A New Rehabilitation Tool in Fibromyalgia: The Effects of Perceptive Rehabilitation on Pain and Function in a Clinical Randomized Controlled Trial

Teresa Paolucci, Carlo Baldari, Manuela Di Franco, Dario Didona, Victor Reis, Mario Vetrano, Marco Iosa, Domenica Trifoglio, Federico Zangrando, Ennio Spadini, Vincenzo Maria Saraceni, Laura Guidetti, Teresa Paolucci, Carlo Baldari, Manuela Di Franco, Dario Didona, Victor Reis, Mario Vetrano, Marco Iosa, Domenica Trifoglio, Federico Zangrando, Ennio Spadini, Vincenzo Maria Saraceni, Laura Guidetti

Abstract

Introduction/Objective. Fibromyalgia might benefit from a specific tactile and proprioceptive rehabilitation approach. The aim of this study was to perform a randomized controlled trial to determine the efficacy of perceptual surfaces (PS) and physical exercises with regard to chronic pain and physical function in fibromyalgia compared with a control group. Methods. Data from 54 females (18-60 years old) with a diagnosis of fibromyalgia and scoring >5 on the visual analog scale were divided into 3 groups and analyzed: group treated with perceptual surfaces (PS-group), physical exercises group (PE-group), and control group (CG). The Fibromyalgia Impact Questionnaire (FIQ), Health Assessment Questionnaire (HAQ), and Fibromyalgia Assessment Scale (FAS) were administered at baseline (T0), at the end of the treatment (T1) (after 10 rehabilitation sessions over a 5-week period), and at the 12-week follow-up (T2). Results. The PS-group experienced a statistically significant improvement versus the CG in FAS and HAQ scores. Good efficacy with respect to pain and function in the PE-group compared with the CG in terms of FAS, HAQ, and FIQ scores was observed. The adherence ratio was 86% for the PE-group and CG and 90% for the PS-group. Conclusions. According to the results, the PS are as promising as the physical exercises, since results were similar.

Figures

Figure 1
Figure 1
Flowchart.
Figure 2
Figure 2
Perceptual surfaces and execution of a rehabilitation session.
Figure 3
Figure 3
Execution of a session in the physical exercises group.
Figure 4
Figure 4
Box and whiskers plots of FIQ (Fibromyalgia Impact Questionnaire), FAS (Fibromyalgia Assessment Status), and HAQ (Health Assessment Questionnaire) scores for the CG (control group), perceptual surfaces group (PS-group), and physical exercises group (PE-group) at the 3 assessments (T0, T1, and T2). The boxes show the lower quartile, median (middle line in box), and upper quartile values. The whiskers represent the most extreme values 1.5 times the interquartile range from the ends of the box, and the circles represent data with values beyond the ends of whiskers.

References

    1. Arnold L. M., Williams D. A., Hudson J. I., et al. Development of responder definitions for fibromyalgia clinical trials. Arthritis and Rheumatism. 2012;64(3):885–894. doi: 10.1002/art.33360.
    1. Smith H. S., Harris R., Clauw D. Fibromyalgia: an afferent processing disorder leading to a complex pain generalized syndrome. Pain Physician. 2011;14(2):E217–E245.
    1. Wolfe F., Clauw D. J., Fitzcharles M.-A., et al. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis Care and Research. 2010;62(5):600–610. doi: 10.1002/acr.20140.
    1. Carville S. F., Arendt-Nielsen S., Bliddal H., et al. EULAR evidence-based recommendations for the management of fibromyalgia syndrome. Annals of the Rheumatic Diseases. 2008;67(4):536–541. doi: 10.1136/ard.2007.071522.
    1. Klement A., Häuser W., Brückle W., et al. Principles of treatment, coordination of medical care and patient education in fibromyalgia syndrome and chronic widespread pain. Schmerz. 2008;22(3):283–294. doi: 10.1007/s00482-008-0673-5.
    1. Segura-Jiménez V., Álvarez-Gallardo I. C., Estévez-López F., et al. Differences in sedentary time and physical activity between female patients with fibromyalgia and healthy controls: the Al-Ándalus project. Arthritis & Rheumatology. 2015;67(11):3047–3057. doi: 10.1002/art.39252.
    1. Ruiz J. R., Segura-Jiménez V., Ortega F. B., et al. Objectively measured sedentary time and physical activity in women with fibromyalgia: a cross-sectional study. BMJ Open. 2013;3(6) doi: 10.1136/bmjopen-2013-002722.e002722
    1. Mannerkorpi K., Nordeman L., Ericsson A., Arndorw M. Pool exercise for patients with fibromyalgia or chronic widespread pain: a randomized controlled trial and subgroup analyses. Journal of Rehabilitation Medicine. 2009;41(9):751–760. doi: 10.2340/16501977-0409.
    1. Langhorst J., Klose P., Dobos G. J., Bernardy K., Häuser W. Efficacy and safety of meditative movement therapies in fibromyalgia syndrome: a systematic review and meta-analysis of randomized controlled trials. Rheumatology International. 2013;33(1):193–207. doi: 10.1007/s00296-012-2360-1.
    1. Wigers S. H., Stiles T. C., Vogel P. A. Effects of aerobic exercise versus stress management treatment in fibromyalgia. Scandinavian Journal of Rheumatology. 1996;25(2):77–86. doi: 10.3109/03009749609069212.
    1. Mengshoel A. M., Komnaes H. B., Forre O. The effects of 20 weeks of physical fitness training in female patients with fibromyalgia. Clinical and Experimental Rheumatology. 1992;10(4):345–349.
    1. Mulvany R., Zucker-Levin A. R., Jeng M., et al. Effects of a 6-Week, individualized, supervised exercise program for people with bleeding disorders and hemophilic arthritis. Physical Therapy. 2010;90(4):509–526. doi: 10.2522/ptj.20080202.
    1. Umeda M., Corbin L. W., Maluf K. S. Examination of contraction-induced muscle pain as a behavioral correlate of physical activity in women with and without fibromyalgia. Disability and Rehabilitation. 2015;37(20):1864–1869. doi: 10.3109/09638288.2014.984878.
    1. Bidonde J., Busch A. J., Webber S. C., et al. Aquatic exercise training for fibromyalgia. Cochrane Database of Systematic Reviews. 2014;10 doi: 10.1002/14651858.CD011336.CD011336
    1. Segura-Jiménez V., Carbonell-Baeza A., Aparicio V. A., et al. A warm water pool-based exercise program decreases immediate pain in female fibromyalgia patients: uncontrolled clinical trial. International Journal of Sports Medicine. 2013;34(7):600–605. doi: 10.1055/s-0032-1329991.
    1. Latorre Román P. Á., Santos e Campos M. A., García-Pinillos F. Effects of functional training on pain, leg strength, and balance in women with fibromyalgia. Modern Rheumatology. 2015;25(6):943–947. doi: 10.3109/14397595.2015.1040614.
    1. Daenen L., Varkey E., Kellmann M., Nijs J. Exercise, not to exercise, or how to exercise in patients with chronic pain? Applying science to practice. Clinical Journal of Pain. 2015;31(2):108–114. doi: 10.1097/ajp.0000000000000099.
    1. Braz Ade S., de Paula A. P., Diniz Mde F., de Almeida R. N. Non-pharmacological therapy and complementary and alternative medicine in Fibromyalgia. Revista Brasileira de Reumatologia. 2011;51(3):269–282.
    1. Wang C. Role of Tai Chi in the treatment of rheumatologic diseases. Current Rheumatology Reports. 2012;14(6):598–603. doi: 10.1007/s11926-012-0294-y.
    1. Paolucci T., Fusco A., Iosa M., et al. The efficacy of a perceptive rehabilitation on postural control in patients with chronic nonspecific low back pain. International Journal of Rehabilitation Research. 2012;35(4):360–366. doi: 10.1097/mrr.0b013e328356427c.
    1. Paolucci T., Morone G., Iosa M., et al. Psychological features and outcomes of the Back School treatment in patients with chronic non-specific low back pain. A randomized controlled study. European Journal of Physical and Rehabilitation Medicine. 2012;48(2):245–253.
    1. Busch A. J., Schachter C. L., Overend T. J., Peloso P. M., Barber K. A. R. Exercise for fibromyalgia: a systematic review. Journal of Rheumatology. 2008;35(6):1130–1144.
    1. Wang C., Collet J. P., Lau J. The effect of Tai Chi on health outcomes in patients with chronic conditions: a systematic review. The Journal of the American Medical Association. 2004;164(5):493–501. doi: 10.1001/archinte.164.5.493.
    1. Wang C., McAlindon T., Fielding R. A., et al. A novel comparative effectiveness study of Tai Chi versus aerobic exercise for fibromyalgia: study protocol for a randomized controlled trial. Trials. 2015;16, article 34 doi: 10.1186/s13063-015-0548-x.
    1. Vierck C. J., Jr., Staud R., Price D. D., Cannon R. L., Mauderli A. P., Martin A. D. The effect of maximal exercise on temporal summation of second pain (windup) in patients with fibromyalgia syndrome. Journal of Pain. 2001;2(6):334–344. doi: 10.1054/jpai.2001.25533.
    1. Kosek E., Ekholm J., Hansson P. Sensory dysfunction in fibromyalgia patients with implications for pathogenic mechanisms. Pain. 1996;68(2-3):375–383. doi: 10.1016/S0304-3959(96)03188-0.
    1. Craig A. D. Pain mechanisms: labeled lines versus convergence in central processing. Annual Review of Neuroscience. 2003;26:1–30. doi: 10.1146/annurev.neuro.26.041002.131022.
    1. Bennett R. M., Bushmakin A. G., Cappelleri J. C., Zlateva G., Sadosky A. B. Minimal clinically important difference in the fibromyalgia impact questionnaire. Journal of Rheumatology. 2009;36(6):1304–1311. doi: 10.3899/jrheum.081090.
    1. Garcia-Larrea L., Peyron R. Pain matrices and neuropathic pain matrices: a review. Pain. 2013;154(supplement 1):S29–S43. doi: 10.1016/j.pain.2013.09.001.
    1. Cazzola M., Atzeni F., Boccassini L., Cassisi G., Sarzi-Puttini P. Physiopathology of pain in rheumatology. Reumatismo. 2014;66(1):4–13. doi: 10.4081/reumatismo.2014.758.
    1. López-Solà M., Pujol J., Wager T. D., et al. Altered functional magnetic resonance imaging responses to nonpainful sensory stimulation in fibromyalgia patients. Arthritis & Rheumatology. 2014;66(11):3200–3209. doi: 10.1002/art.38781.
    1. Melzack R. Pain and the neuromatrix in the brain. Journal of Dental Education. 2001;65(12):1378–1382.
    1. Sarzi-Puttini P., Atzeni F., Fiorini T., et al. Validation of an Italian version of the fibromyalgia impact questionnaire (FIQ-I) Clinical and Experimental Rheumatology. 2003;21(4):459–464.
    1. Iannuccelli C., Sarzi-Puttini P., Atzeni F., et al. Psychometric properties of the Fibromyalgia Assessment Status (FAS) index: a national web-based study of fibromyalgia. Clinical and Experimental Rheumatology. 2011;29(6, supplement 69):S49–S54.
    1. Uhlig T., Haavardsholm E. A., Kvien T. K. Comparison of the health assessment questionnaire (HAQ) and the modified HAQ (MHAQ) in patients with rheumatoid arthritis. Rheumatology. 2006;45(4):454–458. doi: 10.1093/rheumatology/kei181.
    1. Morone G., Iosa M., Paolucci T., et al. Efficacy of perceptive rehabilitation in the treatment of chronic nonspecific low back pain through a new tool: a randomized clinical study. Clinical Rehabilitation. 2012;26(4):339–350. doi: 10.1177/0269215511414443.
    1. Vetrano M., Pournajaf S., Vulpiani M. C., et al. Perceptive rehabilitation of patients with non-specific chronic low back pain: the role of body midline. A randomized controlled trial. European Journal of Physical and Rehabilitation Medicine. 2013;49(4):517–525.
    1. Paolucci T., Morone G., Fusco A., et al. Effects of perceptive rehabilitation on balance control in patients with Parkinson's disease. NeuroRehabilitation. 2014;34(1):113–120. doi: 10.3233/NRE-131024.
    1. Flor H., Denke C., Schaefer M., Grüsser S. Effect of sensory discrimination training on cortical reorganisation and phantom limb pain. The Lancet. 2001;357(9270):1763–1764. doi: 10.1016/s0140-6736(00)04890-x.
    1. Luomajoki H., Moseley G. L. Tactile acuity and lumbopelvic motor control in patients with back pain and healthy controls. British Journal of Sports Medicine. 2011;45(5):437–440. doi: 10.1136/bjsm.2009.060731.
    1. Fink G. R., Marshall J. C., Halligan P. W., et al. The neural consequences of conflict between intention and the senses. Brain. 1999;122(3):497–512. doi: 10.1093/brain/122.3.497.
    1. Myers J. Exercise and cardiovascular health. Circulation. 2003;107:e2–e5. doi: 10.1161/01.cir.0000048890.59383.8d.
    1. Fuentes J., Armijo-Olivo S., Funabashi M., et al. Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: an experimental controlled study. Physical Therapy. 2014;94(4):477–489. doi: 10.2522/ptj.20130118.
    1. Häuser W., Klose P., Langhorst J., et al. Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials. Arthritis Research & Therapy. 2010;12(3, article R79) doi: 10.1186/ar3002.
    1. Gauffin J., Hankama T., Hannonen P., Kautiainen H., Pohjolainen T., Haanpää M. Do fibromyalgia patients use active pain management strategies? A cohort study. Journal of Rehabilitation Medicine. 2013;45(5):477–480. doi: 10.2340/16501977-1133.
    1. Nijs J., Roussel N., Van Oosterwijck J., et al. Fear of movement and avoidance behaviour toward physical activity in chronic-fatigue syndrome and fibromyalgia: state of the art and implications for clinical practice. Clinical Rheumatology. 2013;32(8):1121–1129. doi: 10.1007/s10067-013-2277-4.
    1. Lan C., Chen S.-Y., Lai J.-S., Wong A. M.-K. Tai Chi Chuan in medicine and health promotion. Evidence-Based Complementary and Alternative Medicine. 2013;2013:17. doi: 10.1155/2013/502131.502131
    1. Ablin J., Fitzcharles M.-A., Buskila D., Shir Y., Sommer C., Häuser W. Treatment of fibromyalgia syndrome: recommendations of recent evidence-based interdisciplinary guidelines with special emphasis on complementary and alternative therapies. Evidence-Based Complementary and Alternative Medicine. 2013;2013:7. doi: 10.1155/2013/485272.485272
    1. Kaleth A. S., Saha C. K., Jensen M. P., Slaven J. E., Ang D. C. Moderate-vigorous physical activity improves long-term clinical outcomes without worsening pain in fibromyalgia. Arthritis Care and Research. 2013;65(8):1211–1218. doi: 10.1002/acr.21980.
    1. Köllner V., Häuser W., Klimczyk K., et al. Psychotherapy for patients with fibromyalgia syndrome. Systematic review, meta-analysis and guideline. Der Schmerz. 2012;26(3):291–296. doi: 10.1007/s00482-012-1179-8.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj