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Title: | Effectiveness of a Multicomponent treatment for fibromyalgia based on Pain neuroscience education, Exercise therapy, Psychological support, and Nature exposure (NAT-FM): A Pragmatic randomized controlled trial |
Author: | Serrat, Mayte Almirall, Míriam Musté, Marta Sanabria Mazo, Juan P. Feliu Soler, Albert Méndez Ulrich, Jorge Luis Luciano Devis, Juan Vicente Sanz Ruiz, Antoni |
Keywords: | Fibromiàlgia Teràpia cognitiva Teràpia cognitiva basada en l'atenció plena Teràpia d'exposició Exercici terapèutic Fibromyalgia Cognitive therapy Mindfulness-based cognitive therapy Exposure therapy Exercise therapy |
Issue Date: | 18-Oct-2020 |
Publisher: | MDPI |
Abstract: | A recent study (FIBROWALK) has supported the effectiveness of a multicomponent treatment based on pain neuroscience education (PNE), exercise therapy (TE), cognitive behavioral therapy (CBT), and mindfulness in patients with fibromyalgia. The aim of the present RCT was: (a) to analyze the effectiveness of a 12-week multicomponent treatment (nature activity therapy for fibromyalgia, NAT-FM) based on the same therapeutic components described above plus nature exposure to maximize improvements in functional impairment (primary outcome), as well as pain, fatigue, anxiety-depression, physical functioning, positive and negative a ect, self-esteem, and perceived stress (secondary outcomes), and kinesiophobia, pain catastrophizing thoughts, personal perceived competence, and cognitive emotion regulation (process variables) compared with treatment as usual (TAU); (b) to preliminarily assess the e ects of the nature-based activities included (yoga, Nordic walking, nature photography, and Shinrin Yoku); and (c) to examine whether the positive effects of TAU + NAT-FM on primary and secondary outcomes at post-treatment were mediated through baseline to six-week changes in process variables. A total of 169 FM patients were randomized into two study arms: TAU + NAT-FM vs. TAU alone. Data were collected at baseline, at six-week of treatment, at post-treatment, and throughout treatment by ecological momentary assessment (EMA). Using an intention to treat (ITT) approach, linear mixed-e ects models and mediational models through path analyses were computed. Overall, TAU + NAT-FM was significantly more e ective than TAU at posttreatment for the primary and secondary outcomes evaluated, as well as for the process variables. Moderate-to-large effect sizes were achieved at six-weeks for functional impairment, anxiety, kinesiophobia, perceived competence, and positive reappraisal. The number needed to treat (NNT) was 3 (95%CI = 1.6-3.2). The nature activities yielded an improvement in affective valence, arousal, dominance, fatigue, pain, stress, and self-effcacy. Kinesiophobia and perceived competence were the mediators that could explain a significant part of the improvements obtained with TAU + NAT-FM treatment. TAU + NAT-FM is an e ective co-adjuvant multicomponent treatment for improving FM-related symptoms. |
Note: | Reproducció del document publicat a: https://doi.org/10.3390/jcm9103348 |
It is part of: | Journal of Clinical Medicine, 2020, vol. 9, num. 10, p. 1-24 |
URI: | http://hdl.handle.net/2445/172657 |
Related resource: | https://doi.org/10.3390/jcm9103348 |
ISSN: | 2077-0383 |
Appears in Collections: | Articles publicats en revistes (Mètodes d'Investigació i Diagnòstic en Educació) |
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