Effectiveness and Cost-effectiveness of Modified Pilates Method Versus Aerobic Exercise in Patients With Fibromyalgia

Fibromyalgia Clinical Trial

Official title:

Effectiveness and Cost-effectiveness of Modified Pilates Method Versus Aerobic Exercise in the Treatment of Patients With Fibromyalgia: a Randomized Controlled Trial

Clinical Trial Details — Status: Active, not recruiting

Administrative data

• NCT number: NCT03050606
• Other study ID #: UNICID15
• Status: Active, not recruiting
• Phase: N/A
• Start date: February 15, 2017
• Est. completion date: December 22, 2020

Study information

• Verified date: March 2020
• Source: Universidade Cidade de Sao Paulo
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Fibromyalgia is a rheumatologic disease characterized by generalized chronic pain, hyperalgesia and allodynia. Physical exercises are recommended as the first choice of non-pharmacological therapy. Thus, the purpose of this study is to evaluate the effectiveness and cost-effectiveness of modified Pilates method exercises compared to aerobic exercises in the treatment of patients with fibromyalgia. The hypothesis is that Pilates exercises will be as effective as aerobic exercise in the improvement of clinical outcomes, and that this improvement will be maintained over the medium to long term. It is also expected that aerobic exercises will be more cost-effective.

Description:

Fibromyalgia is a rheumatologic disease characterized by generalized chronic pain, hyperalgesia and allodynia. Physical exercises are recommended as the first choice of non-pharmacological therapy. Thus, the purpose of this study is to evaluate the effectiveness and cost-effectiveness of modified Pilates method exercises compared to aerobic exercise in the treatment of patients with fibromyalgia. For this, the following outcomes of 98 patients will be evaluated by a blinded evaluator at baseline, 8 weeks, 6 and 12 months after randomization: fibromyalgia impact assessed by the Fibromyalgia Impact Questionnaire, pain intensity assessed by the Pain Numerical Rating Scale, kinesiophobia assessed by the Tampa Scale for Kinesiophobia, specific disability assessed by the Patient-Specific Functional Scale, functional capacity assessed by the 6-minute Walk Test, quality of sleep assessed by the Pittsburgh Sleep Quality Index, and health-related quality of life assessed by the EQ-5D-3L and SF-6D questionnaires. Participants will be randomly divided into Aerobic Group, who will perform aerobic exercises on treadmills and/or stationary bikes, and Pilates Group, which will perform exercises of the modified Pilates method. Both groups will be treated for eight weeks, twice a week. The hypothesis is that Pilates exercises will be as effective as aerobic exercise in the improvement of clinical outcomes, and that this improvement will be maintained over the medium to long term. It is also expected that aerobic exercises will be more cost-effective.

Recruitment information / eligibility

• Status: Active, not recruiting
• Enrollment: 98
• Est. completion date: December 22, 2020
• Est. primary completion date: December 22, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 20 Years to 75 Years

Eligibility

Inclusion Criteria:

• Patients that meet the criteria for classification of fibromyalgia according to the criteria of the American College of Rheumatology 2010; and

• Pain intensity greater than or equal to 3 points in the Pain Numerical Rating Scale

Exclusion Criteria:

• Contraindications to physical exercise

• Pregnancy

• Uncontrolled systemic diseases (diabetes mellitus, systemic arterial hypertension and thyroid dysfunctions);

• Neurological, cardiorespiratory and musculoskeletal conditions that interfere with treatment such as: paralysis, significant changes in sensitivity, changes in level of consciousness and understanding, advanced joint diseases (severe arthrosis, hip or knee arthroplasty, severe rheumatoid arthritis), cervicalgia with irradiation to the upper limbs, among others;

• Injury or severe pain in the lower limbs that limit the performance of aerobic exercises: meniscus injury, plantar fasciitis, among others;

• Partial or total muscular ruptures;

• Amputations;

• Recent postoperative; and

• Inability to understand the writing and speaking of the Portuguese language.

Related Conditions & MeSH terms

• Fibromyalgia
• Myofascial Pain Syndromes

Intervention

Other:
• Pilates
Exercises performed on the mat and apparatus, following the six principles of the Pilates method. The exercises will be performed in three levels of difficulty: basic, intermediate and advanced, according to the capacity of the patient.
• Aerobic
Aerobic exercise will be carried out individually on treadmills or stationary bikes. The intensity of the training will be mild to moderate (57% to 76% of the maximal heart rate monitored by the frequencymeter).

Locations

Country	Name	City	State
Brazil	Physical Therapy Outpatient Department	Sao Paulo

Sponsors (1)

Lead Sponsor	Collaborator
Universidade Cidade de Sao Paulo

Country where clinical trial is conducted

Brazil, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Fibromyalgia impact	This outcome will be evaluated by the Fibromyalgia Impact Questionnaire (FIQ) which is composed of 10 items. Item 1 contains 10 questions related to functionality, each of these issues being evaluated by a 4-point Likert scale, which ranges from 0 (always) to 3 (never). In items 2 and 3, the patient scores the number of days that felt well and that was unable to work due to fibromyalgia in the last seven days. Items 4 to 10 are composed of numerical scales that assess difficulty for work, pain, fatigue, morning tiredness, stiffness, anxiety and depression. The FIQ score ranges from 0 to 100 points and the higher values indicate greater fibromyalgia impact on quality of life.	Eight weeks after randomization
Secondary	Fibromyalgia impact	This outcome will be evaluated by the Fibromyalgia Impact Questionnaire (FIQ) which is composed of 10 items. Item 1 contains 10 questions related to functionality, each of these issues being evaluated by a 4-point Likert scale, which ranges from 0 (always) to 3 (never). In items 2 and 3, the patient scores the number of days that felt well and that was unable to work due to fibromyalgia in the last seven days. Items 4 to 10 are composed of numerical scales that assess difficulty for work, pain, fatigue, morning tiredness, stiffness, anxiety and depression. The FIQ score ranges from 0 to 100 points and the higher values indicate greater fibromyalgia impact on quality of life.	Six and twelve months after randomization
Secondary	Pain intensity	This outcome will be evaluated by an 11-point scale ranging from 0 to 10, in which 0 represents "no pain" and 10 represents "pain as bad as it could be." The participant will classify his average pain in the last 7days.	Eight weeks, six and twelve months after randomization
Secondary	Pain intensity	This outcome will be evaluated by an 11-point scale ranging from 0 to 10, in which 0 represents "no pain" and 10 represents "pain as bad as it could be." The participant will classify his average pain before and after each treatment session .	Eigth weeks, before and after each intervention session
Secondary	Functional capacity	This outcome will be assessed using the 6-Minute Walk Test. Two cones will be used, which will mark the starting point and 30 meters, where the patient will turn around and continue walking without hesitation. The area of the test will also have markings every 3 meters. The patient should walk for 6 minutes, as fast as he can, without running, while the evaluator will control the time (for 6 minutes) and count how many laps the patient performs (each turn corresponds to 60 meters). When the stopwatch is stopped, the evaluator will say "stop" and mark the point where the patient stopped with a tape. After the test, the evaluator will request that the patient answer to the Borg's range of effort perception. The measurement of the walked distance will be made by the number of laps added to the meters walked until the patient stops.	Eight weeks after randomization
Secondary	Kinesiophobia	This outcome will be evaluated by a 17-item questionnaire. The score of each question varies from 1 ("strongly disagree") to 4 ("strongly agree") points. For the total score, the scores of the questions 4, 8, 12, and 16 should be inverted. The final score can vary from 17 to 68 points, and the higher the score, the greater the degree of kinesiophobia.	Eight weeks, six and twelve months after randomization
Secondary	Quality of sleep	This outcome will be evaluated by the Pittsburgh Sleep Quality Index, where the patient will report sleep quality in the last month. The questionnaire consists of 19 self-evaluation questions. The 19 questions are classified into seven components (subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, sleeping medication use and daytime dysfunction), which are rated at a score ranging from 0 to 3 (0 = none in the last month, 1 = less than 1 time/week, 2 = 1 or 2 times/week, 3 = 3 or more times/week). The sum of the scores for these 7 components ranges from 0 to 21, where the highest score indicates poorer sleep quality.	Eight weeks, six and twelve months after randomization
Secondary	Specific disability	This outcome will be evaluated using the Patient-Specific Functional Scale. The participants will identify 3 significant activities that are difficult or that are unable to perform because of fibromyalgia. Next, the participants will rate how able they feel to perform these activities on an 11-point scale (0 to 10), with 0 representing "unable to perform activity" and 10 "able to perform the activity at preinjury level." The final score is the mean of the 3 ratings, and the higher the score, the greater the specific ability.	Eight weeks, six and twelve months after randomization
Secondary	Health-related quality of life using the EQ-5D-3L	This outcome will be evaluated by the Euroqol 5 dimensions (EQ-5D-3L). The EQ-5D-3L questionnaire is a generic measure that assesses health-related quality of life through five dimensions, and each dimension with three levels. Health states are labeled with a five-digit numeric code that represents the severity level in each dimension.	Eight weeks, six and twelve months after randomization
Secondary	Health-related quality of life using the SF-6D	This outcome will be evaluated by the Short-Form 6 dimensions (SF-6D). The SF-6D questionnaire also measures health-related quality of life, through six domains: functional capacity, global limitation, social aspects, pain, mental health and vitality. The SF-6D score represents the strength of an individual's preference for a particular health condition, ranging from zero to one, where zero corresponds to the worst health condition and one corresponds to the best health status.	Eight weeks, six and twelve months after randomization