rehabilitation Science1400 Main Street West, 403/EHamiltonCanadaL8S 1C7
| | - Catherine Boden
- University of SaskatchewanLeslie and Irene Dube Health Sciences Library, University LibraryRm 1400 Health Sciences Building 104 Clinic PlaceSaskatoonCanadaS7N 5E5
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20
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Tomas-Carus P, Garrido M, Branco JC, Castaño MY, Gómez MÁ, Biehl-Printes C. Non-supervised breathing exercise regimen in women with fibromyalgia: A quasi-experimental exploratory study. Complement Ther Clin Pract 2019; 35:170-176. [PMID: 31003653 DOI: 10.1016/j.ctcp.2019.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To know the effectiveness and safety of non-supervised breathing exercise regimen by promoting patients' self-management, and to investigate if non-supervised breathing exercise regimen shows similar benefits to supervised regimen in improving pain and fibromyalgia (FM) impact on daily life. MATERIAL AND METHODS Fifty-one women with FM were assigned to: supervised breathing exercise regimen group, non-supervised breathing exercise regimen group, and control group. Pain thresholds tolerance on tender points and FM impact on daily life were evaluated. RESULTS After 12-weeks of breathing exercises statistical differences were not found between supervised and non-supervised regimen. However, supervised regimen showed additional improvements in pain thresholds tolerance and in pain-FIQ subscale. CONCLUSION Our results suggest that performing a non-supervised breathing exercise program could be as safe and effective as the supervised regimen. However, it was observed that there could be a tendency of supervised exercise regimen to show additional benefits in terms of pain.
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Affiliation(s)
- Pablo Tomas-Carus
- Departamento de Desporto e Saúde, Escola de Ciência e Tecnologia, Universidade de Évora, Portugal; Comprehensive Health Research Centre (CHRC), University of Évora, Portugal.
| | - María Garrido
- Neuroimmunophysiology and Chrononutrition Research Group (Department of Physiology), Faculty of Science, University of Extremadura, Spain
| | - Jaime C Branco
- CEDOC, NOVA Medical School, Faculdade Ciências Médicas, Universidade Nova de Lisboa, Serviço de Reumatologia, CHLO, EPE-Hospital Egas Moniz, Portugal
| | - María Yolanda Castaño
- Neuroimmunophysiology and Chrononutrition Research Group (Department of Physiology), Faculty of Science, University of Extremadura, Spain
| | - María Ángeles Gómez
- Departamento de Fisiología, Facultad de Medicina, Universidad de Extremadura, Spain
| | - Clarissa Biehl-Printes
- Instituto de Geriatria e Gerontologia - IGG, Pontifícia Universidade Católica Do Rio, Grande Do Sul - PUCRS, Brazil
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Andrade CP, Zamunér AR, Forti M, Tamburús NY, Silva E. Effects of aquatic training and detraining on women with fibromyalgia: controlled randomized clinical trial. Eur J Phys Rehabil Med 2019; 55:79-88. [DOI: 10.23736/s1973-9087.18.05041-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Massage therapy in cortisol circadian rhythm, pain intensity, perceived stress index and quality of life of fibromyalgia syndrome patients. Complement Ther Clin Pract 2018; 30:85-90. [DOI: 10.1016/j.ctcp.2017.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/04/2017] [Accepted: 12/05/2017] [Indexed: 11/20/2022]
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Owen GT, Bruel BM, Schade CM, Eckmann MS, Hustak EC, Engle MP. Evidence-based pain medicine for primary care physicians. Proc AMIA Symp 2018; 31:37-47. [PMID: 29686550 PMCID: PMC5903506 DOI: 10.1080/08998280.2017.1400290] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The last several decades have seen a marked increase in both the recognition and treatment of chronic pain. Unfortunately, patients frequently misunderstand both the nature of pain and the best practices for its treatment. Because primary care physicians treat the majority of chronic pain, they are ideally situated to provide evidence-based pain care. The majority of the medical evidence supports a biopsychosocial model of pain that integrates physical, emotional, social, and cultural variables. The goal of this primer is to assist primary care physicians in their understanding of pain, evaluation of the chronic pain patient, and ability to direct evidence-based care. This article will discuss the role of physical rehabilitation, pain psychology, pharmacotherapy, and procedural interventions in the treatment of chronic pain. Given the current epidemic of drug-related deaths, particular emphasis is placed on the alternatives to opioid therapy. Unfortunately, death is not the only significant complication from opioid therapy, and this article discusses many of the most common side effects. This article provides general guidelines on the most appropriate utilization of opioids with emphasis on the recent Centers for Disease Control and Prevention guidelines, risk stratification, and patient monitoring. Finally, the article concludes with the critical role that a pain medicine specialist can play in the management of patients with chronic pain.
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Affiliation(s)
- Graves T. Owen
- Texas Pain Rehabilitation Institute, PA, Round Rock, Texas
| | - Brian M. Bruel
- University of Texas Southwestern Medical Center, Dallas, Texas
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Effects of Water-Based Exercise Training on the Cognitive Function and Quality of Life of Healthy Adult Women. J Phys Act Health 2017; 14:899-904. [PMID: 28682652 DOI: 10.1123/jpah.2017-0036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Research regarding the impact of aquatic exercise on cognition is scarce. This study aimed at identifying the effects of water-based exercise training on the cognitive function and quality of life of healthy adult women. METHODS Fifty-one healthy women [mean age: 46.5 (12.3) y] were assigned to group A or B and followed a water-based exercise program for 6 months. During the first 3 months, the sessions performed by group A were focused on stimulating cognitive function. For the next 3 months, the sessions were mainly aimed at improving physical fitness. Participants in group B followed the same program in reverse order. The trail making and symbol digit modality tests were used to assess the impact of the program on cognition. The effects of the intervention on the participants' physical and mental health were measured by means of the medical outcomes study 36-item short-form health survey. RESULTS Once the intervention ended, significant improvements were observed in the participants' cognitive function and mental health domain, regardless of the group in which they were initially included. CONCLUSION Water-based exercise is a training modality capable of enhancing cognitive function and quality of life through improvements in mental health in healthy adult women.
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Silva AP, Chagas DDV, Cavaliere ML, Pinto S, de Oliveira Barbosa JS, Batista LA. Kinematic analysis of subtalar eversion during gait in women with fibromyalgia. Foot (Edinb) 2016; 28:42-46. [PMID: 27744046 DOI: 10.1016/j.foot.2016.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 05/27/2016] [Accepted: 09/20/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To analyse the subtalar eversion range of motion during walking in women with fibromyalgia. METHOD Twenty women diagnosed with fibromyalgia were directed to walk barefoot at comfortable and self-paced speed on a 7m walkway. Subtalar eversion range of motion was measured using the difference between the maximum and minimum values of subtalar eversion in stance phase. A range of motion between 4°-6° was considered as reference values for subtalar eversion during gait. Descriptive statistics were performed. RESULTS In both right and left lower limb analysis of subtalar eversion range of motion, five women showed joint hypomobility, and twelve showed hypermobility. Only one patient performed unaltered subtalar eversion range of motion in both lower limbs. Both joints expressed high variability, and there were no significant differences between the right and left sides. CONCLUSIONS The findings suggest that biomechanical function of the subtalar joint eversion during the loading response phase of gait in women with fibromyalgia, by excessive rigidity or complacency joint, tends to be impaired. This finding suggests that the indication of walking as an auxiliary strategy in the treatment of women with fibromyalgia should be preceded by thorough examination of the mechanical conditions of the subtalar joint of the patient.
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Affiliation(s)
- Ana Paula Silva
- Laboratory of Biomechanics and Motor Behavior, State University of Rio de Janeiro, Brazil
| | - Daniel das Virgens Chagas
- Laboratory of Biomechanics and Motor Behavior, State University of Rio de Janeiro, Brazil; Postgraduate Program in Medical Sciences, State University of Rio de Janeiro, Brazil.
| | - Maria Lúcia Cavaliere
- Laboratory of Exercise Physiology Applied to Physical Education, State University of Rio de Janeiro, Brazil
| | - Sérgio Pinto
- Laboratory of Biomechanics and Motor Behavior, State University of Rio de Janeiro, Brazil; Postgraduate Program in Medical Sciences, State University of Rio de Janeiro, Brazil
| | | | - Luiz Alberto Batista
- Laboratory of Biomechanics and Motor Behavior, State University of Rio de Janeiro, Brazil; Postgraduate Program in Medical Sciences, State University of Rio de Janeiro, Brazil
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Pérez de la Cruz S, Lambeck J. A new approach towards improved quality of life in fibromyalgia: a pilot study on the effects of an aquatic Ai Chi program. Int J Rheum Dis 2016; 21:1525-1532. [DOI: 10.1111/1756-185x.12930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
| | - Johan Lambeck
- Faculty of Kinesiology and Rehabilitation Sciences University of Lovaina Lovaina Belgium
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Morris LD, Louw QA, Grimmer KA, Meintjes E. Targeting pain catastrophization in patients with fibromyalgia using virtual reality exposure therapy: a proof-of-concept study. J Phys Ther Sci 2015; 27:3461-7. [PMID: 26696719 PMCID: PMC4681926 DOI: 10.1589/jpts.27.3461] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/19/2015] [Indexed: 12/02/2022] Open
Abstract
[Purpose] Pain catastrophizing is a key predictor of poor compliance to exercises among
patients with fibromyalgia syndrome. Alteration of pain catastrophizing in this group is
thus warranted. This study aimed to provide proof-of-concept of a novel virtual reality
exposure therapy program as treatment for exercise-related pain catastrophizing in
patients with fibromyalgia syndrome. [Subjects and Methods] An exploratory,
case-controlled study was conducted (fibromyalgia syndrome group and matched control
group). Functional magnetic resonance imaging was used to acquire neural correlates. The
functional magnetic resonance imaging task consisted of two stimuli: active (exercise
activity visuals) and passive (relaxing visuals). Structural images and
blood-oxygenation-level-dependent contrasts were acquired for the conditions and compared
within subjects/groups and between groups. Statistic images were thresholded using
corrected clusters (determined by Z>2.3; level of significance: 0.05). [Results]
Thirteen fibromyalgia syndrome subjects and nine healthy matched controls were included.
The right inferior frontal gyrus, right middle frontal gyrus, right posterior cerebellum,
left thalamus, and left supramarginal gyrus were activated in the fibromyalgia syndrome
subjects. [Conclusion] The study results provide preliminary proof indicating that
exposing patients with fibromyalgia syndrome to visuals of exercises elicits
neurophysiological changes in functional brain areas associated with pain
catastrophization and add to the current body of knowledge regarding the possibility of
objectively identifying cognitive behavioral strategies like pain catastrophization.
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Affiliation(s)
- Linzette Deidrè Morris
- Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Quinette Abegail Louw
- Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - Karen Anne Grimmer
- Division of Physiotherapy, Department of Interdisciplinary Health Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa ; International Centre for Allied Health Evidence (iCAHE), University of South Australia, Australia
| | - Ernesta Meintjes
- MRC/UCT Medical Imaging Research Unit, Faculty of Health Sciences, University of Cape Town, South Africa
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