Avila M.A.1, Camargo P.R.1, Ribeiro I.L.1, Alburquerque-Sendín F.2, Zamunér A.R.1, Salvini T.F.1
1Federal University of São Carlos - UFSCar, Physical Therapy Department, Sao Carlos, Brazil, 2University of Cordoba, Sociosanitary Sciences, Radiology and Physical Medicine Department, Cordoba, Spain
Background: One of the most common complaints of people with fibromyalgia (FM) is shoulder pain, and most of the tender points are located in or have relationship with upper limbs. A previous study has shown that women with FM have altered scapular kinematics compared to a control group. It is well known that hydrotherapy treatment can improve pain and quality of life in women with FM. However, no studies have investigated if these improvements affect scapular kinematics of women with FM.
Purpose: This study aimed to assess scapular kinematics of women with FM before and after a 16-weeks hydrotherapy treatment. Our hypothesis was that an effective treatment would improve pain and quality of life of women with FM, and these improvements would change scapular kinematics.
Methods: Twenty women participated in the study and performed three evaluations before treatment (to establish a baseline), and two other evaluations (after 8 and 16 weeks of hydrotherapy) at the end of treatment. Three-dimensional kinematics of the scapula was evaluated during arm elevation in the scapular plane of movement with the Flock of Birds® system. Patients also answered quality of life and FM impact questionnaires and had pain assessed with a digital algometer. Treatment consisted of 2 weekly hydrotherapy sessions, lasting 45 minutes each, for 16 weeks. Data were analyzed with ANOVA two-way (for kinematics results) and ANOVA one-way (for the other variables). Effect size was assessed with Cohens d coefficient for all quantitative variables. A significance level of 5% was adopted.
Results: Although an important improvement was achieved in terms of pain and quality of life (p 0.05; d>0.8), scapular kinematics did not change after hydrotherapy. The interaction evaluation x angle was not significant (p>0.05), nor was the main effect of evaluation (p>0.05) for scapular internal rotation, upward rotation and posterior tilt during elevation and lowering of the arm (p>0.05); Cohen d coefficients varied from -0.33 to 0.46. Algometry has shown that the only tender points that did not present increase in the pressure pain threshold were right (p>0.05, Cohen d values from 0.03 to 0.54) and left low cervical (p>0.05, Cohen d values from 0.22 to 0.41) and left great trochanter (p>0.05, Cohen d values from 0.21 to 0.71). Impact of FM improved after treatment (p 0.05, Cohen d varying from -1.93 to -0.78) and the only quality of life domain that did not improve was role limitation due to emotional problems (p>0.05, Cohen d from 0.01 to 0.41).
Conclusion(s): Women with FM improved quality of life, pain and FM impact after a 16-week program of hydrotherapy. Pain was significantly improved in shoulder muscles and regions related to the shoulder. However, these benefits did not reflect on alterations in scapular kinematics.
Implications: Shoulder pain in women with FM causes a functional adaptation for shoulder motion, and this adaptation could not be reversed even with improvement of painful symptoms.
Funding acknowledgements: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) and São Paulo Research Foundation (FAPESP) [grant numbers 2011/22122-5 and 2015/50303-5].
Topic: Pain & pain management
Ethics approval: Ethics Committee on Human Research from Federal University of São Carlos (protocol number 485/2011); Study registry at ClinicalTrials.gov (number NTC01839305).
All authors, affiliations and abstracts have been published as submitted.
