What Concept of Manual Therapy Is More Effective to Improve Health Status in Women with Fibromyalgia Syndrome? A Study Protocol with Preliminary Results.

BACKGROUND: Fibromyalgia (FM) is defined as a chronic syndrome characterized by diffuse musculoskeletal pain, associated with characteristic signs and symptoms such as fatigue and/or sleep and mood disorders, and whose etiology, pathogenesis and prognosis may or may not be known. There is growing evidence of manual therapy as a treatment for pain in the short and medium term, also in patients affected by FM. However, the heterogeneity of the manual therapy treatments administered are a very common clinical practice, as they are based more on the judgment or tendency of the physiotherapist, rather than on clear scientific evidence. Therefore, the aim of the present study protocol will be to determine which manual therapy approach is more effective in addressing health status by improving symptoms (sensory, cognitive, emotional and social) in patients with FM. METHODS: a randomized controlled clinical trial with a 3-month follow-up will be carried out with 52 female patients affected by rheumatologist-diagnosed FM will be recruited and evaluated at the Asociación de Fibromialgia y Síndrome de Fatiga Crónica (AFINSYFACRO) in Móstoles, Madrid, Spain. For more details on the protocol, a pilot study was carried out using a non-probability method of judgmental or purposive sampling. Thirteen patients were also evaluated, treated and reevaluated; eight patients were assigned to the myofascial techniques approach (MTA) group and five to the Maitland's mobilization approach (MMA) group. RESULTS: the preliminary results presented here are intended to show how the planned randomized controlled clinical trial will develop. Patients who received MTA had significantly improved pain and health status outcomes after treatment and at 1-month follow-up, with no significant change in those who received MMA. CONCLUSIONS: the exact details of the study protocol on which the manual therapy approach is more effective in addressing health status by improving symptoms (sensory, cognitive, emotional, and social) in patients with FM are presented. Preliminary results show that manual therapy is effective in improving pain and health status in patients with fibromyalgia at short and medium term, with significant results in those who received MTA.

Patient-reported outcomes measured with and without dizziness associated with non-specific chronic neck pain: implications for primary care.

BACKGROUND: The aim of this study was to compare health-related quality of life (HRQoL) and disability and fear of movement in patients with non-specific chronic neck pain (NSCNP) associated with dizziness with respect to patients with isolated NSCNP in primary care settings. METHODS: A cross-sectional study was carried out in a primary care center. A total of 120 patients were divided into two groups and analyzed in this study. One group of patients reported dizziness combined with NSCNP (n = 60), and the other reported no dizziness with their NSCNP (n = 60). Patient-reported outcome measurements were HRQoL (primary outcome) and disability and kinesiophobia (secondary outcomes) assessed by the EuroQoL Five Dimensions and Five Levels (EQ-5D-5L), neck disability index (NDI) and Tampa Scale of Kinesiophobia (TSK-11), respectively. RESULTS: Statistically significant differences (P < 0.05) for a 95% confidence interval (CI) with a large effect size (Cohen d) were found between both groups with greater values of disability (mean difference = 6.30 points; 95% CI [3.84-8.75]; d = 0.94) and kinesiophobia (mean difference = 8.36 points; 95% CI [6.07-10.65]; d = 1.33), and an impairment of HRQoL (mean difference = 16.16 points; 95% CI [11.09-21.23]; d = 1.16), for patients with NSCNP associated with dizziness with respect to patients with isolated NSCNP. CONCLUSIONS: Patients with NSCNP in conjunction with dizziness present higher HRQoL impairment and higher disability and kinesiophobia compared to patients with isolated NSCNP.