Víctor Segura-Jiménez

Fibromyalgia has a larger impact on physical health than on psychological health, yet both are markedly affected: The al-Ándalus project

OBJECTIVES To characterize a representative sample of fibromyalgia women based on a set of relevant factors known to be related to this disease. To distinguish specific factors of the disease from other symptoms that might also exist in non-fibromyalgia women. To test whether fibromyalgia affects more severely physical or psychological outcomes. METHODS A total of 459 fibromyalgia women vs. 214 non-fibromyalgia (control) women from Southern Spain (Andalusia) took part in this cross-sectional study. Several instruments were used to assess tenderness, impact of fibromyalgia, fatigue, health-related quality of life, mental health, and cognitive performance. RESULTS Overall, fibromyalgia women showed a worse status in pain, fatigue, health-related quality of life, depression, and anxiety than controls (P < 0.01). In general, the observed associations presented very large effect sizes (Cohen׳s d from ~1 to ~5.5). No differences between fibromyalgia and controls were observed in cognitive and memory performance, except for delayed recall, but the observed effect size was low (~0.25). The effect size observed for the global physical component (~3.3) was larger than that for the global psychological component (~1.3), all P < 0.001. CONCLUSIONS Our results reinforce the understanding of fibromyalgia as a polysymptomatic distress condition with pain as its main symptom. Our findings support that fibromyalgia seems to have a greater impact on physical than on psychological outcomes, though both are largely affected.

Validation of the modified 2010 American College of Rheumatology diagnostic criteria for fibromyalgia in a Spanish population

OBJECTIVE The aim of this study was to validate the modified 2010 ACR preliminary criteria for FM in a Spanish population. METHODS Five hundred and seventy-nine (550 women) FM and 294 (240 women) control participants were enrolled in the study. FM patients were previously diagnosed by a rheumatologist. All participants underwent both the 1990 ACR criteria (1990c) and the modified 2010 ACR criteria (m-2010c). RESULTS The tender points count showed correlations of 0.69, 0.65 and 0.71 with the widespread pain index (WPI), symptoms severity (SS) and polysymptomatic distress (PSD) scales, respectively (all P < 0.001). The WPI, SS and PSD showed greater correlations with impact of FM health-related quality of life, general fatigue and depression than the tender points count. The 1990c showed sensitivity and specificity values of 84.1 and 97.6, respectively, whereas the m-2010c showed values of 88.3 and 91.8, respectively. Both criteria showed the same overall accuracy, with a value of 0.89. When the 1990c and m-2010c were combined and patients had to satisfy one of two criteria to be diagnosed with FM, the sensitivity, specificity and accuracy of questionnaires were 96.7, 89.8 and 0.94, respectively. The original cut-off points (WPI ≥ 7, SS ≥ 5 and PSD ≥ 12) showed the best test characteristics in the present study. CONCLUSION The m-2010c, with the same cut-off points as the original version, are a valid tool for the diagnosis of FM in our population. Whenever possible, the combination of the 1990c and m-2010c is recommended (patients have to meet one of the two criteria to be diagnosed), since this approach showed the best diagnostic characteristics.

Reliability and feasibility of physical fitness tests in female fibromyalgia patients.

The aim of the present study was to determine the reliability and feasibility of physical fitness tests in female fibromyalgia patients. 100 female fibromyalgia patients (aged 50.6±8.6 years) performed the following tests twice (7 days interval test-retest): chair sit and reach, back scratch, handgrip strength, arm curl, chair stand, 8 feet up and go, and 6-min walk. Significant differences between test and retest were found in the arm curl (mean difference: 1.25±2.16 repetitions, Cohen d=0.251), chair stand (0.99±1.7 repetitions, Cohen d=0.254) and 8 feet up and go (-0.38±1.09 s, Cohen d=0.111) tests. Intraclass correlation coefficients (ICC) range from 0.92 in the arm curl test to 0.96 in the back scratch test. The feasibility of the tests (patients able to complete the test) ranged from 89% in the arm curl test to 100% in the handgrip strength test. Therefore, the reliability and feasibility of the physical fitness tests examined is acceptable for female fibromyalgia patients.

Objectively measured sedentary time and physical activity in women with fibromyalgia: a cross-sectional study.

Objectives To characterise levels of objectively measured sedentary time and physical activity in women with fibromyalgia. Design Cross-sectional study. Setting Local Association of Fibromyalgia (Granada, Spain). Participants The study comprised 94 women with diagnosed fibromyalgia who did not have other severe somatic or psychiatric disorders, or other diseases that prevent physical loading, able to ambulate and to communicate and capable and willing to provide informed consent. Primary outcome measures Sedentary time and physical activity were measured by accelerometry and expressed as time spent in sedentary behaviours, average physical activity intensity (counts/minute) and amount of time (minutes/day) spent in moderate intensity and in moderate-to-vigorous-intensity physical activity (MVPA). Results The proportion of women meeting the physical activity recommendations of 30 min/day of MVPA on 5 or more days a week was 60.6%. Women spent, on average, 71% of their waking time (approximately 10 h/day) in sedentary behaviours. Both sedentary behaviour and physical activity levels were similar across age groups, waist circumference and percentage body fat categories, years since clinical diagnosis, marital status, educational level and occupational status, regardless of the severity of the disease (all p>0.1). Time spent on moderate-intensity physical activity and MVPA was, however, lower in those with greater body mass index (BMI) (−6.6 min and −7 min, respectively, per BMI category increase, <25, 25–30, >30 kg/m2; p values for trend were 0.056 and 0.051, respectively). Women spent, on average, 10 min less on MVPA (p<0.001) and 22 min less on sedentary behaviours during weekends compared with weekdays (p=0.051). Conclusions These data provide an objective measure of the amount of time spent on sedentary activities and on physical activity in women with fibromyalgia.

Association of Physical Fitness with Pain in Women with Fibromyalgia: The al‐Ándalus project

This population‐based cross‐sectional study aimed to characterize the association of different components of physical fitness with pain levels, pain‐related catastrophizing, and chronic pain self‐efficacy in women with fibromyalgia (FM).

Fitness testing in the fibromyalgia diagnosis: the al-Ándalus project.

PURPOSE This study aimed to determine the ability of a set of physical fitness tests to discriminate presence or absence of fibromyalgia in women. METHODS The sample comprised 487 women with fibromyalgia (52.1 ± 8 yr) and 250 control women (49.3 ± 9 yr). We assessed physical fitness using the arm curl, 30-s chair stand, handgrip strength, 8-ft up and go, 6-min walk, chair sit and reach, and the back scratch tests. The revised fibromyalgia impact questionnaire was used to assess fibromyalgia severity and symptomatology. RESULTS Patients with fibromyalgia performed worse than control women in all the fitness tests studied (all, P < 0.001). The receiver operating characteristic analysis showed that all the fitness tests were able to discriminate between presence and absence of fibromyalgia (all, P < 0.001). The area under the curve ranged from 0.708 to 0.910 (all, P < 0.001). Among the fitness tests studied, the arm curl test, followed by the 30-s chair-stand and handgrip strength tests, showed the highest capacity discriminating between the presence and absence of fibromyalgia. An arm curl test score of <20 repetitions was associated with increased odds of having fibromyalgia (odds ratio (OR), 35.6; 95% confidence interval, 12.6-101) in women age 35-44 yr. An arm curl test score of <16 repetitions was associated with increased odds of having fibromyalgia (OR, 23.7; 95% confidence interval, 10.3-54.0) in women age 35-44 yr. In the group of women age 55-65 yr, the highest OR was observed for the handgrip strength test and the odds of having fibromyalgia was 17 times greater than that in patients who performed less than 19 kg. CONCLUSIONS The arm curl, 30-s chair stand, and handgrip strength tests powerfully discriminated women with fibromyalgia from healthy women. Identification of women who fail to meet the suggested standards can help to easily, quickly, and cheaply rule out the presence of the disease, especially in primary care settings.

Differences in Sedentary Time and Physical Activity Between Female Patients With Fibromyalgia and Healthy Controls: The al‐Ándalus Project

To characterize the levels of objectively measured time spent in sedentary activities (sedentary time) and physical activities in female patients with fibromyalgia and compare them with the levels in age‐matched healthy control women.

Effectiveness of Tai-Chi for Decreasing Acute Pain in Fibromyalgia Patients

Tai-Chi has shown benefits in physical and psychological outcomes in diverse populations. We aimed to determine the changes elicited by a Tai-Chi program (12 and 24 weeks) in acute pain (before vs. after session) in fibromyalgia patients. We also assessed the cumulative changes in pain brought about by a Tai-Chi program. Thirty-six patients (29 women) with fibromyalgia participated in a low-moderate intensity Tai-Chi program for 12 weeks (3 sessions/week). Twenty-eight patients (27 women) continued the program for an additional 12 weeks (i. e., 24 weeks). We assessed pain by means of a Visual Analogue Scale (VAS) before and after each single session (i. e., 72 sessions). We observed significant immediate changes (P-values from 0.037 to 0.0001) with an approximately 12% mean decrease of acute pain in the comparison of VAS-values before and after each session (72 sessions in total), with the exception of 4 sessions. We observed significant changes in cumulative pain pre-session (95% CI=-0.019; -0.014; P<0.001) and cumulative pain post-session (95% CI=-0.021; -0.015; P<0.001) along the 24-week intervention only. In conclusion, a low-moderate intensity Tai-Chi program for 12 weeks (3 times/week) decreased levels of acute pain in fibromyalgia patients. A longer period is necessary (e. g. 24 weeks) for observing cumulative changes in pain.

A Warm Water Pool-Based Exercise Program Decreases Immediate Pain in Female Fibromyalgia Patients: Uncontrolled Clinical Trial

Fibromyalgia is characterized by chronic and extended musculoskeletal pain. The combination of exercise therapy with the warm water may be an appropriate treatment. However, studies focusing on the analysis of immediate pain during and after an exercise session are rare. This study aimed to determine the immediate changes of a warm water pool-based exercise program (12 weeks) on pain (before vs. after session) in female fibromyalgia patients. 33 Spanish women with fibromyalgia were selected to participate in a 12 weeks (2 sessions/week) low-moderate intensity warm water pool-based program. We assessed pain by means of a Visual Analogue Scale before and after each single session (i. e., 24 sessions). We observed immediate benefits on pain with a mean decrease ~15% in all sessions, except in the fourth one. There was an association of pain difference (pre-post) session with pain pre session (p=0.005; β=0.097±0.034) and with age (p<0.001; β=0.032±0.008). There were no significant accumulative differences on pain, pre session, post session, and pre-post changes (all p>0.05). Therefore this study showed that a warm water pool-based exercise program for 12 weeks (2 times/week) led to a positive immediate decrease in level of pain in female patients with fibromyalgia. Improvements were higher in older women and in those with more intense pain.

Association of sedentary time and physical activity with pain, fatigue, and impact of fibromyalgia: the al‐Ándalus study

We examined the association of objectively measured sedentary time (ST) and physical activity (PA) levels with pain, fatigue, and the impact of the disease in women with fibromyalgia. Four hundred and nineteen (mean age ± SD = 51.7 ± 7.6 years old) women with fibromyalgia participated. ST and PA levels (light, moderate, and moderate‐to‐vigorous [MVPA]) were measured with triaxial accelerometry. We assessed experimental pain with algometry and clinical pain, fatigue, and impact of fibromyalgia with a number of questionnaires. The association of ST and light PA with most of the pain‐ and fatigue‐related outcomes and impact of fibromyalgia (all, P ≤ 0.019) was independent of moderate and vigorous PA. Furthermore, the association of vigorous PA with general and physical fatigue was independent of ST and light and moderate PA (all, P < 0.001). In conclusion, lower levels of ST or higher levels of light PA are associated with lower pain, fatigue, and the overall impact of the disease independent of moderate and vigorous PA in women with fibromyalgia. Interestingly, higher vigorous PA is independently associated with lower general and physical fatigue. These results are significant for future ST and PA intervention studies in this population.