Serrat Mayte, Almirall Míriam, Musté Marta, Sanabria-Mazo Juan P, Feliu-Soler Albert, Méndez-Ulrich Jorge L, Luciano Juan V, Sanz Antoni
Unitat d'Expertesa en Síndromes de Sensibilització Central, Servei de Reumatologia, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
Stress and Health Research Group, Departament de Psicologia Bàsica, Evolutiva i de l'Educació, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain.
J Clin Med. 2020 Oct 18;9(10):3348. doi: 10.3390/jcm9103348.
A recent study (FIBROWALK has supported the effectiveness of a multicomponent treatment based on pain neuroscience education (PNE), exercise therapy (TE), cognitive behavioral therapy (CBT), and mindfulness in patients with fibromyalgia. The aim of the present RCT was: (a) to analyze the effectiveness of a 12-week multicomponent treatment (nature activity therapy for fibromyalgia, NAT-FM) based on the same therapeutic components described above plus nature exposure to maximize improvements in functional impairment (primary outcome), as well as pain, fatigue, anxiety-depression, physical functioning, positive and negative affect, self-esteem, and perceived stress (secondary outcomes), and kinesiophobia, pain catastrophizing thoughts, personal perceived competence, and cognitive emotion regulation (process variables) compared with treatment as usual (TAU); (b) to preliminarily assess the effects of the nature-based activities included (yoga, Nordic walking, nature photography, and Shinrin Yoku); and (c) to examine whether the positive effects of TAU + NAT-FM on primary and secondary outcomes at post-treatment were mediated through baseline to six-week changes in process variables. A total of 169 FM patients were randomized into two study arms: TAU + NAT-FM vs. TAU alone. Data were collected at baseline, at six-week of treatment, at post-treatment, and throughout treatment by ecological momentary assessment (EMA). Using an intention to treat (ITT) approach, linear mixed-effects models and mediational models through path analyses were computed. Overall, TAU + NAT-FM was significantly more effective than TAU at posttreatment for the primary and secondary outcomes evaluated, as well as for the process variables. Moderate-to-large effect sizes were achieved at six-weeks for functional impairment, anxiety, kinesiophobia, perceived competence, and positive reappraisal. The number needed to treat (NNT) was 3 (95%CI = 1.6-3.2). The nature activities yielded an improvement in affective valence, arousal, dominance, fatigue, pain, stress, and self-efficacy. Kinesiophobia and perceived competence were the mediators that could explain a significant part of the improvements obtained with TAU + NAT-FM treatment. TAU + NAT-FM is an effective co-adjuvant multicomponent treatment for improving FM-related symptoms.
最近的一项研究（纤维肌痛行走研究）证实了一种基于疼痛神经科学教育（PNE）、运动疗法（TE）、认知行为疗法（CBT）和正念的多成分治疗方法对纤维肌痛患者的有效性。本随机对照试验的目的是：（a）分析一种为期12周的多成分治疗方法（纤维肌痛自然活动疗法，NAT-FM）的有效性，该方法基于上述相同的治疗成分，并增加自然接触，以最大限度地改善功能障碍（主要结局），以及疼痛、疲劳、焦虑抑郁、身体功能、正负性情绪、自尊和感知压力（次要结局），以及运动恐惧、疼痛灾难化思维、个人感知能力和认知情绪调节（过程变量），并与常规治疗（TAU）进行比较；（b）初步评估所包含的基于自然的活动（瑜伽、北欧健走、自然摄影和森林浴）的效果；（c）研究TAU + NAT-FM在治疗后对主要和次要结局的积极影响是否通过过程变量从基线到六周的变化进行介导。共有169名纤维肌痛患者被随机分为两个研究组：TAU + NAT-FM组和单独的TAU组。在基线、治疗六周时、治疗后以及整个治疗过程中通过生态瞬时评估（EMA）收集数据。采用意向性分析（ITT）方法，计算线性混合效应模型和通过路径分析的中介模型。总体而言，在治疗后，TAU + NAT-FM在评估的主要和次要结局以及过程变量方面显著比TAU更有效。在六周时，功能障碍、焦虑、运动恐惧、感知能力和积极重新评价方面达到了中到较大的效应量。治疗所需人数（NNT）为3（95%CI = 1.6 - 3.2）。自然活动在情感效价、唤醒、支配、疲劳、疼痛、压力和自我效能方面产生了改善。运动恐惧和感知能力是可以解释TAU + NAT-FM治疗所获得改善的很大一部分的中介因素。TAU + NAT-FM是一种有效的辅助多成分治疗方法，可改善与纤维肌痛相关的症状。
