Avila Mariana Arias, Camargo Paula Rezende, Ribeiro Ivana Leão, Alburquerque-Sendín Francisco, Zamunér Antonio Roberto, Salvini Tania Fatima
Physical Therapy Department, Federal University of Sao Carlos, SP, Brazil.
Sociosanitary Sciences, Radiology and Physical Medicine Department, University of Cordoba, Spain.
Clin Biomech (Bristol). 2017 Nov;49:145-154. doi: 10.1016/j.clinbiomech.2017.09.012. Epub 2017 Sep 21.
Although hydrotherapy is widely used to treat women with fibromyalgia, no studies have investigated the effects of this intervention on scapular kinematics in this population. This study verified the effectiveness of a hydrotherapy program on scapular kinematics, pain and quality of life in women with fibromyalgia.
Twenty women completed the study and performed three evaluations before treatment (to establish a baseline), and two other evaluations (after 8 and 16weeks of hydrotherapy) at the end of treatment. Three-dimensional kinematics of the scapula was evaluated during arm elevation in two different planes with the Flock of Birds® system. Patients also answered quality of life and Fibromyalgia Impact Questionnaires and had pain assessed with a digital algometer. Treatment consisted of 2 weekly hydrotherapy sessions, lasting 45min each, for 16weeks. Data were analyzed with a two-way ANOVA (for kinematics results) and one-way ANOVA (for the other variables). Effect size was assessed with Cohen's d coefficient for all quantitative variables.
Although an important improvement was achieved in terms of pain and quality of life (P<0.05, effect sizes varied from -1.93 to 1.61 depending on the variable), scapular kinematics did not change after treatment (P>0.05, effect sizes from -0.40 to 0.46 for all kinematic variables).
The proposed program of hydrotherapy was effective to improve quality of life, pain intensity and fibromyalgia impact in women with fibromyalgia. However, scapular kinematics did not change after the period of treatment. Although symptoms improved after the treatment, the lack of changes in scapular kinematics may indicate these women have an adaptive movement pattern due to their chronic painful condition.
尽管水疗法被广泛用于治疗纤维肌痛女性患者，但尚无研究调查该干预措施对这一人群肩胛运动学的影响。本研究验证了水疗方案对纤维肌痛女性患者肩胛运动学、疼痛及生活质量的有效性。
20名女性完成了本研究，在治疗前进行了三次评估（以建立基线），并在治疗结束时进行了另外两次评估（水疗8周和16周后）。使用“鸟群”系统在两个不同平面的手臂抬高过程中评估肩胛骨的三维运动学。患者还回答了生活质量和纤维肌痛影响问卷，并使用数字痛觉计评估疼痛。治疗包括每周2次水疗，每次持续45分钟，共16周。对运动学结果的数据采用双向方差分析，对其他变量采用单向方差分析。对所有定量变量用科恩d系数评估效应大小。
尽管在疼痛和生活质量方面取得了显著改善（P<0.05，效应大小因变量而异，从-1.93到1.61），但治疗后肩胛运动学没有变化（P>0.05，所有运动学变量的效应大小从-0.40到0.46）。
所提出的水疗方案对改善纤维肌痛女性患者的生活质量、疼痛强度和纤维肌痛影响有效。然而，治疗期后肩胛运动学没有变化。尽管治疗后症状有所改善，但肩胛运动学缺乏变化可能表明这些女性由于其慢性疼痛状况而具有适应性运动模式。
