eHealth interventions to support self-management: Perceptions and experiences of people with musculoskeletal disorders and physiotherapists - 'eHealth: It's TIME': A qualitative study

BACKGROUND

There is increasing interest in the potential role of eHealth interventions to support self-management in people with musculoskeletal disorders (MSDs). The COVID-19 pandemic appears to have been a significant catalyst for the implementation of eHealth modalities into routine practice, providing a unique opportunity for real-world evaluation of this underutilized method of delivering physiotherapy.

OBJECTIVE

To explore the perceptions of eHealth-mediated supported self-management from the perspective of people with MSDs and physiotherapists who work in this clinical area.

METHODS

A qualitative interpretive descriptive approach was used. Semi-structured telephone interviews with 13 musculoskeletal physiotherapists and 13 people with musculoskeletal disorders were undertaken. Transcripts were analyzed using reflexive thematic analysis.

RESULTS

Three main themes were identified: 1) Flexibility within a blended care model; 2) eHealth as a facilitator of self-management support; and 3) Technology: Getting it right. Participants expressed concerns about assessment and diagnosis, establishing a therapeutic relationship and felt eHealth should be reserved for follow-up purposes. There was a consistent view expressed that eHealth could facilitate aspects of self-management support. A lack of resources and suboptimal user experience remains a challenge.

CONCLUSIONS

eHealth-mediated self-management support interventions were broadly acceptably, predominately as a follow-up option.

Can social prescribing put the 'social' into the biopsychosocial management of people with long-term musculoskeletal disorders?

BACKGROUND

Chronic musculoskeletal disorders (MSD) are a significant burden on individuals' quality of life and society and are made more complex by the presence of multimorbidity. It is recommended that interventions targeting MSD be sustainable, equitable and incorporate the biopsychosocial model of care (BPS).

AIMS

A criticism of the BPS approach is that the social component of this model is not addressed adequately during the management of people with long-term MSD and that a gap exists between theory and implementation. The use of social prescribing (SP) as an intervention to bridge this gap is discussed.

RESULTS AND DISCUSSION

Social prescribing is a holistic non-medical person-centered approach to well-being that utilizes link workers (LW) to support individuals with long-term conditions (LTC) in the community. Social prescribing referrals are received from primary healthcare practitioners to LW and range from light touch signposting for employment or financial advice to more intensive support for LTC such as obesity, decreased physical activity and mental health needs.

CONCLUSION

There is evidence to suggest that SP interventions are effective in the management of LTC; however, due to the paucity of high-quality evidence, it is difficult to be conclusive. Large-scale randomised controlled trials are recommended to support the use of SP interventions in the management of LTC.

The impact of fatigue on people with Fibromyalgia Syndrome: A survey

INTRODUCTION

Fibromyalgia syndrome (FMS) is a common pain syndrome associated with fatigue and anxiety. The aim of this survey was to determine the impact of fatigue on the quality of life (QoL) of people with FMS and to explore the relationships between fatigue, pain, and anxiety.

METHODS

A postal survey was conducted among support groups. Demographic data were collected and participants were asked to complete the Multi-dimensional Assessment of Fatigue Scale (MAF) and two visual analog scales (VAS) measuring pain and anxiety. Data were analysed using descriptive statistics, and relationships between variables were explored using Pearson's correlation coefficient and Fisher's Exact Probability Test. Ethical approval was granted from Ulster University's research ethics committee.

RESULTS

A response rate of 52.5% was achieved (105/200). Fatigue was found to severely impact the QoL of those with FMS. From the MAF, a mean Global Fatigue Index score of 40.7 (range 1 = no fatigue-50 = severe fatigue) was calculated. Fatigue was significantly associated with both pain (r = 0.674) and anxiety (r = 0.546) (both p values < 0.0001), and no significant relationship was found between the duration of FMS and fatigue (r = 0.106; p = 0.320).

CONCLUSION

Fatigue has a major impact on the QoL of patients with FMS. There is a strong relationship between fatigue and other variables such as pain and anxiety. However, there is no relationship between the time since diagnosis and fatigue experienced. Fatigue management should feature highly in any treatment programme for those with FMS.

Behaviour change interventions for physical activity in adults with chronic obstructive pulmonary disease; A systematic review and meta-analysis

BACKGROUND

Physical activity in adults with COPD is poor, but behaviour change interventions could help improve activity. This systematic review aims to examine behaviour change interventions to promote physical activity and health outcomes for adults with COPD.

METHODS

Eight databases were searched from inception until April 2023: Web of Science, CENTRAL, MEDLINE, EMBASE, APA PsychINFO, CINAHL, PROSPERO, Cochrane Airways Trials Register. Relevant studies were appraised to determine the impact of behaviour change interventions on physical activity outcomes. Interventions were mapped to Michie's Theoretical Domains Framework (TDF) and a meta-analysis and narrative synthesis conducted. The Cochrane risk of bias tool 2 and the GRADE criteria evaluated bias and the quality and certainty of the evidence.

RESULTS

Twelve randomized controlled trials (RCTs) were included in the review (n = 1211). The most frequently utilized behaviour change interventions included counselling, stepcount monitoring, social support and goal setting. The most commonly measured outcomes across studies were steps-per-day, physical activity levels, exercise capacity and quality of life. A meta-analysis of comparable studies demonstrated there was no difference in stepcount in favour of behaviour change interventions with respect to steps-per-day (SMD 0.16, 95 % CI -0.03, 0.36; p = 0.10). There was some evidence of short-term improvement in physical activity and quality of life, with behaviour change interventions related to goals, behaviour regulation and social influences.

CONCLUSIONS

People with COPD may benefit from behaviour change interventions to increase physical activity and quality of life in the short-term. The overall certainty and quality of the evidence is low.

Experience and perceptions of Social Prescribing interventions; a qualitative study with people with long-term conditions, link workers and health care providers

Background

Long-term conditions (LTC) are a leading cause of reduced quality of life and early mortality. People with LTC are living longer with increasing economic and social needs. Novel patient centred care pathways are required to support traditional medical management of these patients. Social Prescribing (SP) has gained popularity as a non-medical approach to support patients with LTC and their unmet health needs. The current focus group study aims to explore the experiences and perceptions to SP interventions from the perspective of people with long-term conditions, link workers, healthcare providers and community-based services.

Methods

Six-eight participants will be recruited into three specific 60-minute focus groups relative to their role as a patient, link worker and community-based service. Eight-12 participants with a Health care provider and GP background will be interviewed individually online. The participants within these focus groups and semi-structured interviews will be invited to provide opinions on what factors they think are important to the successful implementation of a SP service from their respective stakeholder positions. The data will be recorded and exported to NVivo software for further analysis using Thematic Reflexive analysis methods. Coded categorical data will inform emerging themes from which a narrative summary will be consolidated and presented for dissemination.

Conclusion

The conclusions made from this study will help inform the next study, which will aim to develop a pilot SP service for patients with long-term musculoskeletal conditions as part of an overall larger project.

Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders - 'eHealth: It's TIME': a study protocol

Background: Musculoskeletal disorders (MSDs) are a leading cause of global morbidity, with the burden expected to increase in the near future. Self-management, with the support of healthcare professionals, is recommended for many MSDs. However, frequent clinical contact is not feasible. Previous research has highlighted the need for a co-designed eHealth-mediated self-management follow-up support intervention which integrates remote monitoring and behavioural change. Thus, the current study aims to develop and design a user-centred, eHealth-mediated self-management support prototype for people with MSDs. Methods: A three-step, iterative system development cycle will be utilised to develop and design the "eHealth: It's TIME prototype". The three-step process will include creating website features and content using two sequential focus groups with people with MSDs (n = 6 - 8); heuristic testing using the 10 heuristic principles of Nielsen (n = 5); and usability testing through in-person 60-minute interviews with people with MSDs (n = 3 - 5) and musculoskeletal physiotherapists (n = 3 - 5). Conclusion: The eHealth: It's TIME prototype will be a systematically developed, follow-up self-management support intervention guided by behavioural change theory and the preferences of end users.

Proof of concept of prehabilitation: a combination of education and behavioural change, to promote physical activity in people with fibromyalgia

OBJECTIVES

To establish proof of concept of a prehabilitation intervention, a combination of education and behavioural change, preceding a physical activity programme in people with fibromyalgia (FM).

SETTINGS

Open-label, feasibility clinical trial.

PARTICIPANTS

Eleven people with FM (10 women).

INTERVENTIONS

The prehabilitation intervention consisted of 4 weeks, 1 weekly session (~1 to 1.5 hours), aimed to increase self-efficacy and understand why and how to engage in a gentle and self-paced physical activity programme (6 weeks of walking with telephone support).

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome was the acceptability and credibility of the intervention by means of the Credibility/Expectancy Questionnaire. Secondary outcomes comprised scales to measure FM severity, specific symptoms and sedentary behaviour. An exit interview was conducted to identify the strengths and weaknesses and barriers to the intervention.

RESULTS

One participant dropped out due to finding the walking programme excessively stressful. Participants expected the intervention would improve their symptoms by 22%-38% but resulted in 5%-26% improvements. Participants would be confident in recommending this intervention to a friend who experiences similar problems. The interviews suggested that the fluctuation of symptoms should be considered as an outcome and that the prehabilitation intervention should accomodate these fluctuation. Additional suggestions were to incorporate initial interviews (patient-centred approach), to tailor the programmes to individuals' priorities and to offer a variety of physical activity programmes to improve motivation.

CONCLUSIONS

This feasibility study demonstrated that our novel approach is acceptable to people with FM. Future interventions should pay attention to flexibility, symptoms fluctuation and patients support.

TRIAL REGISTRATION NUMBER

NCT03764397.

Musculoskeletal Pain: Current and Future Directions of Physical Therapy Practice

Musculoskeletal (MSK) pain is 1 of the most common problems managed by clinicians in MSK care. This article reviews current frameworks for the assessment and management of MSK pain within evidence-based physical therapy practice. Key considerations related to the biopsychosocial model of pain, evidence-based practice, assessment, treatment, physical activity/movement behavior, risk stratification, communication as well as patient education and self-management skills within physical therapy and physical and rehabilitation medicine are addressed. The future direction of MSK pain management is also discussed, including strategies to promote evidence-based practice, behavior change, social prescribing, and the use of technologies.

The effects of intradialytic exercise on sarcopenia-related muscle and strength loss in patients with end-stage renal disease: A systematic review of randomized controlled trials

Objective

To evaluate the effects of intradialytic exercise (IDE) (exercise performed during dialysis) on sarcopenia and quality of life (QoL) in patients with end-stage renal disease (ESRD).

Data Sources

A comprehensive search of 7 electronic databases was performed to identify randomized controlled trials measuring the effects of IDE in adults with ESRD. Searches were limited to the English language.

Study Selection

Included studies were randomized controlled trials that measured the effects of IDE in adults with ESRD. Comparator groups received usual care or low-intensity sham interventions. Outcomes of interest were muscle mass, strength, physical function, and QoL. Papers were independently screened for eligibility by 2 authors, and any discrepancies resolved by a third author.

Data Extraction

One author extracted the data from the included studies. Data were compared and discussed across the team members. Two authors independently assessed risk of bias using the Cochrane Risk of Bias 2 tool. Quality was assessed using the van Tulder scale and a narrative synthesis was conducted. Best evidence synthesis was used to structure the reviews findings.

Data Synthesis

Fourteen studies were included in this review (n=837). While risk of bias was found high in 11 studies, demonstrating mainly selection, performance, and detection bias, the best evidence synthesis indicated strong evidence of resistance training improving muscle mass (16%-4.2%) and strength (45%-18%), and moderate evidence of combined exercise improving strength (37%), and various physical function scores.

Conclusions

Overall, there is strong evidence of resistance exercise, with moderate evidence of combined exercise, improving sarcopenia-related muscle and strength loss, and QoL in end-stage kidney disease. Adequately powered, good quality studies are required to determine the optimal exercise prescription to maximize outcomes.

Physiotherapist beliefs and perspectives on virtual reality supported rehabilitation for the management of musculoskeletal shoulder pain: A focus group study

BACKGROUND

Virtual Reality (VR) is an immersive computer-generated environment that provides a multi-sensory experience for the user. Modern technology allows the user to explore and interact with the virtual environment, offering opportunities for rehabilitation. The use of immersive VR in the management of musculoskeletal shoulder pain is relatively new and research is required to demonstrate its feasibility and effectiveness in this field.

AIM

The aims of this study were, firstly, to explore physiotherapists' beliefs and perspectives of immersive VR as a platform for rehabilitation in patients with musculoskeletal shoulder pain, secondly, to identify potential barriers and facilitators to using VR in a musculoskeletal setting and thirdly, to gain insight from clinicians that would inform the development of a VR intervention for the rehabilitation of musculoskeletal shoulder pain.

METHODS

This study used qualitative descriptive design methodology. A series of three focus group interviews were carried out, via Microsoft Teams. Physiotherapists received an Oculus Quest™ headset to use at home prior to the focus group interviews. A six-phase process of reflexive thematic analysis was carried out to identify themes within the data. Atlas Ti Qualitative Data Analysis software was used to facilitate thematic analysis.

RESULTS

Five themes were identified within the data. They reflected physiotherapists beliefs that VR provides novel opportunities for shoulder rehabilitation and may offer new avenues for managing movement-related fear and improving concordance with rehabilitation. However, barriers related to safety and practical considerations associated with using VR were also identified in the final themes.

CONCLUSION

These findings provide valuable insight into clinician acceptability of immersive VR as a platform for rehabilitation and the need for further research to answer the questions posed by physiotherapists in the current study. This research will contribute to human-centered design of VR-supported interventions for managing musculoskeletal shoulder pain.

The effectiveness of group and home-based exercise on psychological status in people with ankylosing spondylitis: A systematic review and meta-analysis

INTRODUCTION

Ankylosing spondylitis (AS) is an inflammatory rheumatic disease in which the physical impact has been evaluated; however, the psychological consequences are less well explored. The primary aim of this review was to determine the effectiveness of group versus home-based exercises on psychological status of patients with AS.

METHODS

Six databases were searched until January 2020. Eligible studies were randomised controlled trials including group or home-based exercise interventions. Risk of bias (RoB) was evaluated using the Cochrane RoB 2.0 tool. Relative percentage difference (RPD) between groups and effect sizes were presented as standardised mean differences (SMDs) with 95% confidence intervals (CI).

RESULTS

Five studies met the inclusion criteria (n = 240), outcomes of interest were depression, anxiety and mental health. Three studies were low-risk RoB, one study was high-risk RoB and one study there was 'some concerns' of bias. Group-based exercise was more effective than home-based exercise for improving depression at 6-week (RPD 18%) and 3-month (RPD 42%), anxiety (RPD 17%) and mental health (RPD 20%). Home-based exercise was more effective than control interventions for improving depression (RPD 33%). A meta-analysis demonstrated group-based exercises compared to home exercises, improved depression (SMD: -0.54; 95% CI: [-0.89; -0.18]; p = 0.003) and physical function (SMD: -0.49; 95% CI: [-0.84; -0.14]; p = 0.006).

CONCLUSION

Supervised group-based demonstrated improvements in depression, anxiety and mental health compared to home-based exercise. Individualised home-based exercise is more effective than no intervention for improving depression in people with AS.

Design and development of an eHealth intervention to support self-Management in people with musculoskeletal Disorders - ‘eHealth: It’s TIME’: a study protocol

Background: Musculoskeletal disorders (MSDs) are a leading cause of global morbidity, with the burden expected to increase in the near future. Self-management, with the support of healthcare professionals, is recommended for many MSDs. However, frequent clinical contact is not feasible. Previous research has highlighted the need for a co-designed eHealth-mediated self-management follow-up support intervention which integrates remote monitoring and behavioural change. Thus, the current study aims to develop and design a user-centred, eHealth-mediated self-management support prototype for people with MSDs. Methods: A three-step, iterative system development cycle will be utilised to develop and design the “eHealth: It’s TIME prototype”. The three-step process will include creating website features and content using two sequential focus groups with people with MSDs (n = 6 – 8); heuristic testing using the 10 heuristic principles of Nielsen (n = 5); and usability testing through in-person 60-minute interviews with people with MSDs (n = 3 – 5) and musculoskeletal physiotherapists (n = 3 – 5). Conclusion: The eHealth: It’s TIME prototype will be a systematically developed, follow-up self-management support intervention guided by behavioural change theory and the preferences of end users.

18 EDUCATION AND TRAINING TO SUPPORT PHYSIOTHERAPISTS WORKING IN DEMENTIA CARE: A SCOPING REVIEW

Background

Physical impairments associated with dementia include loss of mobility, diminished postural control and reduced muscle strength, which in turn can lead to an increase in falls, hip fractures and frailty. Physiotherapy can play a key role in many aspects of dementia care. Physiotherapists have reported carrying a high caseload of people with dementia. However, there is a paucity of evidence as to what constitutes effective dementia education and training for physiotherapists. The aim of this scoping review was to explore and map the evidence relating to education and training for physiotherapists, with a view to using these findings to inform the design and delivery of an educational program for physiotherapists.

Methods

This scoping review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. The protocol for this review was published in March 2021. This review included studies that examined dementia education and training for the wider healthcare team if physiotherapy was an included profession. All studies with a focus on any aspect of physiotherapy dementia education and training were included. Studies conducted in any setting, including acute, community care and residential or any educational setting were included. A chronological narrative synthesis of the data outlined how the results relate to the objectives of this study.

Results

A total of eleven papers were included. The principal learning outcomes evaluated were knowledge, confidence and attitudes. Immediate post intervention scores showed an improvement in all three outcomes. Most educational interventions reached Kirkpatrick level 2, which evaluates learning. A multi-modal approach, with active participation and direct patient involvement seems to enhance learning.

Conclusion

Allowing for the heterogeneity of intervention design and evaluation, some common components of educational interventions were identified that led to positive outcomes. This review highlights the need for more robust studies in this area. Further research is needed to develop bespoke dementia curricula specific to physiotherapy.

The epidemiology of back injuries in elite Gaelic football athletes: An 8-year prospective study

OBJECTIVES

To describe the epidemiology of back injury in elite male Gaelic football athletes between 2008 and 2016.

DESIGN

Prospective cohort study.

SETTING

Injury data from the National GAA Injury Surveillance Database.

PARTICIPANTS

Elite male Gaelic football athletes.

MAIN OUTCOME MEASURES

Incidence of injury as a rate per 1000 h of exposure.

RESULTS

38 datasets were analysed. Out of a total of 1606 time-loss injuries, 76 were back injuries (4.73%, 95% CI 3.80%-5.88%). The incidence of back injuries in match play was 1.72 (CI 95% 1.21 to 2.45) and in training was 0.2 (CI 95% 0.14 to 0.28) injuries per 1000 h of exposure. The majority of back injuries (63.16%, CI 95% 51.93-73.12) were new, as opposed to recurrent (35.53% CI 95% 25.7-46.74). Most back injuries were acute (51.32%, CI 95% 40.29-62.22), compared to chronic (31.58%, CI 95% 22.23-42.7) or overuse (11.84%, CI 95% 6.36-21.00). The majority of back injuries occurred during non-contact player activities (n = 60, 78.94% CI 95% 68.50-86.60).

CONCLUSIONS

Back injury rates in Gaelic football are similar to soccer and Australian football but less than rugby union. Further research is needed to understand the factors leading to the onset and recurrence of back injury in Gaelic football athletes.

International, multi-disciplinary, cross-section study of pain knowledge and attitudes in nursing, midwifery and allied health professions students

BACKGROUND

Persistent pain is a highly prevalent, global cause of disability. Research suggests that many healthcare professionals are not well equipped to manage pain, and this may be attributable at least in part to undergraduate education. The primary aim of this study was to quantify and compare first and final year nursing, midwifery and allied health professional (NMAHP) students' pain related knowledge and attitudes. The secondary aim was to explore what factors influence students' pain related knowledge and attitudes.

METHODS

In this cross-sectional study, 1154 first and final year healthcare students, from 12 universities in five different countries completed the Revised Neurophysiology of Pain Quiz (RNPQ) [knowledge] and the Health Care Providers Pain and Impairment Relationship Scale (HC-PAIRS) [attitudes].

RESULTS

Physiotherapy was the only student group with statistically and clinically improved pain related knowledge [mean difference, 95% CI] (3.4, 3.0 to 3.9, p = 0.01) and attitudes (-17.2, -19.2 to 15.2, p = 0.01) between first and final year. Pain education teaching varied considerably from course to course (0 to 40 h), with greater levels of pain related knowledge and attitudes associated with higher volumes of pain specific teaching.

CONCLUSIONS

There was little difference in pain knowledge and attitudes between all first and final year NMAHP students other than physiotherapy. This suggests that for most NMAHP disciplines, undergraduate teaching has little or no impact on students' understanding of pain. There is an urgent need to enhance pain education provision at the undergraduate level in NMAHPs.

TRIAL REGISTRATION

The study protocol was prospectively registered at ClinicalTrials.Gov NCT03522857 .

Barriers and facilitators related to self-management of shoulder pain: a systematic review and qualitative synthesis

OBJECTIVE

The objective of this review was to identify barriers and facilitators related to self-management from the perspectives of people with shoulder pain and clinicians involved in their care.

DATA SOURCES

CINAHL, MEDLINE, PsycINFO, SPORTDiscus, Embase, ProQuest Health, Web of Science, and Scopus were searched from inception to March 2022.

REVIEW METHODS

A meta-aggregative approach to the synthesis of qualitative evidence was used. Two independent reviewers identified eligible articles, extracted the data, and conducted a critical appraisal. Two reviewers independently identified and developed categories, with validation by two further researchers. Categories were discussed among the wider research team and a comprehensive set of synthesized findings was derived.

RESULTS

Twenty studies were included. From the perspective of patients, three synthesized findings were identified that influenced self-management: (1) support for self-management, including subthemes related to patient-centred support, knowledge, time, access to equipment, and patient digital literacy; (2) personal factors, including patient beliefs, patient expectations, patient motivation, pain, and therapeutic response; and (3) external factors, including influence of the clinician and therapeutic approach. From the perspective of clinicians, two synthesized findings were identified that influenced self-management: (1) support for self-management, including education, patient-centred support, patient empowerment, time, and clinician digital literacy; and (2) preferred management approach, including clinician beliefs, expectations, motivation, therapeutic approach, and therapeutic response.

CONCLUSION

The key barriers and facilitators were patient-centred support, patient beliefs, clinician beliefs, pain, and therapeutic response. Most of the included studies focused on exercise-based rehabilitation, and therefore might not fully represent barriers and facilitators to broader self-management.

Rating the Quality of Smartphone Apps Related to Shoulder Pain: Systematic Search and Evaluation Using the Mobile App Rating Scale

Background

The successful rehabilitation of musculoskeletal pain requires more than medical input alone. Conservative treatment, including physiotherapy and exercise therapy, can be an effective way of decreasing pain associated with musculoskeletal pain. However, face-to-face appointments are currently not feasible. New mobile technologies, such as mobile health technologies in the form of an app for smartphones, can be a solution to this problem. In many cases, these apps are not backed by scientific literature. Therefore, it is important that they are reviewed and quality assessed.

Objective

The aim is to evaluate and measure the quality of apps related to shoulder pain by using the Mobile App Rating Scale.

Methods

This study included 25 free and paid apps—8 from the Apple Store and 17 from the Google Play Store. A total of 5 reviewers were involved in the evaluation process. A descriptive analysis of the Mobile App Rating Scale results provided a general overview of the quality of the apps.

Results

Overall, app quality was generally low, with an average star rating of 1.97 out of 5. The best scores were in the “Functionality” and “Aesthetics” sections, and apps were scored poorer in the “Engagement” and “Information” sections. The apps were also rated poorly in the “Subjective Quality” section.

Conclusions

In general, the apps were well built technically and were aesthetically pleasing. However, the apps failed to provide quality information to users, which resulted in a lack of engagement. Most of the apps were not backed by scientific literature (24/25, 96%), and those that contained scientific references were vastly out-of-date. Future apps would need to address these concerns while taking simple measures to ensure quality control.

Behaviour change and physical activity interventions for physical activity engagement in community dwelling adults with chronic obstructive pulmonary disease: protocol for a systematic review

Background: Chronic obstructive pulmonary disease (COPD) is a complex respiratory disease and the third leading cause of death worldwide. Pulmonary rehabilitation is recognised as the gold standard of care in the management of COPD, however engagement with pulmonary rehabilitation is low and maintenance of a physically active lifestyle in community dwelling adults with COPD is poor. Supporting positive behaviour change in people with COPD could help to increase their engagement with physical activity. This systematic review will examine behaviour change and physical activity interventions delivered to community dwelling adults with COPD with the aim of increasing physical activity engagement. Interventions will be mapped against Michie’s theoretical domains framework (TDF) to inform clinical practice and health policy.

Methods: The following databases will be searched from inception until December 2021: Web of Science, CENTRAL, MEDLINE (via EBSCO), EMBASE, APA PsychINFO, CINAHL (via EBSCO), AMED, PROSPERO, Cochrane Airways Trials Register. Reference lists of the relevant studies and grey literature will be searched using Grey Literature Report, Open Grey and Google Scholar search engines. Relevant studies will be systematically reviewed and subject to quality appraisal to determine the impact of behaviour change and physical activity interventions on outcomes of community-dwelling adults with COPD. Interventions will be mapped to Michie’s TDF and a narrative synthesis with respect to nature, effectiveness on target population and setting/environment will be provided. Findings will be reported in relation to the generalisability of the primary results and research question, and will include secondary findings on quality of life, self-reported participation in physical activity, exercise capacity, adverse events and intervention adherence. The review will be presented according to the PRISMA guidelines 2020.

Conclusions: This systematic review is necessary to explain the impact of behaviour change and physical activity interventions on outcomes of community dwelling people with COPD.

PROSPERO registration: CRD42021264965 (29.06.2021)

Physiotherapist beliefs and perspectives on virtual reality-supported rehabilitation for the assessment and management of musculoskeletal shoulder pain: a focus group study protocol

Shoulder pain accounts for a large proportion of musculoskeletal disorders and years lived with disability. Musculoskeletal shoulder pain is challenging to manage and while research evidence suggests that exercise should be a cornerstone of shoulder pain rehabilitation, the exact type and dosage of exercise is unclear. Adherence is a barrier to successful outcomes with exercise-based management of musculoskeletal pain, especially for those with co-morbidities, high pain levels and reported boredom associated with competing prescribed exercise. Virtual reality (VR) may offer an effective platform for rehabilitation of musculoskeletal shoulder pain. Virtual Reality has been shown to be effective for management of acute and chronic pain conditions, for delivering education around various health conditions, and for supporting rehabilitation of neurological conditions. Therefore, it is possible that VR may have a role in the delivery of exercise and education for individuals with musculoskeletal shoulder pain. VR intervention design should involve several steps and begin with establishing early acceptability from users as to the suitability of the technology in clinical practice as well as potential barriers and facilitators to using the technology successfully. This study will therefore aim to explore physiotherapists beliefs and perspectives of immersive VR as a platform for assessment and rehabilitation in patients with musculoskeletal shoulder pain. Further, this study will inform the development of a VR intervention for use in the rehabilitation of musculoskeletal shoulder pain. A series of online focus groups will be conducted with physiotherapists in Ireland using a qualitative descriptive approach to data analysis. A six-phase process of data analysis will be carried out to identify important patterns and themes within the data. The current study will be the first to explore clinician's perspectives on the role of VR in musculoskeletal practice.

eHealth Interventions to Support Self-Management in People With Musculoskeletal Disorders, "eHealth: It's TIME"-A Scoping Review

OBJECTIVE

eHealth-mediated interventions have been proposed as one option to support self-management in those with musculoskeletal disorders (MSDs). This scoping review aimed to chart the evidence regarding eHealth modalities, musculoskeletal diagnosis, and outcomes of eHealth-mediated self-management support interventions in persons with MSDs and identify any gaps within the literature.

METHODS

Six electronic databases (MEDLINE, CINAHL, PsycINFO, Embase, Scopus, and the Cochrane Database of Systematic Reviews), 7 grey literature sources (eg, OpenGrey), and reference and citation lists of included studies were searched from database inception to July 2020. Published studies of adult participants with a MSD utilizing an eHealth intervention to support self-management were included. Studies were limited to those published in English. Two reviewers independently screened all studies. Data were extracted by 1 reviewer and reviewed by another reviewer.

RESULTS

After screening 3377 titles and abstracts followed by 176 full texts, 87 studies fulfilled the eligibility criteria. The majority were published in the last 5 years (n = 48; 55%), with almost one-third originating in the United States (n = 28; 32%). The most common eHealth modality type was internet based (n = 22; 35%), with almost one-half (n = 41; 47%) of the included studies involving participants with widespread musculoskeletal symptoms. The most commonly reported outcomes were related to body functions (ie, pain intensity) (n = 67; 45%), closely followed by activities and participation (ie, function) (n = 65; 44%), with environmental factors (ie, health care utilization) the least commonly reported (n = 17; 20%).

CONCLUSIONS

There is considerable variation within the eHealth-mediated self-management support intervention literature. Research is needed on the role of eHealth-mediated self-management support interventions across a broad range of MSDs to guide clinical practice.

IMPACT

This scoping review has identified gaps in the literature relating to specific eHealth modalities, musculoskeletal diagnoses, and health care utilization data, which should guide future research.

Improved Muscle Strength, Muscle Power, and Physical Function After Flywheel Resistance Training in Healthy Older Adults: A Randomized Controlled Trial

ABSTRACT

Sañudo, B, de Hoyo, M, and McVeigh, JG. Improved muscle strength, muscle power, and physical function after flywheel resistance training in healthy older adults: A randomized controlled trial. J Strength Cond Res 36(1): 252-258, 2022-This study aimed to examine whether flywheel resistance exercise training improved muscle strength, muscle power, and physical function in older adults. Thirty-six older adults (64 ± 5 years) were randomly allocated to either a flywheel resistance exercise training group (ETG; n = 18) or a control (CON) group (n = 18). Subjects in the ETG underwent 6 weeks of resistance training on a flywheel squat device (4 sets of 9 maximal repetitions). Isokinetic concentric (60 and 240°·s-1) and eccentric (120°·s-1) knee extension and flexion peak torques and mean power were measured. Physical function was assessed by the 30-second Chair Sit-Stand Test (CST) and walking speed. After the intervention, within-group analyses showed significantly greater flexion torques and mean power with the dominant leg (concentric at 60°·s-1 and 240°·s-1 and eccentric at 120°·s-1; all d > 0.7, p < 0.05) and improvements in CST (d > 0.8) in the ETG, while no substantial differences were found in the CON group. Significant between-group differences in knee flexion torque both concentric (at 60°·s-1: η2 = 0.168 and 240°·s-1: η2 = 0.112) and eccentric (at 120°·s-1: η2 = 0.103) with the dominant leg were also found in favor of the ETG. There was also significantly better performance in the CST for the ETG (η2 = 0.207). There was a significant association between changes in strength and changes in mean power in the ETG. Changes in physical function outcomes were also observed. In conclusion, flywheel resistance exercise training is an appropriate form of activity for improving strength and functional capacity of older adults.

Epidemiology and moderators of injury in Gaelic football: A systematic review and meta-analysis

OBJECTIVES

To quantify the incidence, location and severity of injuries in Gaelic football and to identify potential moderators of those injuries.

DESIGN

Systematic review and meta-analysis.

METHODS

A comprehensive search strategy of six electronic databases was undertaken independently by two researchers in March 2020. Studies must have prospectively investigated injuries sustained by Gaelic footballers over a minimum duration of six months. The Newcastle-Ottawa Scale was used to assess risk of bias. Studies were combined in a pooled analysis using an inverse variance method.

RESULTS

Twelve prospective cohort studies were eligible. The total injury incidence was 10.7 injuries/1000 h of exposure. Match incidence (55.9 injuries/1000 h) was much higher than training (4.6 injuries/1000 h). The lower limb accounted for over 70% of all injuries, with hamstring injuries ranging from 22 to 24% of all injuries. Non-contact injuries were the most common injury mechanism. Players aged >30 were at greatest risk of injury with incidence risk ratios ranging from 1.2 to 2.3. High aerobic fitness and chronic workloads were associated with reduced risk of injury in elite Gaelic footballers.

CONCLUSIONS

Elite Gaelic football athletes are twelve times more likely to get injured during match play compared to training. The lower limb is the most affected body region, and most injuries occur by non-contact mechanisms. Athlete age of greater than 30, poor aerobic fitness and sudden increments in training workload all increase the likelihood of injury. By understanding the incidence and nature of injuries in Gaelic football, targeted injury prevention strategies can be developed and implemented.

Behaviour change and physical activity interventions for physical activity engagement in community dwelling adults with chronic obstructive pulmonary disease: protocol for a systematic review

Background: Chronic obstructive pulmonary disease (COPD) is a complex respiratory disease and the third leading cause of death worldwide. Pulmonary rehabilitation is recognised as the gold standard of care in the management of COPD, however engagement with pulmonary rehabilitation is low and maintenance of a physically active lifestyle in community dwelling adults with COPD is poor. Supporting positive behaviour change in people with COPD could help to increase their engagement with physical activity. This systematic review will examine behaviour change and physical activity interventions delivered to community dwelling adults with COPD with the aim of increasing physical activity engagement. Interventions will be mapped against Michie’s theoretical domains framework (TDF) to inform clinical practice and health policy. Methods: The following databases will be searched from inception until December 2021: Web of Science, CENTRAL, MEDLINE (via EBSCO), EMBASE, APA PsychINFO, CINAHL (via EBSCO), AMED, PROSPERO, Cochrane Airways Trials Register. Reference lists of the relevant studies and grey literature will be searched using Grey Literature Report, Open Grey and Google Scholar search engines. Relevant studies will be systematically reviewed and subject to quality appraisal to determine the impact of behaviour change and physical activity interventions on outcomes of community-dwelling adults with COPD. Interventions will be mapped to Michie’s TDF and a narrative synthesis with respect to nature, effectiveness on target population and setting/environment will be provided. Findings will be reported in relation to the generalisability of the primary results and research question, and will include secondary findings on quality of life, self-reported participation in physical activity, exercise capacity, adverse events and intervention adherence. The review will be presented according to the PRISMA guidelines 2020. Conclusions: This systematic review is necessary to explain the impact of behaviour change and physical activity interventions on outcomes of community dwelling people with COPD. PROSPERO registration: CRD42021264965 (29.06.2021)

An investigation into the use of mHealth in musculoskeletal physiotherapy: Scoping Review (Preprint)

Background

Musculoskeletal physiotherapy provides conservative management for a range of conditions. Currently, there is a lack of engagement with exercise programs because of the lack of supervision and low self-efficacy. The use of mobile health (mHealth) interventions could be a possible solution to this problem, helping promote self-management at home. However, there is little evidence for musculoskeletal physiotherapy on the most effective forms of mHealth.

Objective

The aim of this review is to investigate the literature focusing on the use of mHealth in musculoskeletal physiotherapy and summarize the evidence.

Methods

A scoping review of 6 peer-reviewed databases was conducted in March 2021. No date limits were applied, and only articles written in the English language were selected. A reviewer screened all the articles, followed by 2 additional researchers screening a random sample before data extraction.

Results

Of the 1393 studies, 28 (2.01%) were identified. Intervention characteristics comprised stretching and strengthening exercises, primarily for degenerative joint pain and spinal conditions (5/28, 18%). The most reported use of mHealth included telephone and videoconferencing calls to provide a home exercise program or being used as an adjunct to physiotherapy musculoskeletal assessment (14/28, 50%). Although patient satisfaction with mHealth was reported to be high, reasons for disengagement included a lack of high-quality information and poor internet speeds. Barriers to clinical uptake included insufficient training with the intervention and a lack of time to become familiar.

Conclusions

mHealth has some benefits regarding treatment adherence and can potentially be as effective as normal physiotherapy care while being more cost-effective. The current use of mHealth is most effective when ongoing feedback from a health care professional is available.

Effect of Functional Rehabilitation on Performance of the Star Excursion Balance Test Among Recreational Athletes With Chronic Ankle Instability: A Systematic Review

OBJECTIVE

To determine (1) the effectiveness of rehabilitation for chronic ankle instability as measured by the Star Excursion Balance Test (SEBT) and (2) the relative efficacy and the long-term effects of these rehabilitation interventions.

DATA SOURCES

Ten electronic databases were searched (2009-2019).

STUDY SELECTION

Included articles were randomized controlled trials in English investigating recreational athletes aged ≥18 years with chronic ankle instability. At least 1 functional rehabilitation intervention had to be included and the SEBT test (or the modified version) used as an outcome measure.

DATA EXTRACTION

Two researchers (L.A., O.N.) extracted data regarding participant demographics; intervention characteristics; trial size; and results at baseline, postintervention, and at follow-up, where appropriate.

DATA SYNTHESIS

A systematic review and narrative synthesis was conducted. Methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool and the van Tulder scale. The review was registered with PROSPERO (ID: 164468). Ten studies (n=368), 2 high-quality, 1 moderate-quality, and 7 low-quality, were included in the review. Interventions included balance training, strength training, vibration training, and mixed training. Results suggest that rehabilitation of chronic ankle instability that includes wobble board exercises (average percentage change: 14.3%) and hip strengthening exercises (average percentage change: 12.8%) are most effective. Few studies compared different types of rehabilitation for chronic ankle instability. However, improvements on the SEBT suggest that a rehabilitation program focusing on wobble board training and hip strengthening performed 3 times weekly for 4-6 weeks is the optimal rehabilitation program to improve dynamic postural control in recreational athletes with chronic ankle instability.

CONCLUSIONS

Few studies directly compared different rehabilitation interventions, and there was limited long-term follow-up; therefore, the relative efficacy of different rehabilitation programs remains unclear. However, it seems that rehabilitation of chronic ankle instability should include proprioceptive and strengthening exercises of relatively short duration.

Education and training to support physiotherapists working in dementia care: a scoping review protocol

Background: The care of people with dementia is of global concern. Physiotherapeutic intervention can be of benefit to patients with dementia. Physiotherapists can play a role in assessment, falls prevention, pain management and gait re-education. Dementia care forms a significant part of the workload of a physiotherapist. However, there is a paucity of evidence on what constitutes effective education and training for physiotherapists working in dementia care.

Objective: This scoping review aims to explore and map the evidence on education and training for physiotherapists working in dementia care.

Inclusion criteria: Studies that explore dementia training and/or education for physiotherapists or for multidisciplinary teams, in which physiotherapists have been included. Studies that explore student physiotherapy training will also be considered. Qualitative, quantitative, mixed methods studies, case studies and observational studies will be included.

Methods: This scoping review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews. Databases to be searched as part of this review include: Medline, SocINDEX, CINAHL and, PsycINFO, with no limitation on publication date. Google Scholar and Open-Grey will be searched for grey literature, limited to the first 100 searches. Titles and abstracts will be screened for inclusion and identified full texts reviewed independently by two reviewers. Data will be extracted using a draft data extraction tool based on the JBI data extraction tool. A chronological narrative synthesis of the data will outline how the results relate to the aims and objective of this scoping review.

Fibromyalgia syndrome - a risk factor for poor outcomes following orthopaedic surgery: A systematic review

BACKGROUND

Fibromyalgia (FM) is a complex syndrome incorporating many features associated with poor outcome in orthopaedic surgery. Aim of the present review was to comprehensively characterize the available evidence on the consequences of pre-existent FM on the outcomes of orthopaedic surgery.

METHODS

We performed a systematic search in MedLine and Web of Science (WOS) to identify studies evaluating the effect of FM on patient-centred outcomes, opioids consumption and postoperative complications.

RESULTS

The search strategy identified 519 records in PubMed and 507 in WOS. A total of 27 articles were deemed eligible for inclusion in qualitative synthesis. Based on quality assessment, 10 studies were rated as good quality, 10 as fair quality and 7 as poor quality. Studies reporting the prevalence of FM in consecutive patients undergoing orthopaedic surgery (n = 19) were included in quantitative synthesis. The pooled prevalence of FM in patients undergoing orthopaedic surgery was 4.1% (95% CI: 2.4-6.8) in those receiving hip or knee surgery, 10.1% (95% CI: 5.7-17.2) in those receiving shoulder or elbow surgery and 21.0% (95% CI: 18.5-23.7) in those receiving spinal surgery. The results of our systematic review consistently report FM as a significant risk factor for less satisfaction, higher pain, worse functional outcome, increased risk for postoperative opioids prescription and higher rate of medical and surgical complications following orthopaedic surgery.

CONCLUSION

Identifying pre-existing FM in patients scheduled for elective orthopaedic surgery may help to better assess the benefit/risk ratio, improve patients' awareness and minimize any discrepancy between expectancy and results.

eHealth interventions to support self-management in people with musculoskeletal disorders: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to explore existing literature related to the role of eHealth interventions in supporting self-management in those with musculoskeletal disorders in order to investigate and chart the evidence, and identify any gaps within the literature.

INTRODUCTION

Musculoskeletal disorders are one of the leading causes of disability worldwide. Self-management interventions are consistently recommended as a core component of treatment for people with musculoskeletal disorders. Given limited health care resources, there is increasing interest in the potential role of eHealth interventions to support self-management in this population.

INCLUSION CRITERIA

Studies that include adult participants (older than 18 years) with a musculoskeletal disorder will be considered. Studies that include participants with pain of specific pathological origin (eg, infection, malignancy, osteoporosis, inflammatory disease, fracture), those who are pregnant, or individuals following surgery will be excluded. The concept is eHealth interventions that support self-management conducted in any setting and geographical location. All settings and locations will be included.

METHODS

The following electronic databases will be searched with no limit on publication date: MEDLINE, CINAHL, PsycINFO, Embase, Scopus and the Cochrane Database of Systematic Reviews. A structured search of the gray literature will also be conducted. Studies will be limited to those published in English. Two reviewers will undertake title and abstract screening, followed by full-text screening. Data extraction will be conducted utilizing a standardized form for included studies, and a narrative summary will accompany the charted results and will describe how the results relate to the review's objective.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework (https://osf.io/29rd6).

Physiotherapist beliefs and perspectives on virtual reality-supported rehabilitation for the assessment and management of musculoskeletal shoulder pain: a focus group study protocol

Shoulder pain accounts for a large proportion of musculoskeletal disorders and years lived with disability. Musculoskeletal shoulder pain is challenging to manage and while research evidence suggests that exercise should be a cornerstone of shoulder pain rehabilitation, the exact type and dosage of exercise is unclear. Adherence is a barrier to successful outcomes with exercise-based management of musculoskeletal pain, especially for those with co-morbidities, high pain levels and reported boredom associated with competing prescribed exercise. Virtual reality (VR) may offer an effective platform for rehabilitation of musculoskeletal shoulder pain. VR has been shown to be effective for management of acute and chronic pain conditions, for delivering education around various health conditions, and for supporting rehabilitation of neurological conditions. Therefore, it is possible that VR may have a role in the delivery of exercise and education for individuals with musculoskeletal shoulder pain. VR intervention design should involve several steps and begin with establishing early acceptability from users as to the suitability of the technology in clinical practice as well as potential barriers and facilitators to using the technology successfully. This study will therefore aim to explore physiotherapists beliefs and perspectives of immersive VR as a platform for assessment and rehabilitation in patients with musculoskeletal shoulder pain. Further, this study will inform the development of a VR intervention for use in the rehabilitation of musculoskeletal shoulder pain. A series of online focus groups will be conducted with physiotherapists in Ireland using a qualitative descriptive approach to data analysis. A six-phase process of data analysis will be carried out to identify important patterns and themes within the data. The current study will be the first to explore clinician's perspectives on the role of VR in musculoskeletal practice.

Education and training to support physiotherapists working in dementia care: a scoping review protocol

Background: The care of people with dementia is of global concern. Physiotherapeutic intervention can be of benefit to patients with dementia. Physiotherapists can play a role in assessment, falls prevention, pain management and gait re-education. Dementia care forms a significant part of the workload of a physiotherapist. However, there is a paucity of evidence on what constitutes effective education and training for physiotherapists working in dementia care. Objective: This scoping review aims to explore and map the evidence on education and training for physiotherapists working in dementia care. Inclusion criteria: Studies that explore dementia training and/or education for physiotherapists or for multidisciplinary teams, in which physiotherapists have been included. Studies that explore student physiotherapy training will also be considered. Systematic reviews, qualitative, quantitative, mixed methods studies, case studies and observational studies will be included. Methods: This scoping review will follow the Joanna Briggs Institute (JBI) methodology for scoping reviews. Databases to be searched as part of this review include: Medline, Cochrane Database of Systematic Reviews, SocINDEX, CINAHL and, PsycINFO, with no limitation on publication date. Google Scholar and Open-Grey will be searched for grey literature, limited to the first 100 searches.  Titles and abstracts will be screened for inclusion and identified full texts reviewed independently by two reviewers. Data will be extracted using a draft data extraction tool based on the JBI data extraction tool. A chronological narrative synthesis of the data will outline how the results relate to the aims and objective of this scoping review.

Dietary Interventions in the Management of Fibromyalgia: A Systematic Review and Best-Evidence Synthesis

Fibromyalgia syndrome (FMS) is characterised by chronic widespread pain alongside fatigue, poor sleep quality and numerous comorbidities. It is estimated to have a worldwide prevalence of 1.78%, with a predominance in females. Treatment interventions for fibromyalgia have limited success, leading to many patients seeking alternative forms of treatment, including modifications to their diet and lifestyle. The effectiveness of dietary changes in fibromyalgia has not been widely researched or evaluated. This systematic review identified twenty-two studies, including 18 randomised control trials (RCTs) and four cohort studies which were eligible for inclusion. In total these studies investigated 17 different nutritional interventions. Significant improvements in reported pain were observed for those following a vegan diet, as well as with the low fermentable oligo di-mono-saccharides and polyols (FODMAP) diets. Supplementation with Chlorella green algae, coenzyme Q10, acetyl-l-carnitine or a combination of vitamin C and E significantly improved measures of pain. Interpretation of these studies was limited due to the frequent poor quality of the study design, the wide heterogeneity between studies, the small sample size and a high degree of bias. Therefore, there is insufficient evidence to recommend any one particular nutritional intervention for the management of fibromyalgia and further research is needed.

Emotional intelligence impairments in women with fibromyalgia: Associations with widespread pain

This study aimed at testing the differences in emotional intelligence ability between women with fibromyalgia (cases) and their age-matched counterparts not with fibromyalgia from the general population (controls) and analysing the association between emotional intelligence ability and widespread pain in women with fibromyalgia. A total of 133 cases and 77 controls participated in this cross-sectional study. Controls performed better than cases on emotion understanding. Higher emotion perception and management were significantly associated with lower widespread pain. Therefore, women with fibromyalgia may experience difficulties in understanding emotional information. In fibromyalgia, higher emotion perception and management abilities are independently related to lower widespread pain.

Physical and psychological paths toward less severe fibromyalgia: A structural equation model

OBJECTIVES

Previous research suggested isolated associations of physical and psychological factors with fibromyalgia severity. Integration of physical and psychological, experienced and observed, modifiable factors associated with fibromyalgia severity in a single model will reveal therapeutic paths toward less severity of disease. We aimed to examine an encompassing model of determinants of fibromyalgia severity.

METHODS

This observational, population-based cross-sectional study included 569 people with fibromyalgia. An integrative model of fibromyalgia severity was tested by using structural equation modelling. This model included 8 factors: resilience, catastrophizing, active lifestyle, declarative memory, subjective fitness, objective fitness, psychological distress, and physical fatigue.

RESULTS

Two core paths were associated with reduced fibromyalgia severity: 1) a psychological path connecting high resilience and low catastrophizing with low distress and 2) a physical path, connecting a more active lifestyle (directly and via high objective and subjective physical fitness) with low fatigue. Additional interconnecting paths especially suggested a connection from the psychological to physical path. Our model explained 83% of the fibromyalgia severity.

CONCLUSIONS

The present model integrated the complexity of mutually influencing factors of fibromyalgia severity, which may help to better understand the disease. It emphasised the importance of: 1) physical factors and psychological factors and their interconnections, 2) patients' experiences and clinical measurements, and 3) positive and negative signs such as physical fitness and distress. Future longitudinal and experimental research should aim at testing the causal direction of the associations in the model as well as the clinical implications suggested by the model. For instance, to reduce fatigue, exercise should enhance not only objective fitness but also fitness-related perceptions. Reducing distress and fatigue seems crucial for lowering fibromyalgia severity.

Eccentric exercise therapy in the treatment of subacromial impingement syndrome: A critical review

Aim:

This critical review explores the current evidence underpinning eccentric exercise therapy in the treatment of subacromial impingement syndrome (SAIS).

Method:

A critical review method was used. Four large databases, CINAHL, MEDLINE, SportDiscus and Pubmed, as well as the PEDro and Cochrane electronic libraries were searched. The search terms ‘subacromial impingement’ or ‘SAI’ or ‘shoulder impingement’ and ‘eccentric exercises’ or ‘eccentric loading’ or ‘eccentrics’ were used. All available studies were marked against predetermined inclusion and exclusion criteria.

Results:

Five studies met the inclusion criteria, two of which were RCTs, one a case series, one a single subject A–B experimental design and one a pilot study. Similarities in the nature of the eccentric exercise programmes in these five studies included the exercise regime. Commonly, these studies’ exercise regimes followed three sets of 15 repetitions, twice each day for 2 months, and the resistance was either hand weights or resistance bands, and used the pain monitoring model as a measure of readiness to progress resistance. Main differences in the programmes were the arm position chosen for performance of the exercises and the shoulder muscle groups targeted.

Conclusions:

Although there is a clinical consensus, which would appear to support the above regime, there is limited empirical evidence. Therefore, more research on such areas as the best arm position and exercise regime is required. In addition, while the pain-monitoring model appears to be supported clinically; again, further empirical evidence is needed before it can be recommended as a means of monitoring readiness for exercise progression. More research is needed to determine the best arm position and exercise regime for optimum results.

Effect of whole-body vibration exercise on balance in women with fibromyalgia syndrome: a randomized controlled trial

OBJECTIVES

This study evaluated the effectiveness of a 6-week "usual care" exercise program supplemented with whole-body vibration (WBV) to improve balance and strength in women with fibromyalgia (FM).

DESIGN

This was a randomized controlled study.

SETTINGS

The setting was a physical therapy department in an academic setting.

SUBJECTS

The subjects were 30 postmenopausal women with FM (age: 59±7.90 years).

INTERVENTIONS

Subjects were randomized into one of two groups: an experimental group (EG: n=15), which combined exercise training (2 days a week) with 3 days of WBV, and a control group (CG: n=15), who performed the same exercise training program (2 days a week) but without WBV.

OUTCOME MEASURES

Balance and muscle strength were measured at baseline and after the 6-week intervention.

RESULTS

Significant differences were found (p<0.05) between the study groups for the Medio-Lateral Stability Index (MLSI), when patients were assessed with their eyes open and closed. The effect size of the improvement was large with eyes closed (R2=0.260) and moderate when the eyes were open (R2=0.047). However, no significant differences were found (p>0.05) between the study groups for other outcomes.

CONCLUSIONS

Women with FM may increase their MLSI by engaging in a 6-week traditional exercise program with supplementary WBV. This may have implications for falls prevention in this patient group.

Effects of a prolonged exercise program on key health outcomes in women with fibromyalgia: a randomized controlled trial

OBJECTIVE

To assess the impact of a long-term exercise programme vs usual care on perceived health status, functional capacity and depression in patients with fibromyalgia.

DESIGN

Randomized controlled trial.

SUBJECTS

Forty-two women with fibromyalgia were allocated randomly to 1 of 2 groups: an experimental group that carried out aerobic, strength and flexibility exercises for 24 weeks and a usual care control group.

METHODS

Health status and functional capacity were evaluated using the Fibromyalgia Impact Questionnaire and the Short Form Health Survey 36. Depression was evaluated with the Beck Depression Inventory.

RESULTS

Significant improvements were observed in health status and functional capacity for the exercise group over the control group. The magnitude of the effect size of these improvements, expressed as Cohen's d, was medium. The effect size (95% confidence interval) for the Fibromyalgia Impact Questionnaire was 0.58 (-14.12, -2.35), for the Short Form Health Survey 36. global score 0.54 (1.28, 14.52), and in the mental health domain of the Short Form Health Survey 36. 0.51 (1.20, 16.26). There was a large effect size in vitality. All the aforementioned improvements can be considered as clinically important changes.

CONCLUSION

Results confirm that a long-term combination of aerobic exercise, strengthening and flexibility improves psychological health status and health-related quality of life in patients with fibromyalgia.

The effect of 6-week exercise programme and whole body vibration on strength and quality of life in women with fibromyalgia: a randomised study

OBJECTIVES

The aim of this study was to investigate the effectiveness of a 6-week traditional exercise programme with supplementary whole-body vibration (WBV) in improving strength and health status in women with fibromyalgia (FM).

METHODS

Thirty postmenopausal women with FM (mean (SD) age: 59 (7.90) years) were randomised into one of two groups, one intervention group (GEV n=15), which combined exercise training (two days a week) with three days of WBV (3 sets of 45 s at 20 Hz-3 mm and four sets of unilateral static squats at 20 Hz-2 mm) and another control group (n=15), that performed the same physical activity programme but without vibration training (GEnV). The Fibromyalgia Impact Questionnaire (FIQ) and the global score of the SF-36 were used to assess functional capacity and quality of life. Two additional tests were employed to assess muscle strength. Baseline data and pre-test and post-test data were collected before and after the six-week intervention period.

RESULTS

Significant improvements in all outcomes measured were found from baseline in both groups. A 5% improvement from baseline in total FIQ score was observed in the exercise groups (p≤0.05), and was accompanied by reductions in SF36 scores of 9.8% (p<0.001) and 7.9% (p<0.001) in the GEV and GEnV group, respectively. Improvements were also observed in muscle strength in both groups but greater in the GEV group.

CONCLUSIONS

The results suggest that women with FMS can gain additional health benefits by engaging in a 6-week traditional exercise programme with supplementary WBV.

Tender point count and total myalgic score in fibromyalgia: changes over a 28-day period

Tender point count (TPC) is central to fibromyalgia syndrome (FMS), and with total myalgic score (TMS) is often used to monitor the patient's condition. This study aimed to determine the stability of TPC and TMS over time, and to examine how well these measures reflected patients' perceptions of their condition. Twenty-four patients with FMS completed the Fibromyalgia Impact Questionnaire (FIQ) and a visual analogue scale (VAS) measuring well-being, at entrance into the study, and 7 and 28 days later. There was no significant change in TPC (P = 0.074), FIQ score (P = 0.291) or VAS (P = 0.079) of well-being with time. However, mean TMS score did change over time (P = 0.021). There was no correlation between total FIQ score and the other measures (all P-values > 0.05). The significant change in TMS over time may reflect the natural fluctuation in the clinical presentation of FMS.

Patients' perceptions of exercise therapy in the treatment of fibromyalgia syndrome: a survey

OBJECTIVE

To identify patients' perceptions of the role and benefits of exercise in the treatment of fibromyalgia syndrome (FMS).

DESIGN

A postal questionnaire was sent to all 225 members of the Northern Ireland Fibromyalgia Support Group. The questionnaire consisted of 19 questions and was sub-divided into four sections: (1) background information; (2) previous treatment; (3) opinions on the role of exercise in FMS and (4) current participation in, and barriers to, exercise. Data were analysed using descriptive statistics.

RESULTS

A response rate of 51.1% (115/225) was achieved. Forty nine percent (57) of respondents were receiving FMS-associated disability benefits and 13% (15) were working full-time. All reported previous treatment for FMS. Ninety-six (84%) had received medication and 82 (71%) exercise-based therapy. Just over half (42/82) of those who had participated in exercise therapy reported it to be an effective management strategy. Two thirds (48/71) of those who used bedrest, and over half (52/96) of those who used medications reported these interventions to be effective. Eighty-two per cent (94) 'agreed' or 'strongly agreed' that exercise improved fitness and 60% (69) 'agreed' or 'strongly agreed' that exercise increased feelings of well-being, but only 13.9% (16) reported that it reduced their pain. The most commonly reported barriers to exercise were fatigue (85%, 98) and pain (73%, 84).

CONCLUSION

Exercise therapy is a common treatment for fibromyalgia syndrome, but while respondents accepted its general health benefits, the vast majority did not report that it reduced their pain.