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Effectiveness of a Multicomponent Treatment Based on Pain Neuroscience Education, Therapeutic Exercise, Cognitive Behavioral Therapy, and Mindfulness in Patients With Fibromyalgia (FIBROWALK Study): A Randomized Controlled Trial.
- Source :
- PTJ: Physical Therapy & Rehabilitation Journal; Dec2021, Vol. 101 Issue 12, p1-12, 12p
- Publication Year :
- 2021
-
Abstract
- Objective: The purpose of this study was to evaluate the effectiveness of a 12-week multicomponent treatment based on pain neuroscience education, therapeutic exercise, cognitive behavioral therapy, and mindfulness—in addition to treatment as usual—compared with treatment as usual only in patients with fibromyalgia. Methods: This randomized controlled trial involved a total of 272 patients who were randomly assigned to either multicomponent treatment (n = 135) or treatment as usual (n = 137). The multicomponent treatment (2-hour weekly sessions) was delivered in groups of 20 participants. Treatment as usual was mainly based on pharmacological treatment according to the predominant symptoms. Data on functional impairment using the Revised Fibromyalgia Impact Questionnaire as the primary outcome were collected as were data for pain, fatigue, kinesiophobia, physical function, anxiety, and depressive symptoms (secondary outcomes) at baseline, 12 weeks, and, for the multicomponent group only, 6 and 9 months. An intention-to-treat approach was used to analyze between-group differences. Baseline differences between responders (>20% Revised Fibromyalgia Impact Questionnaire reduction) and nonresponders also were analyzed, and the number needed to treat was computed. Results: At posttreatment, significant between-group differences with a large effect size (Cohen d > 0.80) in favor of the multicomponent treatment were found in functional impairment, pain, kinesiophobia, and physical function, whereas differences with a moderate size effect (Cohen d > 0.50 and <0.80) were found in fatigue, anxiety, and depressive symptoms. Nonresponders scored higher on depressive symptoms than responders at baseline. The number needed to treat was 2 (95% CI = 1.7–2.3). Conclusion: Compared with usual care, there was evidence of short-term (up to 3 months) positive effects of the multicomponent treatment for fibromyalgia. Some methodological shortcomings (eg, absence of follow-up in the control group and monitoring of treatment adherence, potential research allegiance) preclude robust conclusions regarding the proposed multicomponent program. Impact: Despite some methodological shortcomings in the design of this study, the multicomponent therapy FIBROWALK can be considered a novel and effective treatment for patients with fibromyalgia. Physical therapists should detect patients with clinically relevant depression levels prior to treatment because depression can buffer treatment effects. Lay Summary: Fibromyalgia is prevalent and can be expensive to treat. This multicomponent treatment could significantly improve the core symptoms of fibromyalgia compared with usual treatment. [ABSTRACT FROM AUTHOR]
- Subjects :
- PHOBIAS treatment
TREATMENT of fibromyalgia
ANXIETY treatment
NEUROSCIENCES
MINDFULNESS
PAIN measurement
CONFIDENCE intervals
FUNCTIONAL status
EFFECT sizes (Statistics)
VISUAL analog scale
HEALTH surveys
INTERVIEWING
TREATMENT effectiveness
RANDOMIZED controlled trials
COMPARATIVE studies
FUNCTIONAL assessment
FIBROMYALGIA
T-test (Statistics)
PRE-tests & post-tests
BODY movement
MENTAL depression
RESEARCH funding
QUESTIONNAIRES
SYMPTOMS
SCALE analysis (Psychology)
DESCRIPTIVE statistics
CHI-squared test
ANALYSIS of covariance
COMBINED modality therapy
PATIENT education
FATIGUE (Physiology)
STATISTICAL sampling
DATA analysis software
PAIN management
EXERCISE therapy
COGNITIVE therapy
LONGITUDINAL method
EVALUATION
Subjects
Details
- Language :
- English
- ISSN :
- 15386724
- Volume :
- 101
- Issue :
- 12
- Database :
- Complementary Index
- Journal :
- PTJ: Physical Therapy & Rehabilitation Journal
- Publication Type :
- Academic Journal
- Accession number :
- 155122706
- Full Text :
- https://doi.org/10.1093/ptj/pzab200