Fibromyalgia pain management effectiveness from the patient perspective: a qualitative evidence synthesis.

PURPOSE: This qualitative evidence synthesis aimed to identify and integrate findings where adults with fibromyalgia discussed how they managed their pain, and their perceptions of prescribed treatments from healthcare professionals. MATERIALS AND METHODS: A comprehensive search strategy was implemented in PubMed, Scopus, ISI Web of Science, and Cinahl Plus databases. The GRADE-CERQual framework was used to evaluate the findings confidence. The findings were analyzed using an inductive thematic analysis approach. RESULTS: A total of 35 studies (N = 728) were included. The confidence in the findings ranged from high to low confidence. Patients with fibromyalgia often do not benefit from seeking medical attention due to provider stigma, and have varying views on medication effectiveness commonly reporting feeling like "walking chemists." They find mixed effects from exercise, and consider psychological support essential, although the benefits of cognitive-behavioral therapy were controversial. Combining cognitive-behavioral therapy with physical exercise appears more effective, while natural and complementary therapies have short-term benefits and high costs. CONCLUSIONS: Pain management is a source for frustration and an unmet need for patients with fibromyalgia. The current findings provide crucial insight for providers and researchers; and support the need for fibromyalgia phenotyping and precision medicine approaches to pain management.Implications for RehabilitationChronic widespread pain is the defining feature of fibromyalgia, yet pain reduction is often an unmet need for these individuals.The lack of effective treatments resulting in long-term relief proves frustrating for patients and healthcare providers.Rehabilitation professional should consider the unique insight into this complex, heterogeneous condition that this qualitative synthesis provides to better understand their patient's perspective on pain management.Given the differing perspectives on pain treatment approaches individuals with fibromyalgia report, providers should discuss with each patient their current strategies and take a patient-centered, individualized approach to form an effective treatment plan.

Effectiveness of an exercise intervention based on preactivation of the abdominal transverse muscle in patients with chronic nonspecific low back pain in primary care: a randomized control trial.

BACKGROUND: Low back pain is one of the most common disabling pathologies in humanity worldwide. Physical exercises have been used in recent decades to reduce the pain, improve the functionality of the lumbar spine and avoid relapses. The purpose of the study is to analyze the effect of a program based on re-education exercises involving preactivation of the abdominal transverse muscle compared to conventional treatment in adults with chronic nonspecific low back pain. METHODS: A two-arm, single-blind randomized control trial with 35 primary care patients with chronic nonspecific low back pain. Both groups received a 4-week intervention. Data were collected at baseline and at the end of the intervention. Sixteen patients participated in the intervention group, and 19 patients in the control group. RESULTS: For the experimental group, the outcomes of disability and activation of the abdominal transverse muscle decreased significantly (MD -2.9; CI 95% -5.6 to -0.35; η2 = 0.14; p = 0.028) and (MD 2.3; CI 95% 0.91 to 3.67; η2 = 0.25; p = 0.002) respectively, with a large effect size, compared to the control group. There were no differences between the groups in pain intensity, thickness, and resistance of the transverse abdominal muscle. CONCLUSION: A 4-week specific program based on re-education exercises of the preactivation of the abdominal transverse muscle is more effective than conventional treatment for reducing disability and increasing the activation of the abdominal transverse muscle measured by VAS scale and PBU. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03097497. Date of registration: 31/03/2017.

Effectiveness of eHealth therapeutic education interventions in the management of fibromyalgia: protocol for a systematic review and meta-analysis.

INTRODUCTION: Non-pharmacological approaches have shown promising results in improving symptoms and quality of life of patients with fibromyalgia. However, these approaches may not be easily accessible or feasible for everyone. eHealth interventions may offer a more convenient and cost-effective approach to reach a wider range of patients with fibromyalgia and improve their outcomes. As eHealth tools become more prevalent in clinical practice, it is crucial to understand their effectiveness, limitations and how they can be integrated into standard care to optimise clinical outcomes. This systematic review aims to evaluate the effectiveness of eHealth therapeutic education interventions in managing fibromyalgia. METHODS AND ANALYSIS: Randomised controlled trials including eHealth therapeutic education interventions for individuals ≥18 years old with fibromyalgia, published in English or Spanish, will be retrieved by searching the databases PubMed, CINAHL Plus, EMBASE, Scopus, ISI Web of Science, PsycINFO and the Cochrane Central Register of Controlled Trials. Covidence software will be used for the selection of studies and data extraction. The risk of bias and the certainty of evidence will be assessed using the Cochrane Risk of Bias Assessment tool. We plan to perform a meta-analysis contingent on the number of studies retrieved and the interstudy heterogeneity, which will be explored with I2 statistics. ETHICS AND DISSEMINATION: This protocol and the subsequent systematic review will not collect individual-level data and do not require approval by an ethical committee. We intend to disseminate the study results via peer-reviewed scientific journals and relevant (inter)national conferences. PROSPERO REGISTRATION NUMBER: CRD42022343373.

Developing an assistive technology usability questionnaire for people with neurological diseases.

PURPOSE: This study describes the development of a questionnaire for assessing the usability of assistive technologies accessible to people with neurological diseases. METHODS: A Delphi study was conducted to identify relevant items for the questionnaire. After that, the content validity was addressed to identify the essential items. Once the questionnaire was designed following the results of the Delphi study and content validity, the reliability, validity, and the Rasch model of the questionnaire were examined. RESULTS: Two rounds of the Delphi study were carried out. A total of 73 participants (42 experts and 31 users) participated in round 1, and 59 people (27 experts and 32 users) in round 2. A total of 53 and 29 items were identified in rounds 1 and 2, respectively. In the content validity, we found nine items above the threshold of 0.58. Finally, ten items were included in the questionnaire. Fifty-one participants participate in the reliability and validity of the questionnaire. The internal consistency reliability of the questionnaire analyzed by Cronbach's Alpha was α = 0,895. There was moderate to considerable concordance among our questionnaire items test-retest in the Kappa coefficient and a strong association between test-retest in the Spearman's coefficient ρ = 0.818 (p<0,001). The intraclass correlation coefficient was 0,869 with a 95% confidence interval (0,781;0,923). There was a strong correlation between the total scores of the new questionnaire and other validated questionnaires analyzed with Spearman's coefficient ρ = 0.756 (p<0,001). The ten items demonstrated a satisfactory fit to the Rasch model. CONCLUSIONS: The present study suggested that the new questionnaire is a reliable 10-item usability questionnaire that allows subjective and quick assessment of the usability of assistive technologies by people with neurological diseases.

Use of a gamified website to increase pain neurophysiology knowledge and improve satisfaction and motivation among students studying for a degree in physiotherapy: a quasi-experimental study.

BACKGROUND: The scientific evidence highlights the difficulties that healthcare professionals experience when managing patients with chronic pain. One of the causes of this difficulty could be related to the acquired training and the lack of knowledge about the neurophysiology of pain. In the present study, we assessed the effectiveness of a gamified web platform in acquiring knowledge about pain neurophysiology and determining the satisfaction and motivation of students of the Degree in Physiotherapy at the University of Lleida. METHODS: A quasi-experimental study was carried out with a sample of 60 students who had access to a gamified web platform that included notes, videos, and clinical cases prepared by the teaching staff and was based on a previous study that included patients and healthcare professionals. RESULTS: The results show that after the intervention, there was a statistically significant increase in knowledge about the neurophysiology of pain, and the effect size was in the desired area of ​​effect. Likewise, many students considered that their motivation had increased as a result of the methodology used in the present study. CONCLUSIONS: The results support the use of this methodology to promote knowledge about the neurophysiology of pain while improving students' motivation.

Misbeliefs about non-specific low back pain and attitudes towards treatment by primary care providers in Spain: a qualitative study.

AIM: To identify misbeliefs about the origin and meaning of non-specific chronic low back pain and to examine attitudes towards treatment by primary health care providers. DESIGN: Generic qualitative study. METHODS: Ten semi-structured interviews were conducted between October and November 2016 with physicians and nurses from primary health care centres in Lleida. The interviews were transcribed and analysed using inductive thematic analysis via Atlas.ti-8 software. RESULTS: Five themes were identified: i. beliefs about the origin and meaning of chronic low back pain, ii. psychosocial aspects of pain modulators, iii. Therapeutic exercise as a treatment for chronic low back pain, iv. biomedical attitudes of primary health care providers, and v. difficulties in the clinical approach to chronic low back pain. CONCLUSION: Primary health care providers have a unifactorial view of chronic low back pain and base their approach on the biomedical model. Professionals attribute chronic low back pain to structural alterations in the lumbar spine while psychosocial factors are only recognized as pain modulators. For professionals, therapeutic exercise represents a possible solution to chronic low back pain; however, they still do not prescribe it and continue to educate on postural hygiene and recommend limiting physical and/or occupational activities, as opposed to clinical practice guidelines. These findings suggest that to improve the adherence of primary health care providers to the biopsychosocial model, it may be necessary first to modify their misbeliefs about non-specific chronic low back pain by increasing their knowledge on pain neurophysiology. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02962817 . Date of registration: 11/11/2016.

Cognitive behavioral therapy for insomnia (CBT-i) in patients with fibromyalgia: a systematic review and meta-analysis.

PURPOSE: We aimed to evaluate the effectiveness of CBT-i in patients with fibromyalgia in comparison with other non-pharmacological treatments. METHODS: Randomized controlled trials assessing the effects of CBT-i in adults with fibromyalgia, published in English or Spanish, were eligible. Electronic searches were performed using PubMed, Scopus, The Cochrane Library, WebOfKnowledge and Psicodoc databases in March 2021. The main outcome measures were sleep efficiency and sleep quality. Secondary outcomes included pain, depression, and anxiety. RESULTS: Of 226 studies reviewed, five were included in the meta-analysis. CBT-i compared with non-pharmacological treatments showed no significant improvements in sleep efficiency (p = 0.05; standardized mean difference (SMD) [95% CI] 0.31 [-0.00 to 0.61]). CBT-i showed significant improvements in sleep quality (p = 0.009; SMD [95% CI] - 0.53 [-0.93 to -0.13]), pain (p = 0.002; SMD [95% CI] - 0.41 [-0.67 to -0.16]), anxiety (p = 0.001; SMD [95% CI] - 0.46 [-0.74 to 0.18]) and depression (p = 0.02; SMD [95% CI] - 0.33 [-0.61 to -0.05]), compared to non-pharmacological treatments. Effect sizes ranged from small to moderate. CONCLUSIONS: CBT-i was associated with a significant improvement in sleep quality, pain, anxiety, and depression, although these results are retrieved from very few studies with only very low to low quality evidence. Trial registration: The review protocol was registered with PROSPERO (Record ID = CRD42016030161).IMPLICATIONS FOR REHABILITATIONCBT-i has been proven to improve sleep quality, pain, anxiety and depression, although with small effect sizes.Implementing hybrid CBT for pain and sleep or combining CBT and mindfulness may improve symptoms in people diagnosed with FM.This meta-analysis results highlight the need to enhance sleep management skills among people suffering from this health condition.

Patients' and primary healthcare professionals' perceptions regarding chronic low back pain and its management in Spain: a qualitative study.

PURPOSE: This study aimed to explore and compare the perceptions of patients and primary healthcare professionals regarding the management of chronic low back pain. METHODS: Qualitative study using 26 semi-structured individual interviews, and one discussion group, carried out in primary care in Lleida, Spain. RESULTS: Patients and primary healthcare professionals both had assumptions pertaining to: (1) the diagnosis and meaning of chronic low back pain, (2) expectations regarding treatment for pain reduction, and (3) communication between primary healthcare professionals and patients with chronic low back pain. Results suggest a mutual dissatisfaction with the diagnosis of chronic low back pain and a lack of understanding between primary healthcare professionals and patients. Some contradictions between them were also noted: the patients wanted quick solutions to reduce their pain, but the primary healthcare professionals required an accurate etiology to prescribe treatment, and the patients did not always follow the primary healthcare professionals' recommendations. CONCLUSIONS: Diagnosing and treating chronic low back pain is compromised due to differing expectations and the communication barriers that exist between healthcare professionals and their patients. Primary healthcare professionals should be aware of the power of their explanations and recommendations to patients.Implications for RehabilitationPrimary healthcare professionals should negotiate treatments with patients and adapt them to their individual needs, according to a Patient-Centered approach and the biopsychosocial model of pain.Primary healthcare professionals should explain to patients the underlying mechanisms and multifactorial nature of chronic low back pain.Primary healthcare professional-patient communication needs to be improved to help patients to better understand their chronic condition.The healthcare professionals in Spain should be more trained into the (bio)psychosocial model of long-term pain, stop searching for non-evident pathologies and change their biomedical beliefs.

Poor Sleep Quality Experience and Self-Management Strategies in Fibromyalgia: A Qualitative Metasynthesis.

Poor sleep quality is a major concern and a highly prevalent symptom in fibromyalgia. We aimed to develop a metasynthesis of qualitative studies to assess how people diagnosed with fibromyalgia experience and manage poor sleep quality following the concepts of the Symptom Management Theory. The principles of metasynthesis established by Sandelowski and Barroso were utilized. A pre-planned comprehensive search was implemented in PubMed, Scopus, ISI WebofScience, and Cinahl Plus databases. The methodological quality was assessed following the CASP Qualitative Checklist. The findings of the studies were subjected to a metasummary and a metasynthesis. Seventeen studies were included in the metasynthesis. Two overarching themes were pre-established: (1) experience of poor sleep quality in Fibromyalgia and (2) poor sleep quality management strategies in Fibromyalgia. Four sub-themes emerged from the results: (1) evaluation of poor sleep quality, (2) response to poor sleep quality, (3) management strategies to favor sleep, and (4) managing the consequences of a sleepless night. Poor sleep quality is a severe and disabling symptom that negatively impacts the general health status of people diagnosed with FM. Prescribed treatments are commonly seen as ineffective and self-management strategies are a last resort and do not show beneficial effects.

Patient Reported Outcome Measures of Sleep Quality in Fibromyalgia: A COSMIN Systematic Review.

Poor sleep quality is a common concern and a troublesome symptom among patients suffering from fibromyalgia. The purpose of this review was to identify and describe the available patient reported outcome measures (PROMs) of sleep quality validated in adult people diagnosed with fibromyalgia. The COSMIN and PRISMA recommendations were followed. An electronic systematized search in the electronic databases PubMed, Scopus, CINAHL Plus, PsycINFO, and ISI Web of Science was carried out. Validation studies of PROMs of sleep quality in fibromyalgia published in English or Spanish were included. The selection of the studies was developed through a peer review process through the online software "COVIDENCE". The quality of the studies was assessed using the COSMIN Risk of Bias checklist. A total of 5 PROMs were found validated in patients with fibromyalgia: (1) Pittsburgh Sleep Quality Index (PSQI), (2) Jenkins Sleep Scale (JSS), (3) Sleep Quality Numeric Rating Scale (SQ-NRS), (4) Medical Outcomes Study-Sleep Scale (MOS-SS), and (5) Fibromyalgia Sleep Diary (FSD). The quality of the evidence was very good and the quality of the results ranged from moderate to high. All the included PROMs, except for the FSD, showed adequate psychometric properties and, therefore, are valid and reliable tools for assessing sleep quality in the context of FM. However, none of the studies analyzed all the psychometric properties of the included PROMs as established in the COSMIN guidelines, highlighting that this is a potential field of research for future investigations.

A web-based therapeutic patient education intervention for pain and sleep for women with fibromyalgia: A sequential exploratory mixed-methods research protocol.

AIMS: To evaluate cognitive and behavioural factors related to pain and poor sleep quality in women diagnosed with fibromyalgia and to develop and test the effects of a web-based therapeutic education intervention on pain intensity, pain catastrophizing, chronic pain self-efficacy, sleep quality, dysfunctional beliefs and attitudes about sleep and quality of life and health status related to fibromyalgia. DESIGN: The project will employ a sequential exploratory mixed methods research design. METHODS: For the qualitative phase, a theoretical sample living in the community will be recruited to participate in personal, semi-structured interviews. For the quantitative phase, a sample of adult women with fibromyalgia will be recruited from secondary care centres and randomly allocated an intervention or a control group. The study protocol was approved in 2019. DISCUSSION: Fibromyalgia is the most common central sensitivity syndrome and one of the principal worldwide causes of chronic widespread pain among the adult population. Poor sleep quality is a highly prevalent and troublesome symptom for people with fibromyalgia. Psychosocial and behavioural factors have been shown to relate intimately with the symptom experiences of people with fibromyalgia; pain catastrophizing and dysfunctional beliefs and attitudes about sleep can perpetuate those and other fibromyalgia symptoms. CONCLUSION: It is imperative to reflect people's actual symptom experiences to develop effective symptom management strategies. In the Internet era, this project's proposed web-based therapeutic education intervention could offer women with fibromyalgia a new avenue for treatment as part of standard fibromyalgia management programs in primary and secondary healthcare services. IMPACT: Pain and poor sleep quality are highly prevalent and troublesome symptoms for people with fibromyalgia. The web-based therapeutic education intervention proposed in this project could provide women with fibromyalgia a new avenue for treatment in primary and secondary healthcare services. Protocol registration: ClinicalTrials.gov Identifier: NCT03686410.

The influence of an educational internet-based intervention in the beliefs and attitudes of primary care professionals on non-specific chronic low back pain: study protocol of a mixed methods approach.

BACKGROUND: Personal convictions in referral to pain cause misbeliefs in health professionals, which can influence patients who suffer from non-specific chronic low back pain. Likewise, health professionals' beliefs affect their advice and attitudes towards patients' treatment, becoming a possible cause of greater disability. The development of educational interventions based on the best scientific evidence in neurophysiology of pain could be a way to provide information and advice to primary care health professionals to change their cognition towards chronic non-specific low back pain. The use of Information and Communication Technologies allows the development of web sites, which might be one of the effective resources to modify misbeliefs and attitudes, in relation to the origin and meaning of non-specific chronic low back pain, of primary care professionals and that may modify their attitudes in patients' treatment. METHODS: The aim of this project is to identify misbeliefs and attitudes of primary care physicians and nurses about chronic non-specific low back pain to develop a web-based educational tool using different educational formats and gamification techniques. This study has a mixed-method sequential exploratory design. The participants are medical and nursing staff working in primary care centers in the city of Lleida, Spain. For the qualitative phase of this study, the authors will use personal semi-structured interviews. For the quantitative phase the authors will use an experimental study design. Subjects will be randomly allocated using a simple random sample technique. The intervention group will have access to the web site where they will find information related to non-specific chronic low back pain, based on the information obtained in the qualitative phase. The control group will have access to a video explaining the clinical practice guidelines on low back pain. DISCUSSION: This study has been designed to explore and modify the beliefs and attitudes about chronic low back pain of physicians and nurses working in primary care settings, using a web-based educational tool with different educational formats and gamification techniques. The aim of the educational intervention is to change their knowledge about the origin and meaning of pain, with the result of reducing their misbeliefs and attitudes of fear avoidance. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02962817 . Date of registration: 11/09/2016.

The influence of a biopsychosocial educational internet-based intervention on pain, dysfunction, quality of life, and pain cognition in chronic low back pain patients in primary care: a mixed methods approach.

BACKGROUND: Low back pain is the highest reported musculoskeletal problem worldwide. Up to 90 % of patients with low back pain have no clear explanation for the source and origin of their pain. These individuals commonly receive a diagnosis of non-specific low back pain. Patient education is a way to provide information and advice aimed at changing patients' cognition and knowledge about their chronic state through the reduction of fear of anticipatory outcomes and the resumption of normal activities. Information technology and the expedited communication processes associated with this technology can be used to deliver health care information to patients. Hence, this technology and its ability to deliver life-changing information has grown as a powerful and alternative health promotion tool. Several studies have demonstrated that websites can change and improve chronic patients' knowledge and have a positive impact on patients' attitudes and behaviors. The aim of this project is to identify chronic low back pain patients' beliefs about the origin and meaning of pain to develop a web-based educational tool using different educational formats and gamification techniques. METHODS/DESIGN: This study has a mixed-method sequential exploratory design. The participants are chronic low back pain patients between 18-65 years of age who are attending a primary care setting. For the qualitative phase, subjects will be contacted by their family physician and invited to participate in a personal semi-structured interview. The quantitative phase will be a randomized controlled trial. Subjects will be randomly allocated using a simple random sample technique. The intervention group will be provided access to the web site where they will find information related to their chronic low back pain. This information will be provided in different formats. All of this material will be based on the information obtained in the qualitative phase. The control group will follow conventional treatment provided by their family physician. DISCUSSION: The main outcome of this project is to identify chronic low back pain patients' beliefs about the origin and meaning of pain to develop a web-based educational tool using different educational formats and gamification techniques. TRIAL REGISTRATION: ClinicalTrials.gov NCT02369120 Date: 02/20/2015.