Does the Addition of Pain Neurophysiology Education to a Therapeutic Exercise Program Improve Physical Function in Women with Fibromyalgia Syndrome? Secondary Analysis of a Randomized Controlled Trial. (2021)

PICO

Patient/Population

Women with Fibromyalgia Syndrome (n=32)

Intervention

  • Pain neurophysiology education (PNE) + Therapeutic exercise (TE) 

Comparison

  • Therapeutic exercise (TE)

Outcomes

  • Visual Analogue Score (VAS)
  • Senior Fitness Test (SFT); 6-Minute Walk Test (6MWT); Timed Up and Go (TUG); 30 s chair-to-stand (CS); chair sit-and-reach test (CSRT);  back-scratch test (BST)
  • Maximum isometric handgrip strength (dynamometer)

Translatability:   (3/3) Easy                                

Comments: PNE + TE was more effective than TE in isolation in improving TUG and AC in the short term and handgrip at three months of follow-up. No between-groups differences were found for fatigue, sleep disturbances, or the other tests included in the SFT after intervention or at three months of follow-up

Limitations:  sample size was calculated based only on the main variable, and only composed of women; no control group and no binding of patients; duration of the intervention was restricted; no long-term effects were assessed.

Appraisals:

PEDro Scale  – (8/10) Blind subjects: No; Blind therapists: No. (by PEDro- confirmed)

Metrics and
Journal Details:
scite_ report – 

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BTB

Intervention – 1

  • Pain neurophysiology education

Dose

  • 8 sessions – each session lasting 30–45 min

Periodicity

Local/Technic:

“…explanations about acute and chronic pain and the potential sustaining factors of central sensitization such as emotions, stress, illness perceptions, pain cognitions, and pain behavior. Patients were encouraged to apply the new knowledge to their daily life. All questions were answered during the study.”

    Intervention – 2

    • Exercise

    Dose

    • 60 min per sessions

    Periodicity

    • 3 sessions per week for 10 weeks

    Local/Technic:

    Different types of exercise in the same session: progression from low-intensity exercise using the “start low and go slow” approach, and patient-tailored, controlled by a physiotherapist to ensure the patient’s comfort and safety.

    1. Warm-Up (10min)

    • Joint mobility  in all the available ROM: Hip; Knee; Ankle; Shoulder;  Lumbar and Cervical  spine 

    Dynamic stretching of main muscle groups. Submaximal repetitions of the strengthening exercises.

    2. Central Part (40mn)

    • Aerobic (20 min):
      Exercises: Cycling + Walking + Playing games

    Intensity: Low to moderate intensity (40–60% of maximum heart rate).

    • Strengthening (20 min):
      Circuits of 4 exercises with 3 sets of 10–12 repetitions or 3 sets of 30 s for planks.
      Exercises: 

         Lower limb:  Squat + Lunge + Glute bridge + Side glute bridge

         Upper limb:  Biceps brachii curl + Triceps brachii press-down + Rowing with TheraBand + Internal and external rotation with TheraBand + Resistant band side raises

         Trunk: Push-ups + Planks + Lateral planks

    Intensity:
    The intensity was 50% of 1RM. The intensity was increased by 10% according to the individual tolerance.
    Progression: Adding soft elastic bands and dumbbells

    3.Cool Down (10 min)

    • Pulmonary exercises:
      Inspiration through the noise and expiration through the mouth, deep breathing and then expiration through the mouth slowly deep breathing.
    • Stretching exercises:
      3 sets of 30 s.
      Exercises: Gluteus + Quadriceps femoris + Hamstrings + Biceps brachii + Triceps brachii + Deltoid + Latissimus dorsi

    Citation:

    Ceballos-Laita, L., Mingo-Gómez, M. T., Estébanez-de-Miguel, E., Bueno-Gracia, E., Navas-Cámara, F. J., Verde-Rello, Z., Fernández-Araque, A., & Jiménez-Del-Barrio, S. (2021). Does the Addition of Pain Neurophysiology Education to a Therapeutic Exercise Program Improve Physical Function in Women with Fibromyalgia Syndrome? Secondary Analysis of a Randomized Controlled Trial. Journal of clinical medicine, 10(11), 2518. https://doi.org/10.3390/jcm10112518

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