RESUMO
Los objetivos de esta revisión sistemática fueron examinar la eficacia del tratamiento multidisciplinar (TM) aplicado a pacientes con fibromialgia y síndrome de fatiga crónica (SFC), junto con la exploración de predictores, mediadores y moderadores de resultados. Se realizó una búsqueda bibliográfica exhaustiva en las bases de datos Medline, PsycInfo, Scopus y Cochrane Library en el período 1990- 2018. En total, 31 artículos de fibromialgia y seis de SFC fueron identificados. Los resultados reflejaron que en fibromialgia el TM fue más eficaz que la lista de espera (LDE) y el tratamiento médico habitual, produciendo las mejoras más consistentes en funcionalidad, dolor, calidad de vida y aptitud física. En el SFC los beneficios fueron menores que en fibromialgia, y el TM fue solo más eficaz que la LDE y disminuyó principalmente la discapacidad. Sin embargo, las evidencias no fueron suficientes para constatar la superioridad del TM frente a otros tratamientos activos, ni para consolidar el valor pronóstico de los predictores, mediadores y moderadores de resultados informados (AU)
bstract The aims of this systematic review were to analyze and to compare the efficacy of the multidisciplinary treatment (MT) applied to patients with fibromyalgia and chronic fatigue syndrome (CFS). Also, predictors, mediators and moderators of results were examined. An exhaustive literature search was carried out in the databases Medline, PsycInfo, Scopus and Cochrane Library in the period 1990-2018. In total, 31 articles on fibromyalgia and six on CFS were identified. The results showed that in fibromyalgia, MT was more effective than waiting list controls (WLC) and the usual treatment, producing the most consistent improvements in functionality, pain, quality of life and physical fitness. As to CFS, there were fewer benefits than in fibromyalgia, and the MT was only more effective than the WLC, and it mainly decreased the disability. However, the evidence was not enough to confirm the superiority of MT over other active treatments, nor to consolidate the prognostic value of the predictors, mediators and moderators of the reported results (AU)
Assuntos
Humanos , Equipe de Assistência ao Paciente , Práticas Interdisciplinares , Fibromialgia/terapia , Fadiga/terapia , Doença CrônicaRESUMO
Excessive attention to pain is a common psychological characteristic among people who suffer from chronic pain. The Pain Vigilance and Awareness Questionnaire (PVAQ) is an internationally accepted tool to assess this feature, although there is no validated version of this measure for Spanish people with fibromyalgia. Since this pain syndrome mainly affects women, the aim of this study was to determine the psychometric properties of the PVAQ in Spanish women with fibromyalgia. A group of 242 women diagnosed with fibromyalgia aged between 20 and 66 years participated in the study. The goodness of fit of several structures of the PVAQ reported in previous studies was compared via confirmatory factor analysis. A two-factor solution (active vigilance and passive awareness) of the 9-item shortened version (PVAQ-9) was identified as the most appropriate (RMSEA = .08, NNFI = .96, CFI = .97, GFI = .87). It showed good reliability (internal consistency α = .82), convergent validity and divergent validity (p < .01). The optimal cutoff point for identifying fibromyalgia women with worse daily functioning was a score of 24.5, with a sensitivity of .71 and a specificity of .75. The relevance of vigilance to pain for clinical research in fibromyalgia is discussed.
