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Patient-centred education and exercise versus exercise alone for patients with fibromyalgia: a randomized controlled trial
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Abstract(s)
Introdução: O exercício e a educação constituem o tratamento não-farmacológico de
primeira linha recomendado para a fibromialgia. Objetivo: O objetivo deste estudo foi
investigar os efeitos de um programa de 8 semanas que combina educação centrada
no utente e exercício versus exercício na intensidade da dor, incapacidade funcional e
impacto da fibromialgia e perceção global de mudança na dor e funcionalidade.
Metodologia: Sessenta indivíduos com fibromialgia foram aleatoriamente distribuídos
pelo grupo experimental (exercício e educação) ou pelo grupo controlo (exercício). A
medida de avaliação primária foi a intensidade da dor, avaliada pela Escala Numérica
da Dor e a secundária foi a incapacidade, avaliada pela versão portuguesa da Revised
Fibromyalgia Impact Questionnaire, assim como a perceção global de mudança,
avaliada pela versão Portuguesa da The Patient Global Impression of Change. Os
participantes foram avaliados antes da intervenção, 4 semanas após o início e no final
das 8 semanas de intervenção. A significância da efetividade das intervenções para a
dor e para a incapacidade foi avaliada com uma two-way mixed-model ANOVA,
enquanto o chi-square tests of independence foi utilizado para avaliar a relevância
clínica dos resultados. Resultados: Trinta participantes em cada grupo foram
analisados no final da intervenção. Não se verificou efeito de interação entre grupo e
tempo para a intensidade da dor (p=.488) nem para a incapacidade (p=.370). Verificou se que o efeito do tempo foi estatisticamente significativo para a intensidade da dor
(p<.001) e para a incapacidade (p<.001). O efeito de grupo foi estatisticamente
significativo para a intensidade da dor em favor do grupo de controlo (p=.003). A
análise da relevância clínica revelou que não houve diferenças estatisticamente
significativas entre os grupos para a intensidade da dor (p=.432), incapacidade
(p=.405) e perceção global de mudança da dor (p=.071) e da incapacidade (p=.100). A
análise do risco relativo demonstrou que o grupo experimental apresentou 1.3 mais
probabilidade de atingir resultados com relevância clínica na intensidade da dor.
Conclusão: Ambos os tratamentos foram efetivos na redução da dor e da
incapacidade. Um programa de exercício combinado com educação não é mais efetivo
do que um programa de exercício isolado para a diminuição da dor e incapacidade em
indivíduos com fibromialgia. Proporções semelhantes de indivíduos em ambos os
grupos alcançaram melhorias clinicamente significativas para ambas as medidas de
resultados, mas o grupo experimental apresentou mais probabilidade de atingir
resultados com relevância clínica na intensidade da dor
Background: Non-pharmacological therapeutic interventions are highly recommended for treating fibromyalgia. Objectives: To compare the effectiveness of an 8-week intervention programme who combine patient-centred education and exercise versus exercise alone on pain intensity, disability and patient’s global impression of change for pain and function. Methods: Sixty fibromyalgia patients were randomly allocated to the experimental group (education and exercise programme) or control group (exercise alone). The primary outcome was pain intensity, assessed by the Numeric Pain Scale and the secondary outcome was disability, assessed by the Portuguese Revised Fibromyalgia Impact Questionnaire and the patient’s global impression of change, assessed by the Portuguese version of the Patient Global Impression of Change. The participants were assessed at baseline, week 4 and week 8. Two-way mixed-model Anova was used for pain intensity and disability while the clinical relevance was examined using chi-square tests of independence. Results: Thirty patients each group were analysed at the end of the interventions. No significant group-by-time interactions were found neither for pain intensity (p=.488) nor for disability (p=.370). Significant effects of time were found for pain intensity (p<.001) and disability (p<.001). Significant effects of group were found for the control group on pain intensity (p=.003). Clinical relevance showed no significant differences between groups at the end of the interventions for pain intensity (p=.432), disability (p=.405), and patient global impression of change for pain (p=.071) and function (p=.100). Risk Relative revealed that the experimental group have 1.3 more probability to achieve clinically relevant outcomes for pain intensity. Conclusion: Both treatments were effective for decreasing pain intensity and disability. A combined exercise and education program seems not superior to exercise alone in reducing pain intensity and disability for individuals with fibromyalgia. Similar proportions of patients achieved clinically meaningful improvements for both outcomes, but the experimental group have more probability to achieve clinically relevant outcomes in terms of pain intensity.
Background: Non-pharmacological therapeutic interventions are highly recommended for treating fibromyalgia. Objectives: To compare the effectiveness of an 8-week intervention programme who combine patient-centred education and exercise versus exercise alone on pain intensity, disability and patient’s global impression of change for pain and function. Methods: Sixty fibromyalgia patients were randomly allocated to the experimental group (education and exercise programme) or control group (exercise alone). The primary outcome was pain intensity, assessed by the Numeric Pain Scale and the secondary outcome was disability, assessed by the Portuguese Revised Fibromyalgia Impact Questionnaire and the patient’s global impression of change, assessed by the Portuguese version of the Patient Global Impression of Change. The participants were assessed at baseline, week 4 and week 8. Two-way mixed-model Anova was used for pain intensity and disability while the clinical relevance was examined using chi-square tests of independence. Results: Thirty patients each group were analysed at the end of the interventions. No significant group-by-time interactions were found neither for pain intensity (p=.488) nor for disability (p=.370). Significant effects of time were found for pain intensity (p<.001) and disability (p<.001). Significant effects of group were found for the control group on pain intensity (p=.003). Clinical relevance showed no significant differences between groups at the end of the interventions for pain intensity (p=.432), disability (p=.405), and patient global impression of change for pain (p=.071) and function (p=.100). Risk Relative revealed that the experimental group have 1.3 more probability to achieve clinically relevant outcomes for pain intensity. Conclusion: Both treatments were effective for decreasing pain intensity and disability. A combined exercise and education program seems not superior to exercise alone in reducing pain intensity and disability for individuals with fibromyalgia. Similar proportions of patients achieved clinically meaningful improvements for both outcomes, but the experimental group have more probability to achieve clinically relevant outcomes in terms of pain intensity.
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Keywords
Fibromialgia Estudo randomizado controlado Exercício Educação centrada no utente Fibromyalgia Randomized controlled trial Exercise Patient-centred education