Rivas Neira S.1,2, Pasqual Marques A.2, Fernández Cervantes R.1, Vivas Costa J.1
1Universidade da Coruña, Fisioterapia, A Coruña, Spain, 2Universidade de São Paulo, Faculdade de Medicina, São Paulo, Brazil
Background: Recently, balance disorders have been observed in fibromyalgia, causing limitations in patients' daily activities for fear of falling. Aquatic therapy has been used for managing fibromyalgia symptoms; however, further studies with a good methodological control are needed to demonstrate its effectiveness.
Purpose: Determine the effectiveness of two physiotherapy protocols, in water vs. land, in women with fibromyalgia to improve functional balance and decrease pain.
Methods: Forty women (mean age = 49.98 years; SD = 9.10), diagnosed with fibromyalgia, were recruited from the Fibromyalgia, Chronic Fatigue Syndrome and Multiple Chemical Sensitivity Association, in A Coruña (Spain). Following consent, participants were randomly assigned into 2 groups: Aquatic Therapy (n = 20) or Land-based Therapy (n = 20). Both interventions included 60-minute sessions, structured into 4 sections: Warm-up Balance Exercises Stretching Relaxation. They were carried out three times a week for three months, with a total of 38 sessions. Primary outcomes were functional balance, measured with the Berg scale and the Activities-specific Balance Confidence scale and pain, using the Visual Analogue Scale (VAS). Secondary outcomes included quality of life, using the Revised Fibromyalgia Impact Questionnaire; sleep quality, with the Pittsburgh Sleep Quality Index (PSQI) and fatigue, using the Multidimensional Fatigue Inventory. Outcome measures were completed at baseline, three months and 6-weeks post-treatment. A significance level of p ≤ 0.05 was set for all tests.
Results: At the end of interventions, both groups experienced significant improvements in all study outcomes; with the exception of sleep quality in land-based therapy patients. After the 6-weeks follow-up, the aquatic therapy group maintained all these improvements; however, the land-based therapy group experienced a regression in functional balance (Berg, p = 0.013) and pain (EVA, p = 0.021). Following the intervention period, no significant differences were found in between-group comparisons, but at 6-weeks follow-up, clinical results were better for aquatic therapy in terms of pain (EVA, p = 0.02) and sleep quality
(PSQI, p = 0.03).
Conclusion(s): Regarding pain and sleep quality, aquatic therapy demonstrated to be more beneficial than land-based therapy. In addition, the improvements achieved were maintained longer with aquatic therapy. Future studies should consider a methodology that includes more accurate measures for balance assessment.
Implications: The results of this study suggest that aquatic therapy is an effective treatment alternative to manage the fibromyalgia symptoms. Physical and physiological water properties make it a perfect environment to improve functional balance, pain and sleep quality.
Funding acknowledgements: No funding.
Topic: Rheumatology
Ethics approval: Ethics approval was granted by the Research Ethics Committee of A Coruña-Ferrol, Spain; with the registration code 2015/021.
All authors, affiliations and abstracts have been published as submitted.
