Relationship of Pain, Depression, Fatigue, and Sleep Problems with Functional Capacity, Balance, and Fear of Falling in Women with Fibromyalgia: Cross-Sectional Study

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Generally, the the manuscript covers an important aspect in women health through use of cross-methods of data collection and analysis.

This paper seeks to assess the relationship of pain, depression, fatigue and sleep problems with functional capacity, balance and fear of falling in women with fibromyalgia. 

This manuscript is very clear, relevant and interesting. It is well structured following the journal’s layout of original scientific research. As chronic diseases (non-communicable), active ageing and frailty are topical, researched field is quite important.

The authors had a wide range of cited authorities including the recently published articles. No excessive self-citations were identified in this manuscript. However, the authors are reminded to follow the journal’s intext citations. Revision should be done in the discussion section where authors included the authors’ initials.

Line 120 page 3, authors may remove…’’….at different sites.’’ This is repetition.

Considering that the sample, is for adult Spanish women, the authors were silent about whether the questionnaire used were in English or Spanish, translated thereafter.

We suggest that lines 145-7 need to be revisited and paraphrased as a body composition analyser (TANITA MC 780 MA) can calculate BMI after input of height, thus the process. It reads as if the analyser was only for recording weight.

The manuscript’s results are reproducible basing on the details given in the in the materials and methods section. However, the authors did not clearly explain the different sites used for testing, whether the questionnaires were completed and submitted to the research team during physical tests days or after or were online.

Lines 138 -142, refers of demographic data, however, this data is quiet in the manuscript, and we wonder the reason of collecting this data as no correlation is drawn to critical questions that may come with the mentioned demographic characteristics’ long-term effects to women’s health eg., age, employment, smoking and drinking, sleep problems, stress and depression.

All tables and figures in the manuscript are appropriately used and clear to read, although we feel critical information on demographic data is missing in Table A, line 330. They show consistency in data analysis and can be easily interpreted.

Conclusions are consistent with the evidence and arguments presented.

Author Response

Generally, the the manuscript covers an important aspect in women health through use of cross-methods of data collection and analysis.

This paper seeks to assess the relationship of pain, depression, fatigue and sleep problems with functional capacity, balance and fear of falling in women with fibromyalgia. 

This manuscript is very clear, relevant and interesting. It is well structured following the journal’s layout of original scientific research. As chronic diseases (non-communicable), active ageing and frailty are topical, researched field is quite important.

The authors had a wide range of cited authorities including the recently published articles. No excessive self-citations were identified in this manuscript. However, the authors are reminded to follow the journal’s intext citations. Revision should be done in the discussion section where authors included the authors’ initials.

Author’s response:

Dear Reviewer,

We authors appreciate all your comments and recommendations to improve the presentation of our research in this manuscript. Below we respond to all your comments, indicating changes in the manuscript and appropriate clarifications.

Line 120 page 3, authors may remove…’’….at different sites.’’ This is repetition.

Author’s response:

Amended.

Considering that the sample, is for adult Spanish women, the authors were silent about whether the questionnaire used were in English or Spanish, translated thereafter.

Author’s response:

Thank you for your comment. You are right, we use the Spanish validated versions. It has been better explained and the references have been added.

We suggest that lines 145-7 need to be revisited and paraphrased as a body composition analyser (TANITA MC 780 MA) can calculate BMI after input of height, thus the process. It reads as if the analyser was only for recording weight.

Author’s response:

The explanation has been expanded for better understanding. Thank you for your comment.

The manuscript’s results are reproducible basing on the details given in the in the materials and methods section. However, the authors did not clearly explain the different sites used for testing, whether the questionnaires were completed and submitted to the research team during physical tests days or after or were online.

Author’s response:

Thank you for your comment. The explanations have been expanded to make it clearer to understand how the tests and questionnaires were conducted. The physical tests were performed in multi-purpose rooms at each of the four sites.

Lines 138 -142, refers of demographic data, however, this data is quiet in the manuscript, and we wonder the reason of collecting this data as no correlation is drawn to critical questions that may come with the mentioned demographic characteristics’ long-term effects to women’s health eg., age, employment, smoking and drinking, sleep problems, stress and depression.

Author’s response:

            Thank you for your comment. This data has been included in the results.

All tables and figures in the manuscript are appropriately used and clear to read, although we feel critical information on demographic data is missing in Table A, line 330. They show consistency in data analysis and can be easily interpreted.

Author’s response:

Thank you for your comment. As previously commented,This data has been included in the results.

Conclusions are consistent with the evidence and arguments presented.

Reviewer 2 Report

Comments and Suggestions for Authors

• A brief summary 

This study assessed physical function, perceived physical fitness, balance confidence, and fear of falling in 84 Spanish women with fibromyalgia (FM) based on their levels of pain, depression, fatigue, and sleep problems, and found that symptom severity was primarily related to perceptual and subjective aspects of physical condition and fall safety.

The main contribution was to advance knowledge about the relationship between disease symptoms and its objective and subjective functional capacity. The strength was the soundness of this study in general, and organization, statistical analyses, and writing are well done.  The conclusion should be revised.

• General concept comments
  The small sample size and a large number of tests conducted limited the statistical analysis scheme, which was recognized in the limitation.  Due to the problem, each analysis confirms past studies done by other researchers, which indicates the legitimacy of this study but lack of innovativeness. One of missing controls is age. The mean is 57 years old with the range between 20 and 72 years old. Only about 25% of older adults do not have conditions of pain, fatigue, and poor sleep.  If one group of various levels of symptoms consists of mainly older adults, it cannot be ruled out that it was due to FM or age.  If ages are equally distributed among groups, it should be noted. Another possible confounding variable is other illnesses and their severity. Using Spearman’s rho, these covariates may not be incorporated, but acknowledging the possible influence, these may be added in the limitation.

Pain and only pain is strongly associated with objective physical tests ( TUG, FSST, 5r sit to stand, and hand grip) also. The conclusion ignores this finding.

• Specific comments 

1.      In Variables and Instruments to Questions and Questionnaires (pages 3-6), write psychometric properties (reliability and validity) briefly in addition to the description of scales. If a scale is developed for this study, indicate as investigator developed.

2.      In Table 2, Handgrip’s p-value is .001 but it was not recognized as significant. In Table 3, 30” Sit to Stand’s p-value is .002. Is it oversight or is over .002?

3.      On line 513, the word “proven” should be replaced. Our scientific research does not prove something.

Author Response

• A brief summary

This study assessed physical function, perceived physical fitness, balance confidence, and fear of falling in 84 Spanish women with fibromyalgia (FM) based on their levels of pain, depression, fatigue, and sleep problems, and found that symptom severity was primarily related to perceptual and subjective aspects of physical condition and fall safety.

The main contribution was to advance knowledge about the relationship between disease symptoms and its objective and subjective functional capacity. The strength was the soundness of this study in general, and organization, statistical analyses, and writing are well done.  The conclusion should be revised.

            Author’s response:

            Dear Reviewer,

Thank you for your comments. We appreciate the recommendations and suggestions for improvement. We have made the appropriate changes to the manuscript and you will find our responses below.

• General concept comments
  The small sample size and a large number of tests conducted limited the statistical analysis scheme, which was recognized in the limitation.  Due to the problem, each analysis confirms past studies done by other researchers, which indicates the legitimacy of this study but lack of innovativeness.

 

Author’s response:

 

The aspects that help to further advance knowledge through this article can be summarised as follows:

In the manuscript at hand we asked whether presenting a higher degree of severity in the main symptoms of FM was related to worse performance in physical function, self-perception of physical fitness, in balance and greater fear of falling. Previous studies such as Collado-Mateo et al. (2015) had related fear of falling to balance and number of falls, or Leon-Llamas et al. (2022) had related fear of falling to mobility. The article that may be closest to this manuscript is the one published by our research team (Denche-Zamorano et al., 2024) which investigates whether having a greater fear of falling or greater risk of falling is related to poorer performance in physical function, poorer perception of physical fitness, poorer quality of life and greater degree of disability in people with fibromyalgia. Therefore, to our knowledge, this is the first manuscript to specifically investigate whether greater severity of the main symptoms of FM was related to poorer performance in physical function, self-perceived fitness, balance and greater fear of falling in a global manner, including all these components.

 

Collado-Mateo, D., Gallego-Diaz, J. M., Adsuar, J. C., Domínguez-Muñoz, F. J., Olivares, P. R., & Gusi, N. (2015). Fear of Falling in Women with Fibromyalgia and Its Relation with Number of Falls and Balance Performance. BioMed Research International, 2015(1), 589014. https://doi.org/https://doi.org/10.1155/2015/589014

Denche-Zamorano, Á., Pereira-Payo, D., Collado-Mateo, D., Adsuar-Sala, J. C., Tomas-Carus, P., & Parraca, J. A. (2024). Physical Function, Self-Perceived Physical Fitness, Falls, Quality of Life and Degree of Disability According to Fear and Risk of Falling in Women with Fibromyalgia. Journal of Functional Morphology and Kinesiology, 9(3), 174. https://www.mdpi.com/2411-5142/9/3/174

Leon-Llamas, J. L., Murillo-Garcia, A., Villafaina, S., Domínguez-Muñoz, F. J., Morenas, J., & Gusi, N. (2022). Relationship between kinesiophobia and mobility, impact of the disease, and fear of falling in women with and without fibromyalgia: a cross-sectional study. International Journal of Environmental Research and Public Health, 19(14), 8257.

 

 

One of missing controls is age. The mean is 57 years old with the range between 20 and 72 years old. Only about 25% of older adults do not have conditions of pain, fatigue, and poor sleep.  If one group of various levels of symptoms consists of mainly older adults, it cannot be ruled out that it was due to FM or age.  If ages are equally distributed among groups, it should be noted. Another possible confounding variable is other illnesses and their severity. Using Spearman’s rho, these covariates may not be incorporated, but acknowledging the possible influence, these may be added in the limitation.

 

Author’s response:

Thank you for your comment, this has been added to the limitations.

Pain and only pain is strongly associated with objective physical tests ( TUG, FSST, 5r sit to stand, and hand grip) also. The conclusion ignores this finding.

            Author’s response:

            Thank you for your comment, this has been added to the conclusions.

• Specific comments

1. In Variables and Instruments to Questions and Questionnaires (pages 3-6), write psychometric properties (reliability and validity) briefly in addition to the description of scales. If a scale is developed for this study, indicate as investigator developed.

Author’s response:

Amended. Thank you for your comment.

 

2. In Table 2, Handgrip’s p-value is .001 but it was not recognized as significant. In Table 3, 30” Sit to Stand’s p-value is .002. Is it oversight or is over .002?

Author’s response:

Amended. Thank you for your comment.

 

3. On line 513, the word “proven” should be replaced. Our scientific research does not prove something.

Author’s response:

Amended.