Determining the Minimal Clinically Important Difference for 6-Minute Walk Distance in Fibromyalgia

The PACE Trial's GET Manual for Therapists Exposes the Fixed Incremental Nature of Graded Exercise Therapy for ME/CFS

The British National Institute for Health and Care Excellence (NICE) published its updated guidelines for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in October 2021. NICE concluded, after an extensive review of the literature, that graded exercise therapy (GET) is harmful and should not be used, and that cognitive behavioural therapy (CBT) is only an adjunctive and not a curative treatment. An article by White et al., which is written by 51 researchers, claims that there are eight anomalies in the review process and the interpretation of the evidence by NICE. In this article, we reviewed the evidence they used to support their claims. Their three most important claims are that NICE redefined the disease, that CBT and GET are effective, and that fixed incremental increases are not part of GET. However, our analysis shows that the disease was not redefined by NICE. Instead, it was redefined in the 1990s by a group of doctors, including a number of authors of White et al., when they erased the main characteristic of the disease (an abnormally delayed muscle recovery after trivial exertion, which, over the years, has evolved into post-exertional malaise) and replaced it with chronic disabling severe fatigue. Their own studies show that CBT and GET do not lead to a substantial improvement of the quality-of-life scores or a reduction in CFS symptom count, nor do they lead to objective improvement. Also, both treatments have a negative instead of a positive effect on work and disability status. Moreover, a recent systematic review, which included one of the authors of White et al., showed that ME/CFS patients remain severely disabled after treatment with CBT. Our analysis of, for example, the PACE trial's GET manual for therapists exposes the fixed incremental nature of GET. Why the authors are not aware of that is unclear because eight of them were involved in the PACE trial. Three of them were centre leaders and its principal investigators, four others were also centre leaders, and another one was one of the three independent safety assessors of the trial. Moreover, many of these eight authors wrote, or were involved in writing, this manual. In conclusion, our analysis shows that the arguments that are used to claim that there are eight anomalies in the review process and the interpretation of the evidence by NICE are anomalous and highlight the absence of evidence for the claims that are made. Furthermore, our analysis not only exposes the fixed incremental nature of GET, but also of CBT for ME/CFS.

Psychometric properties of performance based tests in patients with Fibromyalgia: A systematic review

Fibromyalgia (FM) impacts patients' health status, functioning and quality of life. Accurate diagnosis and effective treatment planning require reliable, valid and responsive measures of these domains. This study aimed to assess the psychometric properties of performance based tests (PBTs) in FM and to quantify the availability of reliable, valid and responsive PBTs linked to key International Classification of Functioning, Disability and Health (ICF) categories related to functional impact. A systematic review was conducted following the PRISMA checklist, and four databases (PubMed, EMBASE, Cochrane Library and Web of Science) were searched. Eligible studies contained information on population, intervention (assessment), and outcomes (PBTs and their psychometric properties). The risk of bias and the methodological quality were assessed according to the COSMIN criteria. Twenty-two studies evaluating twenty-six PBTs were included. PBTs were linked to five ICF categories: exercise tolerance, muscle power and muscle endurance and changing basic body position and walking. The psychometric properties assessed were reliability, validity and responsiveness. The 6 min walking test was the most often assessed PBT with moderate quality of evidence for reliability, and very good methodological quality for validity. Overall, the methodological quality for reliability was rated as doubtful with very low to moderate evidence, for validity we found very good methodological quality with low to high evidence. No studies investigated criterion validity, and construct validity and responsiveness were seldom determined. Clinicians assessing FM patients should carefully select PBTs. Future research on PBTs psychometrics in FM should follow COSMIN recommendations, ensuring control of symptom variability. PERSPECTIVE: This review confirms that the current understanding of the psychometric properties of PBTs for FM patients is limited, hindered by heterogeneous tests and insufficient evidence, complicating outcome comparisons across studies. This gap underscores the need for future research to enhance methodological quality and address missing ICF categories related to FM. REGISTERED PROTOCOL AT PROSPERO: Registration number: CRD42022380709.

The minimal clinically important difference of the scleroderma clinical trials consortium damage index

Objective

The Scleroderma Clinical Trials Consortium Damage Index is an index of global damage in systemic sclerosis. The objective of this study is to determine the minimal clinically important difference of the Scleroderma Clinical Trials Consortium Damage Index.

Methods

Patients in the Canadian Scleroderma Research Group registry and the Australian Scleroderma Cohort Study who completed Scleroderma Clinical Trials Consortium Damage Index scores and the SF36v2 at baseline and the first full follow-up visit were studied. To calculate the minimal clinically important difference, an anchor question came from SF36v2: "Compared to one year ago, how would you rate your health in general?." Options were: much better, somewhat better, about the same, somewhat worse and much worse. We use the "somewhat worse" or "much worse" categories to indicate those with any worsening. We used four anchor methods: receiver operating characteristic curve, change difference, regression analysis, and average change.

Results

We studied 1672 patients. Mean disease duration was 11.4 ± 10.0 years; 62.5% had diffuse cutaneous systemic sclerosis. Baseline mean Damage Index was 5.3 ± 4.2; mean change of Damage Index over 1 year was 0.9 ± 1.8 units. The calculated minimal clinically important difference values were 1 for receiver operating characteristic method, 0.625 for change difference, 0.1879 for regression analysis, and 1.37 for average change. Omitting the regression analysis method as an outlier, the mean of the other methods was 1.

Conclusion

The most appropriate minimal clinically important difference for the Scleroderma Clinical Trials Consortium Damage Index is a change of ⩾ 1.0 units in the Scleroderma Clinical Trials Consortium Damage Index as is already recognized by patients as a significant change after 1 year. This can be applied to group means as well as to individuals where an ordinal change is required.

The arm curl score is the best indicator of reduced upper extremity exercise capacity in women with fibromyalgia: A cross-sectional study

BACKGROUND

Unsupported upper extremity exercise capacity (UUEEC) is crucial for sustaining everyday functions; whether it is compromised in the fibromyalgia (FM) population is unknown.

PURPOSE

The study aimed to assess UUEEC in women with FM and to determine associated factors.

STUDY DESIGN

This is a cross-sectional study.

METHODS

This study was conducted with 48 women with FM and 48 healthy women between the ages of 18-65. UUEEC, muscle strength, flexibility and disability of upper extremity, disease severity, pain catastrophizing, and quality of life assessed with the Six Minute Pegboard and Ring Test (6PBRT), arm curl test, hand grip strength test, back-scratch test, Disability of Arm, Shoulder, and Hand (DASH), Fibromyalgia Impact Questionnaire (FIQ) and Pain Catastrophizing Scale and Short-form 36 questionnaires, respectively.

RESULTS

The 6PBRT score was significantly decreased in the women with FM compared to healthy women (p < 0.001, Cohen d: 1.28). The multivariate linear regression analysis revealed that the model incorporating the arm curl score, hand grip strength, DASH, and FIQ scores was explained 68% of the variance in 6PBRT score (R2 = 0.672, p < 0.001). The results indicated that all variables in the model were independent predictors of 6PBRT score, with the arm curl score was the strongest predictor (β = 6.36, p = 0.015).

CONCLUSIONS

This study suggests that UUEEC measured by 6PBRT is reduced in women with FM, and the upper extremity muscle strength is closely related to the 6PBRT score. Accordingly, strengthening the biceps brachii muscle in women with FM, whose muscle weakness is common, may be effective in improving UUEEC, which is directly associated to daily activities.

Transcutaneous electrical nerve stimulation for fibromyalgia-like syndrome in patients with Long-COVID: a pilot randomized clinical trial

This study investigated the effect of Transcutaneous Electrical Nerve Stimulation (TENS) for fibromyalgia-like symptoms including chronic widespread musculoskeletal pain, fatigue, and/or gait impairment in twenty-five individuals with long-COVID. Participants were randomized to a high dose (intervention group, IG) or low dose (placebo group, PG) TENS device. Both groups received daily 3-5 h of TENS therapy for 4-weeks. The Brief Pain Inventory assessed functional interference from pain (BPI-I), and pain severity (BPI-S). The global fatigue index (GFI) assessed functional interference from fatigue. Wearable technology measured gait parameters during three 30-feet consecutive walking tasks. At 4-weeks, the IG exhibited a greater decrease in BPI-I compared to the PG (mean difference = 2.61, p = 0.008), and improved in gait parameters including stride time (4-8%, test condition dependent), cadence (4-10%, depending on condition), and double-support phase (12% in dual-task) when compared to baseline. A sub-group meeting the 2010 American College of Rheumatology Fibromyalgia diagnostic criteria undergoing high-dose TENS showed GFI improvement at 4-weeks from baseline (mean change = 6.08, p = 0.005). Daily TENS therapy showed potential in reducing functional interference from pain, fatigue, and gait alterations in long-COVID individuals. The study's limited power could affect the confirmation of certain observations. Extending the intervention period may improve treatment effectiveness.

Improving multidisciplinary management of patients living with obesity: The evaluation of seated bioimpedance measures and relationship to functional performance following targeted intervention

Management of obesity requires a multidisciplinary approach including physical activity interventions, which have significant impacts on overall health outcomes. Greater levels of lean muscle mass are significantly associated with improved health and reduced risk of comorbidities and should be preserved where possible when undertaking rapid weight loss. This article reports on the physical and functional outcomes achieved during a 12-week intensive multidisciplinary intervention targeting obesity and evaluates correlations between body composition and functional outcomes. We additionally aimed to investigate the test-retest reliability and levels of agreement in body composition measurements using bioimpedance spectroscopy between seated and standing positions. Of the 35 participants included in analysis, significant differences were observed between baseline and post-intervention measures. These included weight loss of 12.6 kg, waist circumference reduction of 10.5 cm, fat mass reduction by 2.9%, muscle mass increase by 1.6%, 54.5 m improvement in the 6-minute walk test and 3.8 rep improvement in the 30-second sit-to-stand test. No significant correlations were observed between physical and functional outcome measures. Excellent test re-test reliability was observed in bioimpedance spectroscopy seated measurements (ICC >.9). Significant differences were observed between seated and standing bioimpedance spectroscopy measurements, however they are regarded as small differences in a clinical setting.

Assessing a GPS-Based 6-Minute Walk Test for People With Persistent Pain: Validation Study

BACKGROUND

The 6-minute walk test (6MWT) is a commonly used method to assess the exercise capacity of people with many health conditions, including persistent pain. However, it is conventionally performed with in-person supervision in a hospital or clinic, therefore requiring staff resources. It may also be difficult when in-person supervision is unavailable, such as during the COVID-19 pandemic, or when the person is geographically remote. A potential solution to these issues could be to use GPS to measure walking distance.

OBJECTIVE

The primary aim of this study was to assess the validity of a GPS-based smartphone app to measure walking distance as an alternative to the conventional 6MWT in a population with persistent pain. The secondary aim of this study was to estimate the difference between the pain evoked by the 2 test methods.

METHODS

People with persistent pain (N=36) were recruited to complete a conventional 6MWT on a 30-m shuttle track and a 6MWT assessed by a smartphone app using GPS, performed on outdoor walking circuits. Tests were performed in random order, separated by a 15-minute rest. The 95% limits of agreement were calculated using the Bland-Altman method, with a specified maximum allowable difference of 100 m. Pain was assessed using an 11-point numerical rating scale before and after each walk test.

RESULTS

The mean 6-minute walk distance measured by the GPS-based smartphone app was 13.2 (SD 46; 95% CI -2.7 to 29.1) m higher than that assessed in the conventional manner. The 95% limits of agreement were 103.9 (95% CI 87.4-134.1) m and -77.6 (95% CI -107.7 to -61) m, which exceeded the maximum allowable difference. Pain increased in the conventional walk test by 1.1 (SD 1.0) points, whereas pain increased in the app test by 0.8 (SD 1.4) points.

CONCLUSIONS

In individuals with persistent pain, the 2 methods of assessing the 6MWT may not be interchangeable due to limited validity. Potential reasons for the differences between the 2 methods might be attributed to the variation in track layout (shuttle track vs continuous circuit); poor GPS accuracy; deviations from the 30-m shuttle track; human variability in walking speed; and the potential impact of a first test on the second test due to fatigue, pain provocation, or a learning effect. Future research is needed to improve the accuracy of the GPS-based approach. Despite its limitations, the GPS-based 6MWT may still have value as a tool for remote monitoring that could allow individuals with persistent pain to self-administer frequent assessments of their functional capacity in their home environment.

Effects of progressive intensity resistance training on the impact of fibromyalgia: protocol for a blinded randomized controlled trial

BACKGROUND

Fibromyalgia guidelines indicate that exercise is critical in the management of fibromyalgia, and there is evidence that patients with fibromyalgia can perform resistance training at moderate and high intensities. However, despite the biological plausibility that progression of intensity provides greater benefit to individuals, no studies have compared different intensities (progressive versus constant intensities) of the same exercise in this population.

OBJECTIVE

To compare the effect of 24 sessions of resistance training (progressive vs. constant intensity) on impact of fibromyalgia, sleep quality, anxiety, depression, pain, walking ability, and musculoskeletal capacity.

METHODS

A protocol for a blinded randomized controlled trial. The sample will be randomized into three groups: group 1 (progressive intensity, experimental), group 2 (constant intensity, control A), and group 3 (walking, control B). Group 1 will perform resistance training at moderate intensity (50% of maximum dynamic strength), previously determined by the 1 repetition maximum (1-RM) test in the proposed exercises. The strength of each individual will be reassessed every 4 weeks (by 1-RM) and the intensity of each exercise will be positively adjusted by 20% of the value observed in kg (i.e., first month 50%; second month 70%; third month 90% of the maximum dynamic strength). Group 2 will perform the same procedure, but the intensity will be maintained at 50% of the maximum dynamic strength throughout the treatment (i.e., constant intensity from the first to the third month). Group 3 will perform a 40-minute treadmill walk at low intensity, defined by a walking speed corresponding to 60-70% of the maximum heart rate, which we will control with a heart rate monitor. All groups will receive a 45-minute pain education session prior to the exercise program, covering the pathophysiologic mechanisms of chronic pain, strategies for coping with pain, avoiding hypervigilance, and deconstructing beliefs and myths about chronic pain.

DISCUSSION

The results of the present study may help health care professionals adjust the intensity of resistance training and thus plan the most effective intervention (progressive or constant intensity) to reduce the impact of fibromyalgia on patients' lives.

TRIAL REGISTRATION

Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-9pbq9fg, date of registration: October 06, 2022.

People at a persistent pain service can walk it, but some struggle to talk about it: Reliability, detectable difference and clinically important difference of the six-minute walk test

OBJECTIVES

The six-minute walk test (6MWT) is a commonly used measure of functional capacity. This study is the first to investigate the test-retest reliability, minimal detectable difference (MDD) and the minimal clinically important difference (MCID) for people attending a persistent pain service. Relationships between change in 6MWT performance and change in self-reported physical, functional and psychological outcome measures were also explored.

METHODS

A cross-sectional repeated measures design was used with people having >9 months of pain attending an 8-week outpatient persistent pain programme. For reliability and MDD, 27 people were recruited, for MCID calculations, 32 people were recruited. The MCID was examined by dichotomising people into "improvers", or "non-improvers" based upon the Global Rating of Change (GRC) in physical abilities score.

RESULTS

The mean (SD) 6MWT distance was 389.4 (93.6) m at programme start, and 427.8 (83.0) m at week eight completion. The test-retest reliability was good (intraclass correlation coefficient = 0.89) and the MDD = 86.1 m. As there was no relationship between change in 6MWT distance and GRC physical abilities at week eight (r = 0.132, p = 0.472) the MCID could not be calculated. Furthermore, no relationships were found between change in 6MWT distance and other self-reported measures. Changes in GRC physical abilities and 6MWT were frequently discordant, with increased 6MWT for 7/11 "GRC non-improvers" and decreased 6MWT for 7/21 "GRC improvers".

CONCLUSIONS

Amongst this cohort, change in physical ability may or may not be reflected by self-reported change. Objective tests of physical ability are recommended for people attending pain services, and validated tests should align with intervention aims.

The minimal clinically important difference in the treadmill six-minute walk test in active women with breast cancer during and after oncological treatments

PURPOSE

To examine the minimal clinically important difference (MCID) in the treadmill 6-minute walk test (6MWT) in women with breast cancer.

MATERIALS AND METHODS

A secondary analysis of cross-sectional data from 112 women who were undergoing chemotherapy or had undergone anticancer treatment was conducted. Participants completed the 6MWT on a treadmill and the European Organization for Research and Treatment of Cancer Questionnaire (EORTC-QLQ-C30) twice, eight weeks apart. Change in the physical function domain of the EORTC-QLQ-C30 was used to classify the "positive change" subgroup (≥5 points difference) and the "unchanged" subgroup (<5 points difference). This was combined with the distance difference from the 6MWTs, determining the MCID as the cut-off from the area under the receiver operating characteristic (AUROC) curve (anchor-based determination). The MCID was also determined from (1) the effect size and (2) the difference in standard error (SEM) of the results of the first and second 6MWT (distribution-based determination).

RESULTS

The MCIDs in the during-chemotherapy group was 66.5 and 41.5 m and those in the after-treatment group to be 41.4 and 40.5 m (SEM and effect size based respectively).

CONCLUSIONS

The MCID in the treadmill 6MWT distance could be used to interpret changes in the physical health status of women with breast cancer.IMPLICATIONS FOR REHABILITATIONThe MCID for the 6MWT on treadmill in active women with breast cancer is of approximately 54 m during chemotherapy, and 41.6 m after treatment.The MCID on treadmill 6MWT distance could be used to interpret a decline in the physical health status of women with breast cancer.The 6MWT on treadmill could be an easy, feasible, performed under controlled conditions, alternative to the 6MWT to obtain valuable information in this population.

Translating Outcomes from the Clinical Setting to Preclinical Models: Chronic Pain and Functionality in Chronic Musculoskeletal Pain

Fibromyalgia (FM) is a chronic pain disorder characterized by chronic widespread musculoskeletal pain (CWP), resting pain, movement-evoked pain (MEP), and other somatic symptoms that interfere with daily functioning and quality of life. In clinical studies, this symptomology is assessed, while preclinical models of CWP are limited to nociceptive assays. The aim of the study was to investigate the human-to-model translatability of clinical behavioral assessments for spontaneous (or resting) pain and MEP in a preclinical model of CWP. For preclinical measures, the acidic saline model of FM was used to induce widespread muscle pain in adult female mice. Two intramuscular injections of acidic or neutral pH saline were administered following baseline measures, 5 days apart. An array of adapted evoked and spontaneous pain measures and functional assays were assessed for 3 weeks. A novel paradigm for MEP assessment showed increased spontaneous pain following activity. For clinical measures, resting and movement-evoked pain and function were assessed in adult women with FM. Moreover, we assessed correlations between the preclinical model of CWP and in women with fibromyalgia to examine whether similar relationships between pain assays that comprise resting and MEP existed in both settings. For both preclinical and clinical outcomes, MEP was significantly associated with mechanical pain sensitivity. Preclinically, it is imperative to expand how the field assesses spontaneous pain and MEP when studying multi-symptom disorders like FM. Targeted pain assessments to match those performed clinically is an important aspect of improving preclinical to clinical translatability of animal models.

Pregabalin administration in patients with fibromyalgia: a Bayesian network meta-analysis

Several studies investigated the effectiveness and the safety of different doses of pregabalin in fibromyalgia. However, the optimal protocol remains controversial. A Bayesian network meta-analysis comparing 300, 450, and 600 mg/daily of pregabalin for fibromyalgia was conducted. The literature search was conducted in January 2022. All the double-blind randomised clinical trials comparing two or more dose protocols of pregabalin for fibromyalgia were accessed. Studies enrolling less than 50 patients were not eligible, nor were those with a length of follow-up shorter than eight weeks. The outcomes of interests were: Fibromyalgia Impact Questionnaire (FIQ), sleep quality, and adverse events. The network meta-analyses were performed using the routine for Bayesian hierarchical random-effects model analysis, with log odd ratio (LOR) and standardized mean difference (SMD) effect measure. Data from 4693 patients (mean age 48.5 years) were retrieved. 93.1% (4370 of 4693 patients) were women. The median follow-up was 14.8 weeks. Pregabalin 450 mg/daily resulted in greater reduction in Fibromyalgia Impact Questionnaire (SMD - 1.83). Pregabalin 600 demonstrated the greatest sleep quality (SMD 0.15). Pregabalin 300 mg/daily evidenced the lowest rate of adverse events (LOR 0.12). The dose of pregabalin must be customised according to patients' characteristics and main symptoms.

Individuals with fibromyalgia have a different gait pattern and a reduced walk functional capacity: a systematic review with meta-analysis

Background

The aim of the present study was to perform a systematic review and meta-analysis comparing walking test performance and gait pattern between individuals with and without fibromyalgia (FM).

Methodology

This systematic review was registered in PROSPERO with the following reference: CRD42018116200.The search for the scientific articles in this systematic review was carried out using the MEDLINE, SCOPUS, PEDRO, CINHAL and WEB OF SCIENCE databases. A combination of three conceptual groups of terms was used: (1) fibromyalgia; (2) walk (performance) tests; and (3) gait analysis. The included articles were analyzed for both functional and pattern of walking data of patients with FM. In order to provide a better estimate of the difference between individuals with and without FM on gait, a meta-analysis was performed on the 6MWT (6-minute walk test).

Results

Thirty-six studies were analyzed, with a total population of 4.078 participants (3.369 FM and 709 individuals without FM). From a functional point of view, the 6MWT distance covered by the group of individuals without FM was significantly greater than that of the individuals with FM in all the analyzed studies. In addition, when comparing the results obtained in the gait pattern analysis, it was observed that individuals with FM walked slower, with a shorter stride length and lower cadence compare to individuals without FM.

Conclusions

It is possible to affirm that individuals with FM perform walking tests differently than individuals without FM. It was observed that individuals with FM walk performing a cycle of shorter length and lower frequency, producing a slower gait, which results in a shorter distance traveled, in the same period of time, with respect to healthy subjects.

IL-5 mediates monocyte phenotype and pain outcomes in fibromyalgia

ABSTRACT

Fibromyalgia (FM) is characterized by widespread chronic pain, fatigue, and somatic symptoms. The influence of phenotypic changes in monocytes on symptoms associated with FM is not fully understood. The primary aim of this study was to take a comprehensive whole-body to molecular approach in characterizing relationships between monocyte phenotype and FM symptoms in relevant clinical populations. Lipopolysaccharide-evoked and spontaneous secretion of IL-5 and other select cytokines from circulating monocytes was higher in women with FM compared to women without pain. In addition, greater secretion of IL-5 was significantly associated with pain and other clinically relevant psychological and somatic symptoms of FM. Furthermore, higher levels of pain and pain-related symptoms were associated with a lower percentage of intermediate monocytes (CD14++/CD16+) and a greater percentage of nonclassical monocytes (CD14+/CD16++) in women with FM. Based on findings from individuals with FM, we examined the role of IL-5, an atypical cytokine secreted from monocytes, in an animal model of widespread muscle pain. Results from the animal model show that IL-5 produces analgesia and polarizes monocytes toward an anti-inflammatory phenotype (CD206+). Taken together, our data suggest that monocyte phenotype and their cytokine profiles are associated with pain-related symptoms in individuals with FM. Furthermore, our data show that IL-5 has a potential role in analgesia in an animal model of FM. Thus, targeting anti-inflammatory cytokines such as IL-5 secreted by circulating leukocytes could serve as a promising intervention to control pain and other somatic symptoms associated with FM.

Graded exercise therapy does not restore the ability to work in ME/CFS - Rethinking of a Cochrane review

BACKGROUND

Cochrane recently amended its exercise review for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) in response to an official complaint.

OBJECTIVE

To determine if the amended review has addressed the concerns raised about the previous review and if exercise is an effective treatment that restores the ability to work in ME/CFS.

METHOD

The authors reviewed the amended Cochrane exercise review and the eight trials in it by paying particular interest to the objective outcomes. We also summarised the recently published review of work rehabilitation and medical retirement for ME/CFS.

RESULTS

The Cochrane review concluded that graded exercise therapy (GET) improves fatigue at the end of treatment compared to no-treatment. However, the review did not consider the unreliability of subjective outcomes in non-blinded trials, the objective outcomes which showed that GET is not effective, or the serious flaws of the studies included in the review. These flaws included badly matched control groups, relying on an unreliable fatigue instrument as primary outcome, outcome switching, p-hacking, ignoring evidence of harms, etc. The review did also not take into account that GET does not restore the ability to work.

CONCLUSION

GET not only fails to objectively improve function significantly or to restore the ability to work, but it is also detrimental to the health of≥50% of patients, according to a multitude of patient surveys. Consequently, it should not be recommended.

The effects of a group exercise and education programme on symptoms and physical fitness in patients with fibromyalgia: a prospective observational cohort study

PURPOSE

Given the limited attention on a combined exercise and education approach for those with chronic musculoskeletal pain disorder such as fibromyalgia, the purpose of this was to evaluate the efficacy of a combined exercise and education programme on symptoms and physical fitness in participants with fibromyalgia.

MATERIALS AND METHODS

Using a prospective observational cohort study, participants with fibromyalgia (n = 75) volunteered. The 6-minute-walk-test (6MWT) and revised-fibromyalgia-impact-questionnaire (FIQR) were used before, after (6 weeks) and 6-months post an exercise and education programme.

RESULTS

Forty-three participants (age = 49.7 ± 15.2 y) completed the 6-week programme, with improvements observed for the 6MWT (67 m, p < 0.001) and FIQR (11 AU, p < 0.001), though only two (6MWT) and five (FIQR) participants, respectively, achieved the minimal clinically important difference (MCID). Using 74% of the intial sample, a small-to-moderate improvement in scores were observed across the 6-month period for the 6MWT (37 m, p = 0.002) and FIQR (3 AU, p = 0.01), with only two participants achieving the MCID for the 6MWT.

CONCLUSIONS

The results in this study indiciate small-to-moderate improvements in the 6MWT and FIQR after a combined exercise and education programme, with direct delivery being more effective.Implications for rehabilitationA six-week exercise and education programme elicited moderate, short-term (6 weeks) benefits on physical fitness and key symptoms in patients with fibromyalgia.On average, these benefits were sustained in the long-term (6 months) following the programme but were small-to-moderate and lower than the MCID.Regular follow-up may be required to improve adherence to the education and exercise programme and maintain or increase the observed improvements in 6MWT and FIQR.

"WALK30X5": a feasibility study of a physiotherapy walking programme for people with mild to moderate musculoskeletal conditions

OBJECTIVES

To explore the feasibility of delivering and evaluating a web-based walking intervention for people with long term musculoskeletal conditions (LTMCs), to determine its acceptability and the feasibility of conducting a definitive trial.

DESIGN

Prospective randomised feasibility study, with blind outcome assessment at baseline, 3 and 6 months.

SETTING

Hospital based physiotherapy service.

PARTICIPANTS

Forty one adults referred for assessment and advice for any mild/moderate LTMCs. doing <120minutes of moderate intensity activity per week.

INTERVENTIONS

Participants randomised to: 1. Usual care: one usual physiotherapy advice and assessment session, including setting a physical activity goal and one follow up session (8 weeks). 2. "Walk30×5": session one, usual care plus intervention of walking programme. Participants were shown the website and podcasts and practiced how to use them. One follow up session (8 weeks).

OUTCOME MEASURES

Primary: timed six minute walk test (T6MWT). Secondary: step count, self-reported pain, fatigue, mood, self-efficacy, happiness, objective blood pressure, peak expiratory flow rate, and self-report and accelerometer measured physical activity.

RESULTS

Recruitment target achieved. No adverse events occurred. Adherence was high and the intervention acceptable. Loss to follow up n=3 (7%) at 3 months, n=8 (20%) at 6 months. T6MWT and step count proved suitable outcomes, unlike accelerometry. Estimated sample size for a definitive trial is 216.

CONCLUSIONS

"Walk30×5" is ready for evaluation in a future, appropriately powered (n=216), phase III trial. If effective, the intervention will provide a cheap, highly accessible intervention to enable people with mild/moderate LTMCs to achieve UK physical activity guidelines.

CLINICAL TRIAL REGISTRATION NUMBER

ISRCTN78581097.