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
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 effectiven...
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MDPI AG
2020-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/10/3348 |
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| author | Mayte Serrat Míriam Almirall Marta Musté Juan P. Sanabria-Mazo Albert Feliu-Soler Jorge L. Méndez-Ulrich Juan V. Luciano Antoni Sanz |
| author_facet | Mayte Serrat Míriam Almirall Marta Musté Juan P. Sanabria-Mazo Albert Feliu-Soler Jorge L. Méndez-Ulrich Juan V. Luciano Antoni Sanz |
| author_sort | Mayte Serrat |
| collection | DOAJ |
| description | 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 affect, 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 effects 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-effects models and mediational models through path analyses were computed. Overall, TAU + NAT-FM was significantly more effective 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-efficacy. 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 effective co-adjuvant multicomponent treatment for improving FM-related symptoms. |
| first_indexed | 2024-03-10T15:31:44Z |
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| last_indexed | 2024-03-10T15:31:44Z |
| publishDate | 2020-10-01 |
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| spelling | doaj.art-a2193a1155034115a98f6bacaf8895e62023-11-20T17:35:41ZengMDPI AGJournal of Clinical Medicine2077-03832020-10-01910334810.3390/jcm9103348Effectiveness of a Multicomponent Treatment for Fibromyalgia Based on Pain Neuroscience Education, Exercise Therapy, Psychological Support, and Nature Exposure (NAT-FM): A Pragmatic Randomized Controlled TrialMayte Serrat0Míriam Almirall1Marta Musté2Juan P. Sanabria-Mazo3Albert Feliu-Soler4Jorge L. Méndez-Ulrich5Juan V. Luciano6Antoni Sanz7Unitat d’Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, SpainUnitat d’Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, SpainUnitat d’Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Passeig Vall d’Hebron 119-129, 08035 Barcelona, SpainStress and Health Research Group, Departament de Psicologia Bàsica, Evolutiva i de l’Educació, Universitat Autònoma de Barcelona, 08193 Bellaterra, SpainStress and Health Research Group, Departament de Psicologia Bàsica, Evolutiva i de l’Educació, Universitat Autònoma de Barcelona, 08193 Bellaterra, SpainResearch Group on Socioeducative Interventions in Childhood and Youth (GRISIJ), Department of Methods of Research and Diagnosis in Education, Faculty on Education, University of Barcelona, 08007 Barcelona, SpainInstitut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Catalonia, SpainStress and Health Research Group, Departament de Psicologia Bàsica, Evolutiva i de l’Educació, Universitat Autònoma de Barcelona, 08193 Bellaterra, SpainA 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 affect, 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 effects 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-effects models and mediational models through path analyses were computed. Overall, TAU + NAT-FM was significantly more effective 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-efficacy. 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 effective co-adjuvant multicomponent treatment for improving FM-related symptoms.https://www.mdpi.com/2077-0383/9/10/3348fibromyalgiamulticomponent treatmentpain neuroscience educationexercise therapycognitive behavioral therapymindfulness |
| spellingShingle | Mayte Serrat Míriam Almirall Marta Musté Juan P. Sanabria-Mazo Albert Feliu-Soler Jorge L. Méndez-Ulrich Juan V. Luciano Antoni Sanz 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 Journal of Clinical Medicine fibromyalgia multicomponent treatment pain neuroscience education exercise therapy cognitive behavioral therapy mindfulness |
| 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | fibromyalgia multicomponent treatment pain neuroscience education exercise therapy cognitive behavioral therapy mindfulness |
| url | https://www.mdpi.com/2077-0383/9/10/3348 |
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