Altan Lale, Bingöl Umit, Aykaç Mehtap, Koç Zarife, Yurtkuran Merih
Rheumatic Disease and Hydrotherapy Section, Uludağ University Medical Faculty, Atatürk Rehabilitation Center, Bursa, Turkey.
Rheumatol Int. 2004 Sep;24(5):272-7. doi: 10.1007/s00296-003-0371-7. Epub 2003 Sep 24.
The aim of this study was to compare pool-based exercise and balneotherapy in fibromyalgia syndrome (FMS) patients.
Fifty female patients diagnosed with FMS according to the American College of Rheumatism (ACR) criteria were randomly assigned to two groups: group 1 (n=25) with pool-based exercise, and in group 2 (n=25) balneotherapy was applied in the same pool without any exercise for 35 min three times a week for 12 weeks. In both groups, pre- (week 0) and post-treatment (weeks 12 and 24) evaluation was performed by one of the authors, who was blind to the patient group. Evaluation parameters included pain, morning stiffness, sleep, tender points, global evaluation by the patient and the physician, fibromyalgia impact questionnaire, chair test, and Beck depression inventory. Statistical analysis was done on data collected from three evaluation stages.
Twenty-four exercise and 22 balneotherapy patients completed the study. Pretreatment (week 0) measurements did not show any difference between the groups. In group 1, statistically significant improvement was observed in all parameters ( P<0.01) except for the chair test at both weeks 12 and 24. In group 2, week 12 measurements showed significant improvement in all parameters ( P<0.01) except for the chair test and Beck depression inventory. Week 24 evaluation results in group 2 showed significant improvements in pain and fatigue according to visual analogue scale (VAS), 5-point scale, number of tender points, algometric and myalgic scores, and patient and physician global evaluation (P<0.01 and P<0.05, respectively), while improvements were nonsignificant in morning stiffness, sleep, fibromyalgia impact questionnaire (FIQ), chair test, and Beck depression inventory parameters in this group. Comparison of the two groups based on the post-treatment (weeks 12 and 24) percent changes and difference scores relative to pretreatment (week 0) values failed to show a significant difference between the groups for any parameter except Beck depression inventory (P<0.01).
The results of our study showed that pool-based exercise had a longer-lasting effect on some of the FMS symptoms, but statistical analysis failed to show a significant superiority of pool-based exercise over balneotherapy without exercise. While we believe that exercise is a gold standard in FMS treatment, we also suggest in light of our results that balneotherapy is among the valid treatment options in FMS, and further research regarding the type and duration of the exercise programs is necessary.
本研究旨在比较纤维肌痛综合征（FMS）患者进行水中运动和温泉疗法的效果。
根据美国风湿病学会（ACR）标准诊断为FMS的50名女性患者被随机分为两组：第1组（n = 25）进行水中运动，第2组（n = 25）在同一温泉池中接受温泉疗法，不进行任何运动，每周3次，每次35分钟，共12周。两组均由一位对患者分组不知情的作者在治疗前（第0周）和治疗后（第12周和第24周）进行评估。评估参数包括疼痛、晨僵、睡眠、压痛点、患者和医生的整体评估、纤维肌痛影响问卷、椅子试验和贝克抑郁量表。对从三个评估阶段收集的数据进行统计分析。
24名进行水中运动和22名接受温泉疗法的患者完成了研究。治疗前（第0周）两组测量结果无差异。在第1组中，除第12周和第24周的椅子试验外，所有参数均有统计学意义的改善（P < 0.01）。在第2组中，第12周测量结果显示除椅子试验和贝克抑郁量表外所有参数均有显著改善（P < 0.01）。第2组第24周评估结果显示，根据视觉模拟量表（VAS）、5分制量表、压痛点数量、痛觉测量和肌痛评分以及患者和医生的整体评估，疼痛和疲劳有显著改善（分别为P < 0.01和P < 0.05），而该组的晨僵、睡眠、纤维肌痛影响问卷（FIQ）、椅子试验和贝克抑郁量表参数改善不显著。基于治疗后（第12周和第24周）相对于治疗前（第0周）值的百分比变化和差异评分对两组进行比较，结果显示除贝克抑郁量表外（P < 0.01），两组在任何参数上均无显著差异。
我们的研究结果表明，水中运动对某些FMS症状有更持久的影响，但统计分析未能显示水中运动比无运动的温泉疗法有显著优势。虽然我们认为运动是FMS治疗的金标准，但根据我们的结果，我们也建议温泉疗法是FMS有效的治疗选择之一，并且有必要对运动方案的类型和持续时间进行进一步研究。
