Trevisan D.C.1,2, Driusso P.1, Avila M.A.3,4, Gramani-Say K.5, Moreira F.M.A.2,6, Parizotto N.A.1,2
1Federal University of São Carlos - UFSCar, Physical Therapy Department, Sao Carlos, Brazil, 2Federal University of Sao Carlos, Biotechnology Graduate Program, Sao Carlos, Brazil, 3Federal University of Sao Carlos, Physical Therapy Department, Sao Carlos, Brazil, 4Centro Universitário Central Paulista, Physical Therapy Department, São Carlos, Brazil, 5Federal University of São Carlos - UFSCar, Gerontology Department, Sao Carlos, Brazil, 6Federal University of São Carlos - UFSCar, Physics Department, Sao Carlos, Brazil
Background: Fibromyalgia Syndrome (FMS) is a non-inflammatory chronic pain disease characterized by several symptoms, such as non-restorative sleep, fatigue and depression. Another important and frequent complaint of patients with FMS is are related to balance, that can be linked to the pain, muscle weakness and symptoms severity they experience. These balance difficulties may interfere negatively in quality of life and predispose FMS patients to a greater fall risk and physical incapacity.
Purpose: This cross-sectional study aimed to compare static postural control of women with and without FMS, correlating findings in postural control to variables of pain, fatigue, depression, anxiety and sleep.
Methods: Twenty-nine women with FMS and 20 without FMS were evaluated by means of posturography in six different situations (bipedal, right tandem and left tandem, with eyes opened and closed). Posturography variables were statokinesigram area (in cm²), mean amplitude (obtained by the root mean square RMS calculation) and mean velocity (in cm/s) at anteroposterior (AP) and mediolateral (ML) directions. Other variables were assessed by questionnaires for clinical depression symptoms (Beck Depression Inventory BDI), clinical anxiety symptoms (Beck Anxiety Inventory BAI), sleep quality (Pittsburgh Sleep Quality Index PSQI), along with Visual Analogue Scales (VAS) for Pain and Fatigue. Mann-Whitney U test was used to check differences among groups; Cohen d coefficient was used to measure effect sizes and Pearson Correlation Coefficient was used for correlations among variables. Level of significance adopted was 5%.
Results: Women with FMS have presented worse postural control than women without FMS in all situations (p 0.05), and worse scores in all questionnaires (p 0.05). In the closed eyes situations, women with FMS presented worse postural control than women without FMS in the same conditions. In bipedal stance, patients with FMS presented greater sway area and AP RMS with eyes opened (p 0.05,ES from 0.45 to 0.70) and greater area, ML and AP RMS (p 0.05,ES from 0.45 to 0.65). In the tandem positions with eyes opened and closed, patients with FMS presented greater sway area, RMS and velocity at both AP and ML directions (p 0.05, ES from 0.77 to 2.42). Positive low to moderate correlations were found among VAS for fatigue and all variables (p 0.05;R from 0.25 to 0.58). VAS for pain showed low to high correlations with right and left tandem positions with eyes opened and closed for all variables (p 0.05;R from 0.30 to 0.72).
Conclusion(s): Women with FMS have worse performance in the static posture test, more prominent in reduced support bases with eyes closed. Pain, fatigue, depression and anxiety may have directly influenced postural control in patients with FMS.
Implications: When treating patients with FMS, it is important to include balance exercises, in defying positions (tandem, unilateral stance) and situations (eyes closed), in order to preserve or regain postural control and hence avoid falls. It is also important to control symptoms such as pain and fatigue, which are likely to interfere negatively on balance.
Funding acknowledgements: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES).
Topic: Pain & pain management
Ethics approval: Ethics Committee on Human Research from Federal University of São Carlos (protocol number 010/2012); Study registry at ClinicalTrials.gov (number NTC01839305).
All authors, affiliations and abstracts have been published as submitted.
