ВПЛИВ ГІДРОКІНЕЗОТЕРАПІЇ НА СТАН ПАЦІЄНТІВ З LONG-TERM ФІБРОМІАЛГІЄЮ
LONG-TERM EFFECTIVENESS OF POOL EXERCISE THERAPY AND EDUCATION IN PATIENTS WITH FIBROMYALGIA
Jo Nijs, Martine Van Parijs
Vrije Universiteit Brüssel (VUB), Belgium and Division of Musculoskeletal Physical Therapy, Department of Health Sciences, Hogeschool Antwerpen, Belgium. *
Department of Health Sciences, Hogeschool Antwerpen, Belgium.
Анотація. Джо Нійс, Мартін Ван Парійс. Вплив гідрокінезотерапії на стан пацієнтів з фіброміалгією. У статті розглядається ефективність включення фізичної терапії в басейні до навчальних програм пацієнтів з фіброміалгією.
Ключові слова: фізична терапія у басейні, фіброміалгія, навчання, лікування.
Аннотация. Джо Нийс, Мартин Ван Парийс. Влияние гидокинезеотерапии на состояние пациентов с фибромиалгией. В статье раскрывается эффективность физической терапии в бассейне в учебных программах пациентов с фибромиалгией.
Ключевые слова: физическая терапия в бассейне, фибромиалгия, обучение, лечение.
Abstract. Jo Nijs, Martine Van Parijs. Long-term effectiveness of pool exercise therapy and education in patients with fibromyalgia. The effectiveness of pool exercise therapy in combination with an education program.
Key words: pool exercise therapy, fibromyalgia, education, trearment.
The study of interest in the present review reported on the long-term follow-up of a randomized controlled clinical trial examining the effectiveness of pool exercise therapy in combination with an education program over no treatment in patients with FMS (1, 2). For inclusion of subjects into the trial, other rheumatic diseases and severe somatic or psychiatric disorders were excluded in order to obtain a sample of primary FMS-subjects. The treatment comprised of 6 months of training exercise in a temperate pool (one 35 minutes lasting session a week for six months in groups of 6 to 10 patients) and an educational program (consisting of six 1 hour sessions, once a week). The education sessions aimed at teaching FMS patients self-management skills (learning how to cope with the illness) and to encourage physical activity. Each session of pool therapy contained endurance, flexibility, coordination, and relaxation exercises. All participants were instructed to adjust the exercises individually with respect to their own pain/fatigue threshold. This way, the pool exercise program differs substantially from graded exercise therapies. The main topics of the education program were: symptoms and explanatory theories for long-lasting pain (including theories on central pain processing), usage of different techniques of pain alleviation, active and passive modes of relaxation, and lifestyle changes (identification and consequent modification of possible causes that may increase pain severity). All interventions were led by a physical therapist.
The results of the study point towards positive effects of pool therapy in combination with education, compared to no treatment, in patients with FMS (1). Comparing the therapy group with the control group, statistically significant improvements were found for both primary outcome measures (i. e., the Fibromyalgia Impact Questionnaire total score and the distance covered during the 6 minutes walk test). Interestingly, a sense of pleasure during exercising in the pool (joy about a mode of physical training that did not increase pain, and the ability to relax in the water) was reported by the participants. The improvements in the treatment group (symptom severity, physical functioning, and quality of life) were still seen at 6- and 24-month follow-up. Since the FMS subjects who had been randomized to the control group had been offered treatment at the end of their control period, these patients were not available for the long-term follow-up study (2). These long-term results may, at least in part, be attributed by the high number of subjects in the treatment group who, at the end of the initial study, reported that they had made some changes to their lifestyle (22/28 or 79%). These lifestyle changes mainly addressed self-management techniques in order to enhance their own well-being, including acceptance of their own limits, making priorities in their everyday life, and increasing their level of physical training.
During the past decade, a number of studies addressing the effectiveness of physical exercise therapy in patients with Fibromyalgia Syndrome (FMS) have been published. One study showed positive effects of self-management techniques in combination with physical exercise therapy (3), while Martin and colleagues (4) found exercise training (comprised of aerobic exercise, flexibility training, and strengthening exercise) to be superior over relaxation therapy. Buckelew et al. (5) reported a positive long-term outcome of exercise therapy in combination with relaxation. Although Wigers and colleagues (6) found good short-term effectiveness of both aerobic exercise training and stress-management, the four-year follow-up study revealed extinction of the initial effects. Two additional studies reported favourable results of cardiovascular fitness training (7, 8). Gowans and colleagues reported significant improvements in the 6-minutes walk test, well-being, fatigue, self-effi-cacy, and knowledge after a 6-week exercise and educational program for patients with FMS. The follow-up study also indicated gains in walking distance, well-being, and self-efficacy (9). Addressing the effectiveness of pool therapy