Chiaramonte, Rita; Bonfiglio, Marco; Chisari, Sergio

doi:10.1590/1806-9282.65.10.1265

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Sumário

ORIGINAL ARTICLE • Rev. Assoc. Med. Bras. 65 (10) • Out 2019 • https://doi.org/10.1590/1806-9282.65.10.1265 copiar

Multidisciplinary protocol for the management of fibromyalgia associated with imbalance. Our experience and literature review

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

OBJETIVO

Relatamos nosso protocolo multidisciplinar para o manejo da fibromialgia associada ao desequilíbrio. Nosso objetivo foi verificar a eficácia do programa de treinamento proprioceptivo como terapia complementar de um protocolo tradicional (exercícios aeróbicos, de resistência e flexibilidade).

MÉTODOS

Estudo retrospectivo em 84 mulheres com fibromialgia primária associada a desequilíbrio. Um grupo de pacientes realizou o treinamento tradicional; em um segundo grupo o treinamento foi complementado com exercícios de propriocepção. Cada sessão durou de 40 a 60 minutos e foi realizada três vezes por semana durante 12 semanas.

RESULTADOS

Após três meses de treinamento e oito meses após o término do treinamento, a avaliação do equilíbrio revelou diferenças signiﬁcativas nos testes Timed Up and Go, Escala de Equilíbrio de Berg e Escala de Tinetti em comparação com a linha de base, com uma melhora maior no grupo de treinamento proprioceptivo (p<0,05). Redução da dor e melhora do desempenho funcional e muscular e da qualidade de vida foram observadas em ambos os grupos (p<0,05), mas sem diferenças significativas entre eles na Escala Numérica de Dor, Fibromyalgia Impact Questionnaire e Short Form Health Survey (p>0,05). Quinze meses após o final do programa, os efeitos do treinamento não foram mantidos.

CONCLUSÃO

O presente estudo revelou que o treinamento suplementado com exercícios de propriocepção tem efeitos benéficos sobre os achados clínicos e melhora o equilíbrio em pacientes com fibromialgia, mesmo que os resultados positivos não tenham persistido após a interrupção do programa de reabilitação no longo prazo.

Fibromialgia; Equilíbrio postural; Dor crônica; Protocolos clínicos; Qualidade de vida

Exercise	Description	Progression
WARM-UP 10’
Walking	Walking	Increase in time and speed
Swimming pool sessions	34˚C water	Overall mobility using water as resistance
Core stability	With breathing exercises
AEROBIC EXERCISES 20’
Walking on the treadmill	With an initial speed of 6 and no inclination	Increase in time and speed
ANAEROBIC EXERCISES 10’
Lower limb exercises
Anterior, lateral, zigzag, and circles straight leg raise	In supine or side-lying	Increase in external resistance (elastic band)
Hip exercise	Side-lying with knee extension. Horizontal hip abduction	Increase in external resistance (elastic band) /isometry at the end of the series (10 s)
Bridge exercise	–	Bipodal and unipodal support
Stand up and sit down	–	Straight back
Mini squats with bipodal and unipodal support	Bilateral squats: 8 sets of 30 seconds with 45 seconds of recovery between sets	Unilateral squat: 5 sets of 30 seconds, with 45 seconds of recovery between sets
Forward lunge	–	Sideway lunge
Up and down stairs	–	Load in the ankle (1 kg)
Calf raises	–	Bipodal and unipodal support
Upper limb exercises
Shoulders elevation	Shoulder flexion on scapular plane	Increase external resistance (elastic band)
Pull back exercise	Shoulder extension + elbow flexion + scapular adduction	Increase external resistance (elastic band)
Pull down exercise	Shoulder extension with straight elbow	Increase in external resistance (elastic band)
Push up exercise	–	Upper support on step
Trunk exercises
Elbow plank exercise	Support on knee	Increase in time
One side plank exercise	In side-lying	Increase in time
PROPRIOCEPTIVE TRAINING 10’
Coordination exercises with open and closed eyes	Movement with the head (head left, right, up and down	Balancing on both feet and one foot
Unipodal balance	Stand on one leg whit opened eyes (3×1 min)	Associate tasks with upper limbs and with contralateral lower limb
Stand up and sit down	–	Bipodal and unipodal support
Standing on balance pads	With eyes open and closed	Balancing on both feet and one foot
Tandem exercises, bending exercises, lateral and backward movements, skipping, scissoring gait, rolling and twisting exercises,	With eyes open and closed	Balancing on both feet and one foot
Freeman board training	Walk on unstable ground, like sand	During dual-task like forward counting
Postural biofeedback exercises	Catch, speedball, sky ball	With more coordination
STRETCHING 10’
Flexibility exercises	Static stretching of great muscles groups: elongation of neck, shoulder, spine, hamstring, quadriceps, gastrocnemius	6 repetitions for each muscle group. Increase in time (5–10 min)
Breathing exercises	With accessory respiratory muscles	For 3 minutes

Scales	Group 1 Score	Group 1 Score	Group 1 Paired t Test	Group 1 P value	IC-95%		Group 2 Score	Group 2 Score	Group 2 Paired t Test	Group 2 P value	IC-95%
	At T0	AF and 8m	AF and 8m		Group 1		At T0	AF and 8m	AF and 8m		Group 2
					Lower limit	Upper limit					Lower limit	Upper limit
Tender points	14±2.14	12±0.70	t 1.58	p >0.05	0.62	1.48	14±2.24	31±3.54	t 1.62	p > 0.05	-6.49	4.74
N. falls	31±3.84	21±3.45	t 1.90	p > 0.05	1.61	3.82	31±3.54	8±4.01	t 1.96	p > 0.05	5.08	7.37
FIQ	56 ±5.07	38 ±7.02	t 2.68	p < 0.05	1.11	4.77	56±8.02	38±7.65	t 2.69	p < 0.05	-0.36	4.38
NRS	9 ±1.05	6 ±0.98	t 2.79	p < 0.05	0,29	2.72	9±1.90	5±0.95	t 2.72	p < 0.05	2.12	2.98
TUGT	19 ±1.08	10 ±2.01	t 1.23	p > 0.05	0.93	4.34	19±2.01	10±1.85	t 1.48	p > 0.05	4.11	5.28
BBS	28 ±3.01	35 ±2.89	t 1.52	p > 0.05	-3.31	-1,53	28±4.25	44±6.01	t 1.60	p > 0.05	-4.40	-1.29
Tinetti	26 ±2.85	25 ±3.02	t 1.58	p > 0.05	-0.52	1,26	26±2.74	22±3.01	t 1.43	p > 0.05	0.52	2.29
MRC	3 ±0.04	5 ±0.05	t 2.72	p < 0.05	-44.72	-44.69	3±0.12	5±0.62	t 3.98	P < 0.05	-4.57	4.35

	Group 1	Group 2	Impaired t -Test	P-value	IC-95%		Group 1	Group 2	Impaired t -Test	P-value	IC-95%
	AF and 8m	AF and 8m	AF and 8m	AF and 8m	AF and 8m		15 m	15m	15m	15m	15m
					Lower limit	Upper limit					Lower limit	Upper limit
Tender points	12 ±0.50	12 ±0.25	t 0.05	p > 0.05	-0.15	0.08	14 ±0.50	13 ±0.25	t 0.06	p> 0.05	2.41	2.64
N. of falls	21 ±2.01	8 ±1.06	t 2.71	p < 0.05	7.58	8.51	-	-	-	-	-
FIQ	38 ±1.98	38 ±2.51	t 0.09	p > 0.05	-0.60	0.76	51 ±2.98	52 ±1.51	t 0.10	p> 0.05	-1.33	0.03
NRS	6 ±0.10	5 ±0.19	t 0.65	p > 0.05	6.64	6.72	8 ±0.10	8 ±0.19	t 0.68	p> 0.05	-0.03	0.06
TUGT	19 ±2.01	10 ±1.82	t 2.82	p < 0.05	4.14	5.30	18 ±1.01	17 ±0.82	t 1.82	p> 0.05	0,79	1,35
BBS	35 ±5.01	44 ±4.98	t 2.90	p < 0.05	-3.34	-0.32	30 ±1.02	32 ±0.98	t 1.91	p> 0.05	-2.34	1.74
Tinetti	25 ±3.01	22 ±2.74	t 3.09	p < 0.05	0.14	1.88	26 ±1.01	25 ±1.74	t 1.06	p> 0.05	0.41	1.24
MRC	5 ±0.05	5 ±0.09	t 0.81	p > 005	-0.02	0.03	4 ±0.05	4 ±0.09	t 0.84	P> 005	-0.02	0.03

	Group 1	Group 2	Impaired t -Test	P-value	IC-95%
SF-36 after treatment					Lower limit	Upper limit
Pain	50 ±3.84	52 ±4.03	t 0.38	p > 0.05	-1.68	0.70	-	-	-	-	-	-
Fatigue	52 ±2.01	51 ±2.10	t 0.45	p > 0.05	-0.12	1.13	-	-	-	-	-	-
Mobility	39 ±2.86	56 ±4.02	t 2.71	p < 0.05	-5.80	-3.72	-	-	-	-	-	-

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[1] CORRESPONDING AUTHOR: Rita Chiaramonte Department of Physical Medicine and Rehabilitation. University of Catania, via Santa Sofia, 78. 95100 Catania. Italy Fax: +390957315384 – Telephone: +393895114718 E-mail: ritachiaramd@gmail.com