Abstract
Balance impairment is a frequent disorder in patients with fibromyalgia (FMS), increasing the risk of falls and decreasing physical function and quality of life. In recent years, the use of active therapy-based training (ATBT) has increased, with the aim of improving balance in women with FMS. Our study aimed to assess the effect of ATBT to improve different balance outcomes in subjects with FMS. A systematic review with meta-analysis was carried out. We searched PubMed Medline, SCOPUS, Web of Science, CINAHL, and PEDro (Physiotherapy Evidence Database) databases up to September 2020. We included randomized controlled trials (RCT) that assessed the balance in patients with FMS after ATBT and compared to other treatments or no intervention. In a random-effects model, the standardized mean difference (SMD) was used to calculate the effect size. Ten studies were included in the review providing data from 546 FMS patients with a mean age of 52.41 ± 2.90 years old (98% females). Our results showed a medium effect favors ATBT with respect to other therapies for monopedal static balance (SMD = 0.571; 95% CI = 0.305, 0.836; p < 0.001), dynamic balance (SMD = 0.618; 95% CI = 0.348, 0.888; p < 0.001), and functional balance (SMD = 0.409; 95% CI = 0.044, 0.774; p = 0.028). No statistically significant differences were found for balance on unstable support. The present meta-analysis showed moderate-quality evidence of a medium effect of ATBT to improve dynamic and functional balance and low-quality evidence of a medium effect to improve monopedal static balance with respect to other therapies or no intervention.
Highlights
Fibromyalgia Syndrome (FMS) is defined as a chronic disorder characterized by widespread and persistent non-inflammatory musculoskeletal pain that includes concomitant symptoms such as fatigue, insomnia, morning stiffness, depression, anxiety, and cognitive problems [1]
The inclusion criteria used were as follows: (1) Experimental studies, including randomized controlled trials (RCT) and RCT pilot studies; (2) studies that included patients diagnosed with FMS; (3) studies in which the intervention group received a treatment based on active therapy-based training (ATBT); (4) studies with a comparison group that received a different therapy to the intervention group or did not receive any therapy; (5) studies that assessed postural balance as an outcome measure; and (6) studies that provided data susceptible to be used in the quantitative synthesis
The benefits that physical exercise has in the management of patients with FMS has been reported previously, our results show the benefits that ATBT provides for balance in FMS patients
Summary
Fibromyalgia Syndrome (FMS) is defined as a chronic disorder characterized by widespread and persistent non-inflammatory musculoskeletal pain that includes concomitant symptoms such as fatigue, insomnia, morning stiffness, depression, anxiety, and cognitive problems (forgetfulness, concentration difficulties, mental slowness, and memory and attention problems) [1]. There are multiple evidence-based treatment guidelines for FMS, and all of them recommend standard symptomatic or pain pharmacological therapy (such as anti-epileptic drugs, anti-depressants, and muscle relaxants) and physical exercise in the form of aerobic, resistance, or flexibility training [7]. The high frequency of balance disorders in patients with FMS and the resulting consequences, such as an increased falls risk, which can produce musculoskeletal damage added as bone fractures or disabling contusions [13] that reduce more the functional capacity of an individual with FMS, have led to a growing interest in the efficacy of exercise to improve balance and/or to reduce the risk of falls in subjects with FMS. To the best of our knowledge, there are no meta-analyses analyzing the effect of this therapy on balance in FMS subjects. The aim of this systematic review and meta-analysis was to search for the best evidence and to analyze the effects of active therapy-based training (ATBT) on balance in subjects with FMS
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